A new vaccine and the risks of compulsion

Compulsion is as essential to government as water is to snow. Most of what governments do requires forcing people to do things they might choose not to ­ pay taxes, stop at red lights, respect the property of

others, avoid creating public nuisances, and so on.

But the measure of a free society is its willingness to use compulsion only when it is indispensable. And by that measure, the state of Texas is falling short.

Recently, Gov. Rick Perry issued an executive order that surprised both friends and foes ­ stipulating that before entering sixth grade, every girl must receive a vaccination against the human papillomavirus, a common sexually transmitted disease that causes genital warts and cervical cancer. In a reversal of their usual view of the conservative Republican Perry, Planned Parenthood of North Texas applauds the measure, while Concerned Women for America

opposes it.

Mandatory immunization, far from being a new development, goes back to the 19th century. But these days, government generally imposes on schoolchildren only for serious illnesses that can spread easily by casual interaction, such as measles, whooping cough, diphtheria and polio. HPV is not one of those.

Sound reasons exist for immunizing pre-adolescents. It makes sense to confer protection well before potential victims become sexually active ­ when it may be too late. In a startling revelation, the Food and Drug Administration reports that "at least 50 percent of people who have had sex will have HPV at some time in their lives." Even someone who is a virgin upon marrying and monogamous afterward can get it unwittingly from a spouse.

Nor is immunization useful only for girls who will choose to have sex. Someone carrying the virus could molest them.

A clinical study that led to FDA approval found the vaccine is nearly foolproof in preventing two types of HPV that account for 70 percent of all cervical cancers, which kill nearly 4,000 American women each year.

But the inoculation (which the government has not approved for boys) is new, and it targets a disease that most people know nothing about. A mandate would force on people something that most of them, in time, probably will want to accept voluntarily. The first need is public education, in the form of a comprehensive effort to tell Americans and their doctors about the dangers of HPV and the efficacy of immunization.

Even medical experts are wary of forcing it on the unwilling. The Texas Medical Association, which says many of its members already are administering the vaccine, does not favor requiring it. The American Academy of Pediatrics (AAP), which recommends the vaccine, also has declined to endorse the mandate.

"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 also might 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 undoubtedly will increase, once HPV is in the mix. Groups that see the inoculation as potentially dangerous, or as an implied approval of premarital sex, undoubtedly will mobilize to encourage mass refusal. Parents who might accept something recommended by the family pediatrician may resist if it's commanded by the state.

The HPV vaccine ought to get a chance to establish itself voluntarily before any state makes it mandatory. Public health is one of those areas in which, even by my libertarian lights, the government sometimes has a right to force people to protect themselves and others. But compulsion should be a last resort, not a first.

(Steve Chapman's e-mail is through the Creators Syndicate web page at www.creators.com)