Should Florida law require school kids to get the HPV vaccine?

During a spring legislative session dominated by school safety concerns, lawmakers left another pressing health issue on the back burner. And, like the Parkland shootings that commanded their attention, it involves life, death and young people.

A bill called the "Women's Cancer Prevention Act" would have required children entering Florida public schools to receive the vaccine that protects against cervical and other cancers caused by human papillomavirus (HPV) infections.

While it didn't get much traction in the Capitol this time around, the bill is likely to pop up again next year as other states begin to pass and consider similar legislation. It also enjoys overwhelming support from the medical community.

Still, the continuing controversy over the HPV vaccine threatens to stand in the way.

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"The introduction of any new vaccine is controversial. But as a country, we seem to forget the benefit of vaccination. The message that we need to get out is that we can prevent multiple cancers in men and women with this vaccine," said Dr. Anna Giuliano, founding director of the Center for Infection Research in Cancer at Tampa's Moffitt Cancer Center.

Nearly all sexually active adults carry some of HPV's 170 active strains. Most are harmless, but a few are known to cause cancer. Reproductive cancers of the cervix, vagina, vulva and anus are most common, but HPV is also the cause of 72 percent of oropharyngeal cancers, which can impact the base of the tongue, tonsils and walls of the pharynx.

Because of this, the sexual stigma attached to the vaccine makes it difficult for physicians to talk to worried parents about it. Sometimes, it's hard to convince them to give the shot to their 10- or 11-year-old child, said Dr. Ellen Daley, a professor studying women's health at the University of South Florida.

In addition, according to physicians and researchers, anti-vaccination groups have spread fear and misinformation about the vaccination online, with stories of health problems including deaths.

"No, it's not causing autism and no, it's not causing your kid to walk backwards," Daley said. "It's a very, very researched vaccine, but I think when people are not ready to trust something, there's nothing you can say to make them change their mind. It's a tough group to break into."

• • •

A photo shared on Facebook shows the smiling face of a blonde teenage girl sitting comfortably near a lake. The image is from 2014, but just last week, it had been shared on social media thousands of times.

"We decided we would protect our beautiful daughter from cervical cancer by letting (doctors) administer the Gardisal vaccine," the caption reads, referring to the most commonly used and approved HPV vaccine in the U.S. and internationally.

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It goes on to detail a terrible story. Jessica Ericzon, 17, experienced headaches, "a pain in the lower left back of her head," joint aches and fatigue. "We thought it was because she was training really hard for high school sports," the caption read. But her parents would later find their daughter dead, shortly after she was given the third and final booster shot of Gardasil.

Posted on the Facebook page "Gardasil Kills2", the story is often recirculated online and used as a warning against HPV vaccines, even though they have never been medically linked to Ericzon's sudden death.

The vaccine has been studied for years, despite fears and misinformation online that try to convince the public otherwise.

Gardasil, produced by the pharmaceutical company Merck, is 99 percent effective in protecting against the four most common strains of HPV that lead to cancer in women. Medical authorities around the world, including the Centers for Disease Control and Prevention in the U.S., the World Health Organization and the European Medicines Agency, monitor the use of the HPV vaccine and publish studies on their findings. Most research continues to prove that the vaccine is safe and effective with few minor risks.

Still, stories like the tale of Jessica Ericzon's death continue to circulate.

"What you read online is fake news propagated by the anti-vaccinating community. I don't think they understand the risks of not vaccinating," Giuliano said. "There is this warped sense of benefit and risks."

She added: "To be clear, we are very close to eliminating these kinds of cancers, starting with cervical cancer. You can't say that about any other kind of cancer."

The U.S. Food and Drug Administration reported seven deaths related to Gardasil doses from 2014 to 2017, out of 29 million doses administered. Among the seven, two were able to be verified through medical reviews and autopsy reports. The other reports were considered hearsay, meaning, "there was not enough information to confirm whether death occurred" from the vaccine, the FDA report said.

From 2006 to 2015, about 80 million doses of the HPV vaccine were given in the U.S., and 117 reports of death were received in relation to Gardasil. Among those reports, 51 cases reviewed by the CDC were verified. But the agency concluded there was no pattern of death among those reports, and there was no evidence to suggest Gardasil was the cause of those deaths.

The FDA and the CDC still recommend the vaccine, and consider it to be "very safe" with "low risk."

Deaths in the U.S. are reported to the Vaccine Adverse Events Reporting System, which is maintained by the CDC and the FDA. The Vaccine Safety Datalink conducted a study in 2016 evaluating reported deaths within 30 days following the administering of the Gardasil vaccine. It examined 13 deaths, of which nine were due to external causes such as accidents, homicide or suicide. The remaining four deaths were unrelated to vaccination or did not show enough evidence to confirm Gardasil as the cause of death.

The World Health Organization's Global Advisory Committee on Vaccine Safety regularly reviews international cases of issues related to HPV vaccination. In March 2017, the committee issued a statement concluding there was no evidence of any link between HPV and some previously reported side effects like chronic fatigue after the EMA in Europe initiated a safety study.

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Despite the research, vaccination rates remain low in the U.S. compared to other countries. In Florida, 29 percent of children received the first dose of the HPV vaccine in 2016, according to Blue Cross Blue Shield's Health Of America Report, released in February. Only 7.3 percent got all three required shots. Meanwhile, rates in some other countries like Australia and Canada are as high as 80 to 90 percent, depending on the region.

"The end game here is the elimination of cancers," said Giuliano, of Moffitt Cancer Center. "We can do that with the cancers caused by HPV. What everyone needs to know is that you can't say that about any other cancer. That's why vaccination is so important."

• • •

In the U.S., public health campaigns to increase vaccination rates have been trying to focus less on sexually transmitted infections like HPV and more on the prevention of cancer, said Daley, the USF professor. Television commercials focus on young boys, too, not just girls, for vaccination.

"We've been trying for years to get away from that since it's such a sensitive and complicated topic. Parents don't like to associate sex with their 10- or 11-year-old," she said. "But if we were able to get the HPV vaccine as part of school entry, that would take care of all of these low vaccine rates. The number of the cancers that could be prevented would be astounding."

That's why it's so hard to see "sensational stories" shared so often on social media, Daley said.

"Maybe a bill would do it? I don't know if a lot of politicians want to touch it," she said. "But it will come back up again."

Currently, Rhode Island, Virginia and the District of Columbia require HPV vaccines for school attendance. A similar bill surfaced in Florida in 2011, but it didn't make it very far through the Legislature.

"I remember a time when all you had to do was tell people the science behind an issue, factually what it means, and they would support something," Daley said. "Now you can talk until you're blue in the face and people won't change their minds."

Contact Justine Griffin at jgriffin@tampabay.com or (727) 893-8467. Follow @SunBizGriffin.