Immigrant Rights

Your discussion of forced vaccination - a real issue - is unfortunately clouded by a one-sided anti-vaccine indictment. The efficacy of Gardisal and Cervarix remains a debated topic, one that is far more nuanced than the view you represent above.

I recommend as a starting point for anyone interested in learning more about these vaccines to look here: http://www.informationisbeautiful.net/2009/how-safe-is-the-hpv-vaccine/

After presenting the visuals, the author links to other studies - both for and anti- the vaccine. By no means comprehensive, but a good place to start and understand that it is not quite as cut and dry as presented here.

I think we can all agree that we would like these women (and all women) to be given the opportunity to make an educated decision about whether they wish to be vaccinated. Neither forcing the choice on them, nor presenting the debate as you have above, does so.

I, too, believe that women should have a choice, immigrant or otherwise. This is a perfect example of something the US always does to immigrants - making them do something and not paying for it, supposedly for their and citizens' "well-being." I think they'd be a lot better off if they didn't have to pay 600 something dollars for a worthless vaccine.

Yeah - I got the Gardasil vaccine (luckily my insurance covered it), and I have HPV now. so, yeah, it doesn't really work all too well. It only covers a few types of HPV, which are supposedly the most common ones, but hey, like I said, I got HPV AFTER I got the vaccine.

It might help a little, but definitely not enough. These women should not have to pay that money to get it just to come into this country. Unless they want to get. Then, by all means, get it. But gardisil is definitely not as good as its cracked up to be.

http://latinainstitute.org/sites/default/files/publications/HPV_FAQ-24Sept07-FINAL.pdf

NATIONAL LATINA INSTITUTE FOR REPRODUCTIVE HEALTH

50 Broad Street, Suite 1825, New York, NY 10004

www.latinainstitute.org · nlirh@latinainstitute.org

THE HUMAN PAPILLOMAVIRUS (HPV),

Human Papillomavirus (HPV) is the name of a group of viruses, many of which are spread through

skin to skin contact, particularly during sexual activity. HPV has been linked to both cervical cancer

and genital warts. There are approximately 120 types of HPV, but two types (strains 16 and 18) are

responsible for approximately 70% of all cases of cervical cancer.

HPV is the most common sexually transmitted infection in the United States with an estimated 6.2

million people newly infected each year. It is estimated that a quarter of teenage girls and half of

women in their early 20s have the virus. It is important to note that there is currently no cure or

treatment for HPV and oftentimes there are no symptoms. According to the American Cancer

Society, the infection usually disappears without any treatment and any abnormal cell growth or

warts caused by HPV can be treated effectively. It is important to note that HPV is not the same as

HIV or Herpes (Herpes simplex virus or HSV)i.

2. HOW IS HPV ASSOCIATED WITH CERVICAL CANCER?

Approximately a dozen strains of HPV can infect a woman's cervix (lower part of the womb) and

cause the cells to change.ii While most cases of HPV infection are resolved on their own, certain

strains can lead to cervical cancer if not treated over time.iii The strains most associated with cervical

cancer are 16 and 18.

According to the Center for Disease Control and Prevention (CDC)iv, about 40 types of HPV can

infect the genital areas of men and women. These types also have been linked to other less common

genital cancers- including cancers of the anus, vagina, and vulva (area around the opening of the

vagina). Other types of HPV can cause warts in the genital areas of men and women.

3. HOW COMMON IS CERVICAL CANCER AND HOW DOES IT IMPACT LATINAS?

According to the American Cancer Society, there are approximately 10,000 cases and 3,700 deaths

from cervical cancer in the U.S. per year.v The incidence of cervical cancer for Latina women in the

United States is almost twice as high as non-Latina white women. Latina women have the 2nd

highest mortality rate from cervical cancer (after black women), although mortality for Latina

women is higher in communities along the Texas-Mexico border.vi This is largely due to Latina

women's low rates of routine gynecological care, particularly pap smears and cervical cancer

screening. These low rates are caused by lack of insurance, fear associated with their immigration

status, embarrassment, lack of knowledge, and limited English proficiency.vii About 85% of women

who die from cervical cancer never had a pap smear.

4. WHAT IS THE HPV VACCINE?

In June 2006, the federal Food and Drug Administration (FDA) approved the first vaccine,

Gardasil®, manufactured by Merck & Company, developed to prevent cervical cancer and genital

warts caused by four strains of HPV; two strains (strains 16 and 18) that are responsible for 70% of

cervical cancer incidences and two strains (strains 6 and 11) which are responsible for 90% of genital

warts caused by HPV. Subsequently, the CDC's Advisory Committee on Immunization Practices

(ACIP) recommended that the vaccine be administered to all girls ages 11-12, and approved it for

administration to women from 9 to 26 years old.

