The following post first appeared on FactCheck.org.
Carly Fiorina recently said some unnamed vaccine-preventable diseases are “not communicable” and “not contagious,” and some immunizations are not “necessary” for school-age children. The fact is that every immunization recommended by the Centers for Disease Control and Prevention covers a highly communicable disease.
Fiorina, a former businesswoman, is running for the Republican presidential nomination. Though her campaign did not respond to repeated requests to clarify which diseases and vaccines she meant, Fiorina on two occasions suggested the vaccine for human papillomavirus, or HPV, should not be mandatory for children. However, the HPV virus is highly communicable through many forms of sexual contact, and the vaccine has been proven to prevent its transmission and thus help prevent cervical cancer as well.
Fiorina spoke at a town hall event in Alden, Iowa, and afterward addressed reporters. According to multiple media outlets, including Time magazine and CNN, she addressed the idea of parental choice with vaccinations:
Fiorina, Aug. 13: When you have highly communicable diseases where you have a vaccine that’s proven, like measles or mumps, then I think a parent can make that choice, but then I think a school district is well within their rights to say, “I’m sorry, your child cannot then attend public school.” ….
I think when we’re talking about some of these more esoteric immunizations, then I think absolutely a parent should have a choice and a school district shouldn’t be able to say, “sorry, your kid can’t come to school” for a disease that’s not communicable, that’s not contagious, and where there really isn’t any proof that they’re necessary at this point.
We sent multiple emails and left a voicemail with Fiorina’s campaign asking for clarification on which vaccines are “esoteric,” which diseases are not communicable or contagious, and for which vaccines we do not have proof of their necessity. We did not get a response, and we will update this post if we do.
Regardless of her answers to those questions, however, her statement regarding contagious or communicable diseases is inaccurate. The CDC’s recommended immunization schedule for children contains 14 vaccines (some versions only recommended for older children and certain high-risk groups), and every one of them includes coverage against diseases considered highly communicable. The only disease covered by recommended vaccines that is not passed from person to person is tetanus, and that is generally covered in a vaccine that also provides immunization against diphtheria and pertussis, two highly contagious infections.
On two occasions, Fiorina has suggested the HPV vaccine should not be mandatory for school-age children. During the town hall in Iowa, she told a story about her daughter being “bullied” into letting her own daughter receive the vaccine for HPV. Fiorina also mentioned this vaccine in an interview with Buzzfeed in January:
Fiorina, Jan. 24: I think there’s a big difference between — just in terms of the mountains of evidence we have — a vaccination for measles and a vaccination when a girl is 10 or 11 or 12 for cervical cancer just in case she’s sexually active at 11. So, I think it’s hard to make a blanket statement about it. I certainly can understand a mother’s concerns about vaccinating a 10-year-old.
If her more recent comments are also in reference to HPV, Fiorina again has missed the mark. HPV is common and communicable, through sexual contact. The CDC says that “[y]ou can get HPV by having vaginal, anal, or oral sex with someone who has the virus,” and the virus can be spread even when no signs or symptoms are present. According to the CDC, about 14 million Americans become infected with HPV — there are about 40 types of the virus — every year.
Fiorina could have meant that “highly communicable” diseases, such as measles, are transmitted through the air, simply by being in proximity to infected individuals. This is true, but the other vaccine-preventable diseases are also highly communicable, though by different routes in some cases. Some of the infections are transmitted through the air, others through the fecal-oral route (i.e., unwashed hands), and others, including hepatitis B and HPV, are sexually transmitted. HPV cannot be transmitted through the air, like measles.
The CDC currently recommends that all boys and girls aged 11 or 12 years old should receive the HPV vaccine, and “catch-up” vaccines are recommended through the age of 21 for males and 26 for females. The vaccine is not given to a girl at a young age “in case she’s sexually active at 11″ — it is given then because that is before most people become sexually active. In fact, the CDC says that “[p]reteens should receive all three doses of the HPV vaccine series long before they begin any type of sexual activity and are exposed to HPV.” The fundamental purpose of a vaccine is to administer it before one is at risk for the disease in question.
Though one might debate whether the HPV vaccine should be required, there is ample proof that it is effective. Multiple studies have shown that vaccines, including Gardasil and Cervarix, offer long-lasting protection against strains of HPV that are known to cause cervical cancer.
Because the first HPV vaccine was introduced in the U.S. in 2006, it may take years to firmly connect declining cervical cancer rates to vaccination. However, studies already have foundexcellent protection against a cervical cancer precursor called cervical intraepithelial neoplasia, or CIN. A review paper published in the journal Vaccine in 2012 found that “the excellent trial results strongly support the potential of the vaccines as high value public health interventions.” The CDC says that HPV infections cause about 17,000 cancer cases in U.S. women and 9,000 cases in U.S. men every year, and vaccines could lower those rates significantly.
Regardless of which immunizations Fiorina considers “esoteric,” there are no common vaccines that fit the profile she describes. All of the CDC’s recommended immunizations, including those for HPV in preteen boys and girls, are highly effective at preventing communicable and dangerous diseases.
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