Pro-Family Law Center Analysis of CA HPV Mandate

CoG for Life Applauds Pro-Family Law Center:  Speaks out Against HPV Vaccine Mandate

Note to our readers: The following letter was sent to the California Legislature from the Pro-Family Law Center in opposition to their proposed mandate for the HPV vaccine.  For further information, visit their website at

January 25, 2007

California State Legislature
State Capitol
Sacramento, California    94249

Re: Opposition to AB 16

Dear Gentlepersons:

The Pro-Family Law Center opposes AB 16 proposed by California State Assembly Speaker Pro-Tempore Sally Lieber.  AB 16 would mandate California school districts to require their female students receive an immunization to the human papillomavirus (HPV) prior to entrance to the sixth grade.

The Pro-Family Law Center opposes this proposed legislation on the grounds that it infringes on parental rights, unequally protects female students over male students from HPV, and disturbs a natural incentive for teenage students to abstain from sexual intercourse to avoid the contraction of certain sexually transmitted infections.

Our society holds strong beliefs granting certain rights to parents with regard to their responsibility to raise their children.  Among these rights is that of the parents to choose the proper time and place to discuss the issue of sex with their children.  When female students receive the HPV vaccine through a series of three injections over a period of six months, there is little doubt that rumors and discussing among the girls and the general student population will arise on the topic of sex.

This would lead to false truths being spread to public school students throughout California.  By requiring the HPV immunization and subsequently the discussion of sex between young public school girls, the state infringes on the right of parents to choose when it is appropriate to discuss that sensitive issue with their daughter.  We believe that parents alone have such a right to decide when and how their children will be exposed to sexual issues.  The Pro-Family Law Center believes that parents have the right to decide how to raise their children and the government should not have the ability to supersede this right.  AB 16 would do exactly that.

The rights of the students who would be subject to vaccination under AB 16 is also an important factor in this issue.  Female students are entitled to privacy in matters concerning their body with exceptions permitted should a compelling state interest arise.  We do not believe that there is a compelling state interest in implementing the HPV vaccination as a requirement for public school females.  If they are entitled to have an abortion while at school and without parental notification or consent, they are certainly entitled to make their own other health decisions.

The individual student and her family know best when it comes to her health and well being.  There are also concerns over the religious rights of families that oppose subjecting their children to the HPV vaccination on the grounds of it preaching immorality and acting as a counter to abstinence. In Wisconsin v. Yoder the United States Supreme Court upheld the rights of parents to control the upbringing of their children per their religious beliefs over the interest of the state in mandating education for students until a certain age.  It is then the case that the religious beliefs shared by many conservative households which advocate abstinence rather than “safe sex” in this case through vaccinations, should be protected over the states interest in mandating such a vaccination that would trample the religious beliefs of such families.

There are two methods by which a student may be exempted from an immunization requirement in a California public school.  A medical exception for students who have a licensed physician state that their health would be negatively affected by the vaccination under California Health and Safety Code section 120370.  There is also a philosophical exception for parents to file an affidavit stating that the immunization is against their beliefs.  This is provided by California Health and Safety Code section 120365.  Thus parents of female students required to receive the HPV vaccination may choose to submit an affidavit to the school district explaining that the HPV vaccination is against their beliefs and there daughter would therefore not be required to receive the vaccine.  The school district may temporarily exclude such a student from school instruction should they find reason to believe that the student has contracted HPV.  The question then raised is how a school district may responsibly monitor the sex lives of their students without invading their privacy, in an effort to maintain the health and safety of the general school population.  For this reason it seems impracticable that the HPV vaccine be included in the list of required immunizations for entrance into public schools.

These students have the right to a free and equal education to be provided by the state of California.  It is reasonable to assume that a student and her family may decide that she should not receive the HPV vaccine based on her family’s religious beliefs, and the family does not wish to file an affidavit stating this, a burden placed upon them by the state to act as an incentive for parents to follow the vaccine guidelines rather than challenge a vaccine on religious or philosophical grounds.  In this instance that student would be deprived of her right to participate fully in the educational process free from discrimination and harassment (California Education Code section 201a.)  The student is certainly within her rights to refuse the vaccine and still attend public school to continue her education and preserve her religious beliefs.  The Pro-Family Law Center strongly believes that the right of students to participate fully in the educational process should not be violated, especially when it collides with a vaccination requirement.