The vaccine requires a three-shot regimen over the course of 6 months and is quite costly at

approximately $120 per shot, for a total of $360 for the series. Administrative charges tacked on by

the doctor may increase the cost, and anecdotal reports indicate that some women have paid as much

as $700 for the three-shot series.

5. WHAT'S IN THE VACCINE? HOW DOES IT WORK?

The vaccine is made from non-infectious HPV-like particles that trigger an antibody response that

prevents recipients from contracting HPV strains 6, 11, 16, and 18. It is important to note that,

according to the FDA, because the vaccine only contains a protein, and not the actual virus, the

vaccine will not cause HPV.viii

6. HOW DO I ACCESS THE HPV VACCINE?

Many gynecologists or pediatricians have the vaccine available, although recent reports indicate that

some doctors are not stocking the vaccine because of its hefty price tag. Publicly funded access to the

HPV vaccine varies state-to-state, although all low-income adolescents between the ages of 9

through 19 who are either uninsured, Medicaid-eligible, American Indian, or Alaska Native, have

access to the vaccine through the federal Vaccines for Children (VFC) Program. For women over the

age of 19 with private health insurance, 96% of private plans cover the vaccine; for women who are

uninsured and Medicaid-eligible, it is imperative that they verify if their state has chosen to provide

optional vaccine coverage. Additional publicly-funded or Merck-funded programs may be available

to provide vaccine access for low-income women, but these programs are not universally available

nationwide.

7. WHEN SHOULD I GET THE VACCINE?

The HPV vaccine is approved by the FDA for use by girls and women ages 9 to 26. It is ideal to

obtain the shots prior to the onset of sexual activity, but women who are sexually active are still

recommended to receive the vaccine up to age 26. The FDA has not approved the vaccine for use in

women over the age of 26, and it is not recommended for women who are pregnant. Also, women

who already have HPV can still benefit from the vaccine because it targets particular strains that the

woman may not have contracted. However, the HPV vaccine does not treat existing HPV infections.

8. I ONLY HAVE SEX WITH OTHER WOMEN; DO I NEED TO RECEIVE THE

Yes! Lesbian and bisexual women are also at risk of acquiring HPV. According to research

conducted by National Network for Immunization Information, cervical pre-cancers and cancerous

changes have been found in women who exclusively have sex with women.ix Lesbian and bisexual

women oftentimes practice oral sex, genital to genital sex, vaginal finger penetration, and/or sharing

of sex toysx; all which could contribute to the transmission of HPV. In addition, women who have

sex with women face barriers to preventive reproductive health services, including encountering

health providers with negative or judgmental attitudes, and misperceptions about the diversity of

their health needs.xi

9. WHAT DOES THIS NEW APPROVAL OF THE HPV VACCINE MEAN FOR

While cheered in the medical community as a breakthrough for women's health, the HPV vaccine is

still out of reach for many women with its price tag of over $360 for the recommended three-shot

regimen. Barriers to accessing the HPV vaccine are compounded for Latina and immigrant women,

who may have limited English proficiency, may be without health insurance and/or may be

undocumented. Latina women are less likely to receive adequate reproductive health care services

and often forgo critical pap smears and screenings that could provide early detection of abnormal

pre-cancerous cells that can lead to cervical cancer. More than half of all U.S. women diagnosed with

cervical cancer have not had a pap smear in the last three years. Researchers have found that Latina

women were more likely than other women to be diagnosed with cervical cancer at an advanced

stage, largely because of the lack of education about the importance of pap smears and their link to

early detection of pre-cancerous cells. The lack of education is often a result of poverty, language

barriers and cultural stigma around discussing issues of sex and sexuality in the Latino community.

10. HOW SHOULD THE HPV VACCINE BE PROVIDED?

NLIRH advocates a standard of care that will provide Latinas with all the possible options for

preventing cervical cancer. This standard of care includes: regular HPV and cervical cancer

screenings during gynecological visits, comprehensive sexuality information, affordable access to

reproductive health technologies such as the HPV vaccine, and accurate information on preventing

HPV and other sexually transmitted infections. NLIRH supports Latina's full access to new

reproductive technologies when they are coupled with unbiased information and implementation

that is free from coercive policies and practices. Additionally, policy makers should advance

legislation that provides universal access to the vaccine through public funding such as Title X,

Medicaid and the State Children's Health Insurance Program (SCHIP), and private insurance

coverage requirements for girls and women ages 9 to 26 years old.

