Four years ago, Gov. Rick Perry put aside his social conservative bona fides and signed an order requiring Texas girls to be vaccinated against HPV.
The human papillomavirus is a sexually spread virus that can cause cervical cancer, and he says his aim was protecting against that cancer. But it didn't take long for angry conservatives in the Legislature to override a measure they thought tacitly approved premarital sex, and for critics to accuse Perry of cronyism.
Now Perry's taking heat on the issue anew as he runs for the presidential nomination of a GOP heavily influenced by conservatives who are sour on the government dictating health care requirements. Illustrating the delicate politics at play, he's both defending himself and calling his action a mistake.
"If I had it to do over again, I would have done it differently," Perry said Monday night as he debated his rivals, insisting that he would have worked with the Legislature instead of unilaterally acting. But he did not back down from his stance that girls should be vaccinated against the virus, which is generally spread by sexual contact. He argued that it wasn't a mandate and noted that he included the right for parents to opt out of the vaccinations.
"This was about trying to stop a cancer," he said. "I am always going to err on the side of life."
Not that the explanation satisfied his GOP opponents.
Former Pennsylvania Sen. Rick Santorum told Perry, "This is big government run amok. It is bad policy, and it should not have been done."
And Minnesota Rep. Michele Bachmann, looking to siphon support from Perry's base of evangelical and tea party supporters, said: "To have innocent little 12-year-old girls be forced to have a government injection through an executive order is just flat out wrong." She also noted that that the company that makes the vaccine, Merck & Co., employed Mike Toomey, Perry's former chief of staff, as a lobbyist in Texas, and that the drug company had donated to Perry's campaigns.
Renewing the attack Tuesday, Bachmann said on NBC's "Today" show that "it's very clear that crony capitalism could likely have been the cause" of Perry's executive order.
The exchanges mirror the criticism Perry took in 2007.
It all began when Merck, which won approval for the first HPV vaccine a year earlier, was spending millions lobbying state legislators to require girls to be vaccinated with the new product, Gardasil. The company also was donating money to a national organization called Women in Government, which in Texas was led by state Rep. Dianne White Delisi, who chaired the House public health committee. She was also the mother-in-law of Perry's chief of staff at the time, Deirdre Delisi _ the same woman who now is one of Perry's top presidential campaign aides.
Schedule and campaign finance reports show that on one day _ Oct. 16, 2006 _ Deirdre Delisi held a staff meeting to discuss the vaccine and Merck's political action committee gave Perry $5,000. The drug maker had previously given $6,000 in donations. Perry's office called the timing of the donation a coincidence.
A review of campaign finance reports shows that Merck's political action committee continued to contribute, a total of $17,500 to Perry's campaign fund between 2008 and 2010 even though Perry's order was eventually overturned.
By early 2007, Toomey and Dianne White Delisi were working to overcome opposition among lawmakers to a bill to require the vaccination. But conservatives said they feared the requirement would infringe on personal liberties and signal approval of premarital sex. Rather than wait for the Legislature to act, Perry signed an executive order on Feb. 2, 2007, requiring the vaccination _ with an opt-out provision. It surprised even his allies who acknowledged that it was out of step with his limited-government stance.
Perry explained his action by pointing to his long-documented passion about fighting cancer. He had signed a host of legislation to that end, including a constitutional amendment in Texas that created a cancer research institute funded with $3 billion from bond sales.
"We have a vaccine that's going to save young women's lives," Perry said in 2007. "This is wise public policy."
The governor quickly found that Texas parents didn't like the idea of the government telling preadolescents to be vaccinated against a sexually transmitted disease. Within three weeks, the House public health committee approved a bill negating the order but Perry persisted in defending his initiative. By May 8, when it was clear the Legislature was going to pass the bill stopping his order, Perry said he would stop fighting.
A statewide requirement for the three-shot, $360 vaccine in Texas could have earned millions for Merck, at the time the only company with a vaccine on the market. GlaxoSmithKline's Cervarix was approved in 2009.
At issue are sexually transmitted strains of the human papillomavirus, the leading cause of cervical cancer in women. HPV also can cause genital warts, penile and anal cancer _ and types of oral cancer when spread through oral sex. More than 11,000 U.S. women are diagnosed with cervical cancer each year, and about 4,000 die from it.
Many specialists say that among the sexually active, HPV is about as common as the common cold. The Centers for Disease Control and Prevention says about 20 million people are infected, most in their late teens and early 20s _ although most no show obvious symptoms and eventually clear the virus. A handful of high-risk HPV strains can silently linger in the body to cause cancer years later.
Though not required, about half of teen girls got one dose of the vaccine last year _ and a third had gotten all three doses. Specialists say the sex factor plays a role in reluctance, as pediatricians struggle to explain why it's best to inoculate before the teen years or parents wonder if getting their youngster a vaccination means they also should start discussing sexual activity. Studies have found no serious side effects, with the most common reactions being redness or swelling at the injection site.
Many experts recommend that parents get their children vaccinated, with girls starting the shots at 11 or 12, an age set so that most girls would have the full series completed well before they become sexually active _ although the shots can be given up to age 26. Gardasil is approved for boys and young men, too, as protection against genital warts and anal cancer, but Perry never suggested that the requirement be extended to boys.
Since 2006, 41 state legislatures and the District of Columbia have introduced laws related to promoting or requiring insurance coverage for the HPV vaccination, but only Virginia and the District of Columbia have laws requiring it.
The issue is certain not to go away for Perry. He's speaking Wednesday at Liberty University in Virginia, a Christian school founded by the Rev. Jerry Falwell, before an audience of evangelical conservatives who may cringe at this part of his record.
"If there's one thing that Governor Perry is going to have to deal with it's the mandate for HPV," said Tea Party Express chairman Amy Kremer. She credited Perry for publicly admitting a mistake but added: "I don't think this is the last we've heard of it."
Associated Press writers Lauran Neergaard in Washington and Brian Bakst in Minneapolis contributed to this report.