MINNEAPOLIS, January 31, 2008—The Minnesota Department of Health submitted a report to the Legislature Friday recommending that vaccination for human papilloma virus (HPV) not be made a requirement for school enrollment in Minnesota at this time.

The report follows six months of careful review and consideration by MDH staff, an advisory panel and other professionals. The best approach to preventing cervical cancer, the report says, is a combination of continuing good cervical cancer screening and educating people about HPV and the vaccine.

In 2006, the Food and Drug Administration licensed an HPV vaccine for girls and women ages 9 through 26 years. A second vaccine has been developed for women ages 10 through 55 that is pending FDA licensure. Clinical trials have shown that the vaccines are effective at preventing the types of HPV that most commonly cause cervical cancer in women.

With the advent of these vaccines, the 2007 Legislature directed the Commissioner of Health to prepare a report on whether the HPV vaccine should be required for school enrollment for junior-high age girls. Minnesota’s school immunization law allows exemptions for medical or conscientious reasons.

MMA member Edward Ehlinger, M.D., who serves on the state advisory committee for immunization practices that made the recommendations, told the Pioneer Press that the initial research suggests Gardasil is safe and protects for at least five years. But more studies are needed to confirm its long-term efficacy.

The MDH report looked at the patterns of HPV infection and cervical cancer in the population, the effectiveness and safety of the vaccine, the status of federal immunization recommendations, and the cost of HPV vaccine. The report concludes that adding HPV to the school immunization schedule should not be mandated at this time for several main reasons: 

• Providers need more time to become accustomed to ordering, stocking and offering the vaccine to their patients;
• More time is needed for the public to become aware of the vaccine, accept it and understand its limitations;
• More time is needed for manufacturers to ensure adequate production and supplies. As has happened with other new vaccines, including the vaccine in the school immunization law too early would result in a surge in demand that manufacturers might not be able to keep up with.
• Currently, funding sources that would ensure equal access to the vaccine if it were mandated are not as reliable or consistent as they could be. 
• More time is needed for more children to be vaccinated so the responsibility for vaccination does not fall too heavily on schools. If a majority of students are not vaccinated prior to a mandate, primary responsibility to assure vaccination shifts to schools, rather than public health or private health care providers.

Each of these reasons is described in more detail in the report. In addition, the report notes that the rate of cervical cancer in Minnesota is relatively low because of Minnesota’s effective screening programs.

Currently, the vaccine is recommended in a number of provider organizations’ immunization guidelines and providers are increasingly ordering the vaccine for their practices.

“Through our recommendations to consumers and providers and through the federal Vaccines for Children program, MDH is implementing an HPV vaccination program as part of a comprehensive cervical cancer prevention strategy,” said Minnesota Health Commissioner Sanne Magnan. “However, mandating the vaccine as a requirement for school attendance is premature. “Until some of the issues we’ve noted have been resolved, we believe it is the best use of public health resources to proceed with a three-pronged approach to cervical cancer prevention.”

The report says MDH and health care providers should:

Continue to educate the public about the causes, prevention and early detection of HPV and cervical cancer.

Continue to stress the importance of Pap tests for cervical cancer screening at the same time information is given about the vaccine.

Continue to actively educate adolescents, preadolescents and their parents about the advantages and limitations of the HPV vaccine, so these individuals can make an informed decision about vaccination.


A thorough discussion of the pros and cons of mandating is contained in the report. To access the report, go to www.health.state.mn.us/divs/idepc/dtopics/vpds/hpv/index.html.

More information on the HPV vaccine can also be found on the MDH Web site at www.health.state.mn.us/divs/idepc/dtopics/vpds/hpv/index.html.

More information on cervical cancer can be found at www.health.state.mn.us/divs/hpcd/ccs/info/cervical.htm.