11. I DON'T WANT TO GET THE VACCINE; ARE THERE OTHER WAYS TO PREVENT

HPV is very common, and both women and men are carriers of the virus. There is still much to be

studied about HPV, but according to the CDC, the only way to prevent contracting HPV is to abstain

from all sexual activity.xii HPV could be spread from skin-to-skin contact, and recent studies have

found HPV under the fingernails of men. While utilizing condoms during sex can reduce the

transmission of HPV, it does not provide full protection because areas not covered by a condom can

be exposed to the virus.xiii However, condom use is highly encouraged because of protection against

other sexually-transmitted infections.

The best way to prevent developing cervical cancer is to obtain regular pap smears-ideally, once a

year beginning with the initiation of sexual activity. Pap smears are the most effective way to screen

for the pre-cancerous cells that can lead to cervical cancer. For women over 30, there is a HPV test

that can be used along with the pap smear as part of routine cervical cancer screening.xiv

Additional studies have shown that maintaining a healthy lifestyle with a diet rich in fruits and

vegetables can help reduce the risk of developing cervical cancer.xv Furthermore, women who do not

smoke are less at risk than those who smoke. According to the American Cancer Society, tobacco

by-products have been discovered in the cervical mucus of women who smoke, leading to the damage

of DNA cells in the cervix.xvi This exposes women to the risk of developing cervical cancer at a rate

twice as high as non-smokers.xvii

ADDRESSING THE CONTROVERSY: WHY HAS THE HPV

The studies are currently being conducted on boys to see if the vaccine will be effective. While boys

cannot get cervical cancer and HPV remains symptom-less, they can transmit it to their partners. It

is more difficult to track boys and cervical cancer because to participate in the study, researchers

must track their sexual partners and their incidence of cervical cancer.

HPV impacts boys in a different way. According to the New England Journal of Medicine, a team of

researchers at Johns Hopkins University confirmed that infection with HPV via oral sex is by far the

leading cause of throat cancer, which strikes 11,000 American men and women each year.xviii HPV is

also a major cause of anal cancer and genital warts, both of which affect either sex; HPV is also linked

to penile cancer in boys and men. It is not clear whether the HPV vaccine could prevent anal, penile

or throat cancer or if it will be effective for boys, but research and data are forthcoming.

2. WHAT KIND OF SIDE EFFECTS HAVE THEY FOUND?

According to the CDCxix, the most common side effect is soreness at the injection site. The CDC,

working with the FDA, will continue to monitor the safety of the vaccine after it is in general use.

Despite rumors that have been circulating, there is no thimerosal or mercury in the HPV vaccine. It is

made up of proteins from the outer coat of the virus (HPV). There is no infectious material in this

vaccine. In addition, claims of three deaths associated with the vaccine have proven unrelated and an

FDA spokesperson states that the deaths occurred independently of the vaccine.xx

3. DID THEY REALLY TEST THE VACCINE ENOUGH TO KNOW ABOUT LONG TERM

According to Merck & Co., Gardasil® has been studied for more than a decade in more than 25,000

individuals, including 1,124 adolescent girls ages 9 to 15.xxi These studies have shown no serious side

effects. The most likely long term effect might be the necessity for a booster (similar to the Tetanus

vaccine) after five years, although this is not a conclusive finding.

4. WHAT ABOUT THE CONTROVERSY WITH MERCK AND THEIR LOBBYING? ARE

Our pharmaceutical industry is for-profit, which means that companies invest a lot of money in

research on new technologies. Many of those technologies do not turn into effective medicines, and

so when one technology does prove effective (and is approved by the FDA) the company has to make

up its losses on all the experimental research, as well as make a profit. This results in high prices for

medicines. High prices often result in new reproductive technology becoming out of reach for many

women in our community.

Merck led a strong campaign to make the vaccine mandatory in public schools, and ended up having

to rescind its push for state legislation due to the controversy. While pharmaceutical lobbying is

controversial, the matter of the fact is that this vaccine is an important tool to fight a deadly form of

cancer, and we need legislation to help increase access to it.

