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Vaccinations are among the most cost-effective and widely used public health interventions, but have provoked popular resistance, with compulsion framed as an unwarranted state interference. When the FDA approved a human papillomavirus (HPV) vaccine in 2006, conservative religious groups strongly opposed a mandate, arguing it would condone pre-marital sex, undermine parental rights, and violate bodily integrity. Yet, Governor Rick Perry signed an executive order in 2007 making Texas the first state to enact a mandate — later revoked by the legislature.

Mandatory HPV vaccination reached the heights of presidential politics in a recent Republican debate. Calling the vaccine a "very dangerous drug" that could lead to "mental retardation," Michele Bachmann asserted, "To have innocent little 12-year-old girls be forced to have a government injection through an executive order is just wrong." Rick Santorum added, "There is no government purpose served for having little girls inoculated at the force and compulsion of the government." Governor Perry almost immediately disavowed his action, saying first that the vehicle of an executive order was wrong and then vaccination should be "opt-in."

This political theater could frighten parents from vaccinating their children, causing preventable suffering and death. The scientific evidence demonstrates that population-based HPV vaccination is highly safe and effective, justifying widespread adoption of the vaccine. The only question is whether a state mandate would increase vaccination rates or result in a backlash against HPV and wider childhood vaccinations. Given the political divisiveness, states should launch health education campaigns before resorting to compulsion.

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306 JAMA 1699-1700 (2011)