One of the hottest public health debates today is over whether or not adolescent girls should be required take the vaccination against the human papillomavirus, which can cause cervical cancer. The debate is being closely watched by black medical professionals, organizations and parents, since African-American women are at least 50 percent more likely to die from cervical cancer than white women.

In Texas, Gov. Rick Perry issued an executive order in February requiring sixth grade girls be inoculated before entering school. But last week, amid controversy, the state lawmakers rejected the order.

In Washington, D.C. the city council had voted to support a vaccination bill requiring the series of shots be administered beginning in 2008. Last week, despite protests, the council approved immunization, but pushed the the program back to 2009. The council said over the next year, there will be an aggressive citywide education HPV campaign. The compromised proposal also makes it easier for parents to have their daughters opt out of the program.

To date, 20 states have introduced bills to require girls get the vaccine, according to the Associated Press. In Virginia, lawmakers approved a requirement targeting girls before they start middle school, but the governor wants to amend their action to make it easier for parents to opt out, according to The Washington Post. In New Mexico, legislation requiring sixth grade girls to be vaccinated awaits the governer’s signature.

If the District mayor signs the proposal into law, as he is expected to do, and Congress approves, then Washington, D.C. would be one of the few jurisdictions to add the HPV vaccine to its school immunization schedule, according to the Post.

“We have to seize this opportunity to save our daughters from the scourge of HPV,” said Mary M. Cheh, co-sponsor of the council's bill.

In the national debate, while some parents and medical professionals believe more research is needed before the vaccination becomes mandatory, others believe the research is adequate and that the risks are no greater for the HPV vaccination than for any other inoculation. Supporters believe the fact that the HPV vaccine blocks the virus that causes cervical cancer is enough to warrant a public health endorsement of mass inoculation.

In June 2006, the pharmaceutical company Merck announced it had received FDA approval for Gardasil, the first vaccine against cervical cancer. The drug protects almost completely against two HPV strains that cause more than 70 percent of the 10,000 cervical cancer cases in this country annually, according to the Post.

The drug works best in women who have not been exposed to HPV, usually girls or women who have not become sexually active, as noted by Tracy Nelson Christia, BlackDoctor.org, in a BlackAmericaWeb article in March. Gardasil is approved for females aged nine though 26, and the Centers for Disease Control, and the American College of Obstetrics/Gynecology recommend immunizing girls ages 11-12.

Several conservative groups maintain that administering the vaccine to young girls may give them implicit approval to become sexually active, Christia said.

This national debate is healthy “and all stakeholders should be involved,” said Dr. Terry Mason, commissioner of the Chicago Department of Public Health.

“This is the first time we have had a tool that actually helps prevent cervical cancer. I understand and support the move to make this vaccination one that should be required because of the lives it can save,” said Mason. “But if there is a mandatory rule, it should be funded so everyone can get it. If it’s not funded, then I am not for making it mandatory.”

The HPV inoculation costs about $400. Even with the inoculation, women should still get a regular Pap smear to check for the early signs of cervical cancer. Unfortunately, many women without health care insurance do not get regular checkups.

Dr. Gaile Christopher, director of the Joint Center Health Policy Institute in Washington, D.C., said the center does not have an official stand on the debate. Personally, she said, she is concerned that compulsory vaccination is premature.

“Anything that is mandatory in the absence of an equally robust education campaign is premature at best,” said Dr. Christopher. “Our parents deserve a full chance to explore the issue. Parents, when educated properly, make decisions about vaccination based on what they believe the dangers and risks are.”

Dr. Christopher said she too understands the excitement over the vaccination. “We have a wonderful opportunity to have access to something that could have a significant effect on unnecessary disease and deaths. But we don’t want to jump ahead and make this compulsory,” she said.

Angel Shannon, who is a critical care nurse and lives in Randallstown, Md., said she and her husband have decided they would opt out of any program that would mean HPV inoculation for their 10-year-old daughter.

“My biggest concern is that there is not enough data out there yet to conclusively say what the long-term effect of vaccination will be,” said Shannon, who noted current research and discussions about the possible link between vaccinations and autism.

“I think we have to be very careful how we approach blanket vaccination, especially when you have a daughter like mine who is nowhere near being sexually active,” said Shannon. “Sure, there are some girls who are active, but there are a whole lot who are not.

“I also don’t think it is the government’s place to demand immunization," she said, "for something that is clearly a life choice.”

Dr. V. Leah McKinney, an OB-GYN in Atlanta and also the mother of a daughter, shares Shannon’s reservations. But she said she will support mandatory inoculation if it is made available to everyone and “the cost is covered by the government.”

McKinney has an additional concern. She said she is weary of researchers approaching sexual issues by laying the burden on girls and women.

“There’s not even an HPV test for boys,” said Dr. McKinney. “It’s always all about the girls. Can’t we use the same technology for boys? Why don’t we have a penile swab run on boys? The focus needs to be equal.”

While the debate roars, the nonprofit organization Balm In Gilead is working on its Isis Project, a public education campaign project entitled “Black Women of Faith and Medicine: Working Together to Eradicate Cervical Cancer.”

“The focus is getting black women to take the HPV test and educating them about Pap smears also,” said Permessa Seele, Balm in Gilead founder and CEO. “Educating them about the vaccine is secondary."

Seele believes that because the church is the center of life for many African-Americans, the program will be able to reach women who are underinsured and frequently under-use cancer screening services.

The organization does not take a stand on the issue mandatory vaccinations. “If I had a daughter, yes, I would have her take the vaccination,” said Seele.

She’s heard the theory that pharmaceutical companies are behind the rush to use inoculation, but she is more concerned about women’s health than about the money drug companies stand to gain if inoculation becomes mandatory.

“Health care in America is big business. They make millions of dollars on our headaches, sinuses, hemorrhoids, you name it,” said Seele.

“I am most concerned," she said, "that women are educated about the vaccine and allowed to make a decision for themselves.”