5. WHAT ABOUT THE HISTORY OF ABUSES AGAINST WOMEN OF COLOR? HOW

History has demonstrated that women of color were often coerced into sterilization and were used as

guinea pigs in contraception trials. Many of these coercive practices were in place until the 1970's

and were seen as part of a wide-spread eugenics movement that discriminated against people of

color. This history has led many Latinas to mistrust the medical system and to be suspect of new

medical policies that infringe upon their reproductive self-determination. However, legislative

mandate proposals, ethical standards and clinical research procedures have evolved through the

establishment of the Office for Human Research Protections. In addition, vaccine approval by the

FDA is a very strenuous process and all vaccines must be thoroughly tested before deemed safe and

effective. This vaccine has been recommended for use by all girls and women up to the age of 26

(with some limited exceptions), and efforts to expand access to the vaccine should be embraced. The

somber reality is that cervical cancer disproportionately impacts women of color; Latina women have

the highest rates of cervical cancer (almost twice the rate of non-Latina white women), followed by

Black women and Asian Pacific Islander women. Black women are most likely to die from cervical

cancer, followed by Latina women. This is due to the tremendous health disparities that exist in our

country that are perpetuated by race, class, socio-economic status, English-language proficiency and

immigration status. The HPV vaccine could help reduce some of the disparities that exist for women

with cervical cancer, and would serve as a tool to protect the fertility of women of color by

preventing cancer treatment surgeries such as hysterectomies. However, access to the vaccine

remains a challenge. Unless states take action to expand access to the vaccine for low-income and

uninsured women, the cervical cancer disparities in this country will continue.

6. WHY DO THE GIRLS NEED TO GET IT SO YOUNG? AND WHAT ABOUT WOMEN

The HPV vaccine has proven most effective for girls who receive it prior to onset of sexual activity.

According to the CDCxxii, nationwide, 6.2% of high school students had sexual intercourse for the

first time before age of 13; for Latinas, the rate is 3.6%. By the time students reach the 12th grade,

46.8% will have had sexual intercourse, including 44.4% of Latinas. Sexual activity increases the

likelihood of exposure to HPV, so the vaccine is recommended for administration to girls 11-12 years

of age, and girls as young as 9 years old can receive it.

Regarding women over the age of 26, research on the vaccine's safety and efficacy is currently being

conducted. Another pharmaceutical company, GlaxoSmithKline, is currently testing a cervical

cancer vaccine on women up to age 55. However, at this time, the Gardasil® vaccine is approved by

the FDA for girls and women only between 9 to 26 years of age.

7. DOES THE VACCINE PROMOTE PROMISCUITY?

No! Although religious and conservative groups have purported that the vaccine would promote

promiscuity and that encouraging wide-spread vaccination goes against their "abstinence-only"

message, the general public (including parents, health care providers, and sexual health advocates)

have largely rejected that message.xxiii Studies have shown that young people do not abstain from

sexual activity due to fear of contracting HPV (the vaccine does not protect against other sexually

transmitted infections) and there has been no scientific evidence that the HPV vaccine will promote

sexual activity.

8. IF I PLAN ON ABSTAINING FROM SEX UNTIL I MARRY, DO I STILL NEED THIS

Yes. While abstaining from sexual intercourse is one of the best methods to prevent contracting

HPV, it can be misleading. Individuals that abstain from intercourse but engage in other forms of

sexual activity, such as fondling and other forms of intimate partner contact, can still be exposed to

the virus through skin-to-skin contact. In addition, individuals who have abstained from sexual

activity may marry a spouse or commit to a life partner that has been exposed to HPV through

previous sexual activity.

For more information on Cervical Cancer, HPV and the vaccine, visit the National Latina Institute

i Centers for Disease Control and Prevention (CDC), "HPV Vaccine Questions and Answers", August 2006.

ii Ibid.

NATIONAL LATINA INSTITUTE FOR REPRODUCTIVE HEALTH

50 Broad Street, Suite 1825, New York, NY 10004

www.latinainstitute.org · nlirh@latinainstitute.org

7

iii Henry J. Kaiser Family Foundation, "Fact Sheet: HPV Vaccine: Implementation and Financing Policy", January 2007.

iv Centers for Disease Control and Prevention (CDC).

v American Cancer Society, "Detailed Guide: Cervical Cancer", October 2005.

vi Byrd, Chavez and Wilson, "Barriers and Facilitators of Cervical Cancer Screening Among Hispanic Women", Ethnicity & Disease, Volume 17,

Winter 2007.

vii Ibid.

viii Food and Drug Administration, "Product Approval Information- Licensing Action, Gardasil® Questions and Answers", June 8, 2006.

ix National Network for Immunization Information, "HPV Vaccines: HPV Infection in Women who have sex with Women", March 1, 2007.

x Ibid.

xi Ibid.

xii Centers for Disease Control and Prevention (CDC).

xiii Ibid.

xiv Ibid, "HPV. Common Infection. Common Reality" Brochure.

