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Keeping choice on the Gardasil vaccine

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If some state lawmakers around the country prevail, girls as young as 10 could soon face a mandatory medical appointment: They would need to be vaccinated against a sexually transmitted virus said to cause cancer – or risk being denied entrance to school.

Already 20 states are considering making the vaccine mandatory for preteen girls. In Texas, Gov. Rick Perry avoided a legislative debate with an executive order requiring all girls who will be sixth-graders in September 2008 to be vaccinated.

In most states, including Texas, parents who object on religious or medical grounds would be able to opt out. But why can't lawmakers reverse the process, letting those who want it "opt in" voluntarily?

Doctors say the human papillomavirus is the leading cause of cervical cancer. Drug manufacturer Merck claims that the vaccine, called Gardasil, could eliminate 70 percent of cases of the disease if girls are vaccinated before becoming sexually active. The Food and Drug Administration approved the vaccine in June for females between the ages of 9 and 26. Supporters are hailing the vaccine as a sure way to reduce deaths. But some doctors are urging caution.

Besides the estimated $360 cost for a series of three shots, the most pressing questions are moral and ethical, beginning with: Why the rush? And why the medical coercion?

If successful, these efforts would mark a shift in public-health policy. Until now, mandatory inoculations have been reserved for diseases regarded as communicable, representing a public health risk. Gardasil is designed to protect against a virus whose transmission can be prevented through individual behavior.

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