"We don't know if it will be necessary," says Joseph Bocchini, a Louisiana pediatrician who heads the AAP's committee on infectious diseases. Given sufficient information about this new protection, he believes, "most people would want it for their daughters." But making it a requirement for school admission would risk a backlash against the vaccine before it has even gotten a foothold. It might also prod more parents to reject other immunizations.
Texas law, after all, allows parents to exempt their children from any required vaccine. Currently, less than 2 percent of kids in the state opt out, but that number will undoubtedly rise once HPV is in the mix. Groups that see the inoculation as potentially dangerous, or as an implied approval of premarital sex, will undoubtedly mobilize to encourage mass refusal. Parents who would be inclined to accept something recommended by the family pediatrician may resist if it's commanded by the state.
The consensual approach avoids those hazards, and it can be highly effective. The federal Centers for Disease Control and Prevention report that, though they are not covered by school vaccination requirements, more than 90 percent of children under age 3 are immunized against polio, measles, mumps, rubella and hepatitis B.
The HPV vaccine ought to get a chance to establish itself on a voluntary basis before any state makes it mandatory. Public health is one of those areas in which, even by my libertarian lights, the government is sometimes entitled to force people to take measures to protect themselves and others. But compulsion should be a last resort, not a first.
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