by Daniel C. Vock, Stateline.org Staff Writer

None of the dozen or so inoculations widely required for children — from polio to chickenpox — has stirred as large an outcry as has the new cervical cancer vaccine, Gardasil.

Most of the turmoil is over questions involving teen sex and lobbying. Should parents or the state choose whether to vaccinate adolescent girls against a sexually transmitted disease? Did Merck & Co. overstep in pushing states to mandate the vaccine it produces?

But among a number of vaccine experts, there’s a different concern. Many worry there’s too big a rush to require girls to be inoculated against human papillomaviruses, or HPV, the culprit in cervical cancer, which kills 3,700 American women a year. Among their concerns: the chance of adverse side effects, difficulties in getting pre-teens inoculated, a question of supply shortages, the vaccine’s high cost and damage to the public’s views toward vaccines.

“For many of us in public health who have been involved in immunization and state laws, it’s been too quick,” said Dr. Neal Halsey, the director of the Institute for Vaccine Safety at the Johns Hopkins Bloomberg School of Public Health.

“You want the demand to come from the public who realize the potential benefits from the vaccine, not to be imposed upon them,” he said.

Just seven months after the U.S. Food and Drug Administration approved the cervical cancer vaccine, Texas Gov. Rick Perry (R) in February decreed that sixth-grade girls must get the three-shot regimen — though his edict was ruled unenforceable by the attorney general and now might be overturned by the Legislature. Lawmakers in New Mexico and Virginia also voted to require the vaccine for middle-school girls. New Mexico’s measure awaits the governor’s signature; Virginia’s bill returned to the Legislature, which will consider the governor’s revisions. Legislators in 19 other states also have considered similar mandates.

A look at the history of vaccines in the United States sheds light on why there’s unease over the quick march toward requiring the new vaccine.

No other vaccine has been pushed so quickly to be mandatory. No other vaccine has been required for just one sex. No commonly administered vaccine is more expensive. And none has been so aggressively marketed, lobbied for and promoted by its manufacturer as Gardasil was by Merck.

The track record of other vaccines also deflates certain arguments raised against Gardasil.

Because HPV is spread exclusively through sexual contact, the debate over the vaccine often shifts to frank talk about teen sex. Yet Gardasil isn’t the first widely required vaccine that fights a sexually transmitted disease. Forty-eight states require schoolchildren to get shots against hepatitis B, a disease that attacks the liver and also causes cancer. That disease can be transmitted by sexual contact, dirty needles or blood transfusions.

Some question whether Gardasil was thoroughly tested before it won federal approval. In fact, Gardasil’s trials were typical in size and duration for vaccines.