xv Singh, VN and Gaby, SK., "Premalignant Lesions: Role of antioxidant vitamins and beta-carotene in risk reduction and prevention of

malignant transformation", American Journal of Clinical Nutrition, Volume 53, 386S-390S, 1991.

xvi American Cancer Society, "What are the Risk Factors for Cervical Cancer?", August 2006.

xvii Ibid.

xviii Mundell, E.J., "Experts Debate Giving HPV Vaccine to Boys", MedicineNet.com, May 18, 2007.

xix Centers for Disease Control and Prevention (CDC).

xx Food and Drug Administration, www.fda.gov.

xxi Merck & Co. Product News, "CDC Finalizes Advisory Panel Recommendations for Gardasil®, Merck's Cervical Cancer Vaccine", March 22,

2007.

xxii Centers for Disease Control and Prevention (CDC), Youth Risk Behavior Surveillance, US, 2005.

xxiii Gibbs, Nancy. "Defusing the War over the ‘Promiscuity' Vaccine", Time, June 21, 2006.

http://www.arhp.org/about-us/position-statements#hpv

HUMAN PAPILLOMAVIRUS AND CERVICAL CANCER

Vaccines for human papillomavirus (HPV) represent the next major breakthrough in prevention of cancer and sexually transmitted infections. The Association of Reproductive Health Professionals (ARHP) supports the development of and widespread access to HPV vaccines as part of a comprehensive prevention screening and treatment strategy for cervical cancer and other HPV-related conditions, such as genital warts. HPV vaccines will be able to prevent some of the most virulent strains of HPV that cause cervical cancer and genital warts.

Cervical cancer has become the second most common female malignancy worldwide and kills nearly 250,000 women each year.[1,2] In the United States alone, every year close to 12,000 women are diagnosed with cervical cancer, resulting in 4,000 deaths.[3] Nearly half of the women who are diagnosed with cervical cancer in the United States have not been properly screened.[4] For this reason, routine visits to a health care provider for ongoing surveillance remain a critical component in the fight against cervical cancer. ARHP encourages health care providers to adopt screening for HPV using the latest technologies available, including the liquid-based Pap test and HPV DNA testing, for all appropriate candidates.

ARHP encourages HPV vaccines to become the standard of care. ARHP supports the recommendation of the Advisory Committee on Immunization Practices (ACIP) of the Centers for Disease Control and Prevention (CDC) that HPV vaccines be added to the routine schedule for girls and women throughout the age ranges as deemed appropriate by ACIP. ARHP supports the vaccines' placement on CDC's "Vaccines for Children" program, which helps ensure that girls from low-income families are immunized. ARHP strongly encourages all states within the United States to adopt vaccination policies to ensure that all people can easily access this important method of prevention.

ARHP supports and encourages access to HPV and cervical cancer prevention, screening, and treatment for women and girls, regardless of age, race, ethnicity, income, sexual orientation, or immigration status. Although HPV vaccines are important developments in efforts to eradicate cervical cancer and genital warts, disparities in access to health care continue to be a public health challenge. Lack of access leaves many girls and women without regular and adequate preventive health care services. To encourage equal access to these technologies by all people who need them, ARHP supports private insurance coverage and public funding for the vaccines and related prevention, screening, and treatment technologies and encourages the US Department of Health and Human Services to make the vaccines available through the Title X program initiative.

HPV vaccines can be effective only if providers and the public are educated about their safety and efficacy and are encouraged to offer and receive them. ARHP supports provider training for the vaccine and related screening and treatment technologies and their incorporation into practice and for public education about the benefits of these new tools. While vaccines offer a new approach to preventing HPV and cervical cancer, ARHP encourages health care providers to continue promoting safe sex practices and choices to their patients.

Eddy DM. Screening for cervical cancer. Ann Intern Med 1990;113(3):214-26.

Sawaya GF, Brown AD, Washington AE, Garber AM. Clinical practice. Current approaches to cervical cancer screening. N Engl J Med 2001;344:1603-7.

American Cancer Society. (2004, accessed October 27, 2004) Cancer Facts & Figures 2004. [Online] www.cancer.org/downloads/STT/CAFF_FinalPWSecured.pdf.

National Institutes of Health. Cervical Cancer. NIH Consensus Statement. 1996;14:1-38.

ARHP's position statement on HPV and cervical cancer was recommended by ARHP's policy committee on August 25, 2006 and approved by ARHP's board of directors on September 6, 2006.

I checked this out with the immigration staffer in my congressman's office (Earl Blumenauer).  After some searching, he responded that this rule will not go into effect.  He sent me the page of the Federal Register (today's) - Federal Register / Vol. 74, No. 218 / Friday, November 13, 2009 / Notices