Support is growing for HPV vaccine for girls
Acceptance of the first human papillomavirus (HPV) vaccine continues to grow, as the national immunization schedule for children and teens has been updated to include Gardasil, manufactured by Merck & Co., of Whitehouse Station, NJ.1,2
The Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP), the American Academy of Pediatrics, and the American Family of Physicians has published the Childhood Immunization Schedule, which indicates recommended ages for the routine administration of currently licensed vaccines for children. The publication follows ACIP's June 2006 recommendation for routine use of the vaccine for females ages 11-12, and permissive use of the vaccine in females as early as age 9 and up to age 26.
Pediatricians routinely see young women in the 11-12 age range for a well-child check, notes Renee Jenkins, MD, professor and chair of the Department of Pediatrics and Child Health at Howard University College of Medicine in Washington, DC. The well-child visit already includes vaccinations for tetanus/diphtheria/acelular pertussis and meningitis, so it is not out of the ordinary to ask them to come in at this age group for care, she notes.
Many states are moving to mandate use of the HPV vaccination in young women. Kentucky legislators have introduced a bill to require girls in public and private middle schools to receive the shot, while District of Columbia legislators have proposed adding the vaccine to the list of required shots for girls prior to sixth-grade enrollment. Two similar bills have been introduced in the Virginia General Assembly, while a Maryland bill is calling for middle school vaccinations.3 The Texas state legislature will consider legislation that would require girls entering the sixth grade to receive the vaccination, but it also would allow parents to apply for an exemption if they do not want their daughters to receive the shot.
New Hampshire and South Dakota have set up pools of vaccine to provide the shot free of charge to girls and young women.
Since the HPV vaccine now is included in the federal Vaccines for Children (VFC) program, it is available to young women 18 and younger who are Medicaid-eligible, uninsured, American Indian or Alaska Native, or underinsured.
At the present time, many insurance plans are setting policy on coverage of the vaccine, reports Alina Salganicoff, PhD, vice president and director of women's health policy at the Menlo Park, CA-based Kaiser Family Foundation. The private foundation is tracking policy issues surrounding the HPV vaccine, and recently sponsored an expert roundtable on the subject. While it appears that private insurance is paying for vaccine coverage for girls, it remains to be seen how copays and deductibles will affect affordability, Salganicoff states. The vaccine, administered in three shots, runs $360, which does not include provider administration fees, she points out.
For women in the 19-26 age range, there are fewer sources for funding when it comes to the HPV immunization, says Salganicoff. About 30% of women in this age range have no health insurance coverage, while about 14% have Medicaid coverage, she states. Those who have private insurance coverage may find that their plan will not cover the shot, says Salganicoff. "We're hearing some anecdotal evidence that not all plans are covering the vaccine for this older age group," she states. "They actually may be liable for the cost themselves."
Merck has initiated a patient assistance program to aid women in this age group. Currently available in private physicians' offices, the program allows Gardasil and other proprietary vaccines to be provided free of charge to those ages 19 and older who are uninsured and who are unable to afford vaccines.
Patients may be eligible for the program if all three of the following conditions apply:
- United States resident, age 19 or older;
- no health insurance coverage (examples of coverage include private insurance, health maintenance organization, preferred provider organization, college health plan, Medicaid, veterans' assistance, or any other social service agency support);
- household income less than $19,600 for individuals, $26,400 for couples, or $40,000 for a family of four.
Will the Merck program help family planning patients? For clinics that are funded by the federal Title X program, patients would not qualify for assistance under the company's program.4 [Editor's note: The Association of Reproductive Health Professionals (ARHP) and the Planned Parenthood Federation of America have formed a partnership to develop the clinical education program, HPV and Cervical Cancer: Comprehensive Prevention, Screening, and Treatment. To request an ARHP speaker, contact the ARHP education staff at (800) 787-2747. Speaker honoraria and travel expenses will be covered by ARHP.]
- American Academy of Pediatrics Committee on Infectious Diseases. Recommended immunization schedules for children and adolescents — United States, 2007. Pediatrics 2007; 119:207-208, 3 p following 208.
- Centers for Disease Control and Prevention. Recommended immunization schedules for persons aged 0-18 years — United States, 2007. MMWR 2006; 55(51&52):Q1-Q4.
- Levine S, Harris HR. Wave of support for HPV vaccination of girls. Washington Post, Jan. 12, 2007; B01.
- Kaiser Family Foundation. HPV Vaccine: Implementation and Financing Policy. Fact sheet. January 2007.