Current California Health and Safety Code section 104200 provides for the required vaccination of public school students against a number of contagious diseases in order to attend a public school.  The current vaccinations required are for ten diseases, six of which are spread through the air (diphtheria, haemophilus influenza type b, measles, pertussis, rubella, and varicella), mumps is spread by saliva transfer, poliomyelitis (polio) is spread through contaminated water and food, tetanus is spread through open wounds, and hepatitis B is spread through blood to blood transfers and sexual contact.  With the exception of hepatitis B, those diseases are spread by conceivable situations at a school.  Since students spend a majority of the time at school in closely confined rooms with their peers, it is reasonable to assume that they may contract six of the ten diseases that are spread through the air.  Saliva transfer may inadvertently occur with the using of another peer’s drink at lunch time, and contaminated water or food is always an issue that may arise with cafeterias.  The adoption of hepatitis B to the list of vaccinations changed the notion that vaccinations be required for students to protect them at school from diseases and infections they may easily contract through little or no fault of their own.  The addition of hepatitis B to the list may be to protect students’ from the threat of medical institutions using non-sanitized needles just as it protects them from unprotected sexual intercourse and non-sanitized needles utilized by drug users.  The vaccination for HPV protects against the four types that are spread exclusively through sexual contact however.  There is no presumption that a student may innocently contract HPV during school or in a hospital.  It assumes that the student is sexually active or will soon become sexually active.

California Health and Safety Code section 104200 also states that the state may require any vaccinations for “Any other disease that is consistent with the most current recommendations of the United States Public Health Services’ Centers for Disease Control Immunization Practices Advisory Committee and the American Academy of Pediatrics Committee of Infectious Diseases, and deemed appropriate by the department.”  Both the Immunization Practices Advisory Committee (IPAC) and the California Department of Public Health (CDPH) recommend the vaccine for HPV be administered to girls aged 9-26.  The four types of HPV that the vaccine protects against cause 70% of cervical cancer cases and 90% of genital warts cases.  The IPAC and CDPH feel that vaccinating females in California public schools against HPV will lead to a substantial decrease in cervical cancer cases.  There is another method to accomplish this same goal; the practice of sexual abstinence until marriage would protect against all sexually transmitted infections with the exception of rape.

The state already stresses abstinence as one of its means to prevent pregnancy among minors (California Education Code section 8902b.)  It would seem more effective to stress the same preventative measures to prevent HPV contraction as the state already does to prevent minor pregnancies.  The American College of Pediatricians released a statement on January 22, 2007, stating their opposition to A16:

“The American College of Pediatricians is opposed to any legislation which would require HPV vaccination for school attendance. Excluding children from school for refusal to be vaccinated for a disease spread only by penetrating vaginal intercourse is a serious, precedent-setting action that trespasses on the right of parents to make medical decisions for their children as well as on the rights of the children to attend school. In addition, this vaccine prevents a disease which is exclusively sexually transmitted; mandating it as early as 9 years of age places the medical provider in an ethical dilemma. First, the administration of the vaccine requires explanation to both the parent and the child. Parents may have chosen not to introduce the subject of sexual activity to their nine year olds due to their physical and emotional immaturity. Also, most 9-12 year old children are not sexually active; many have not entered puberty. Forcing a parent to forsake his/her better judgment and discuss this information with the child would be inappropriate and unnecessarily intrusive.”

The FDA approved vaccine for HPV has only been approved for use in females, not males and AB 16 only mandates that female students receive the vaccine prior to entrance into the sixth grade.  This suggests that there is an unequal protection of the health of female students over male students in California public schools.  Since the vaccine is only approved for females, they are given an unfair advantage over males with regard to protection of HPV.  The state would mandate disadvantaging male students against HPV protection.  Both male and female students are entitled to equal treatment in public schools and mandating a vaccination for one gender of students and not another is inherently unequal.  While there is no available vaccine to protect male students against HPV, they are still entitled to the same health immunizations as female students.

The intention of mandating the HPV vaccination is to protect against cervical cancer.  The HPV vaccination protects against four types of HPV which cause 70% of cervical cancer cases.  It also protects against a majority of cases of genital warts;  although this does not appear to be the primary motivation for the implementation of the HPV vaccine, it is none the less a significant externality.  It will cause female students to believe that they will avoid contracting genital warts by being vaccinated for HPV and may very well cause a significant increase in sexual activity among the female student population in California public schools.  This would impair the incentive female girls have to abstain from sexual activity with multiple partners while still in high school.

Focus on the Family released a position statement supporting the universal availability of HPV vaccines but opposes mandatory HPV vaccinations to public school.  They further state that “The HPV vaccines do not, in any circumstance, negate or substitute the best health message of sexual abstinence until marriage and sexual faithfulness after marriage.”  It may be seen that Focus on the Family does not wish to restrict the widespread availability of the HPV vaccine to protect women against contracting the disease in the case of uncontrollable circumstances such as rape.

The Pro-Family Law Center concurs with Focus on the Family with regards to the need to place emphasis on abstinence rather than vaccinations.  We also believe that the vaccine should not be a requirement for entrance into any specific grade or the public school system in general.  It should be made available to students and their parents should be the ones to sign a consent agreement for their daughters to receive the vaccination, rather than go out of their way to prevent them from receiving it.

Most Respectfully,

s/s RYAN FLYNN Pro-Family Law Center Legislative Analyst