Testimony in Support of a Resolution Regarding Competent Minors’ Ability to Consent to HPV Vaccination

My name is Erin Beth Harrist and I am a Staff Attorney with the New York Civil Liberties Union. I would like to thank the Committee on Health and the Committee on Women’s Issues for inviting the NYCLU to provide testimony today relating to the proposed resolution calling upon the New York State Legislature to pass legislation clarifying competent minors’ ability to consent to preventive healthcare for the Human Papillomavirus (HPV).

The NYCLU, the state affiliate of the American Civil Liberties Union, is a not-for-profit, nonpartisan organization with eight offices across the state, and nearly 50,000 members. The NYCLU’s mission is to defend and promote the fundamental principles, rights and constitutional values embodied in the Bill of Rights of the U.S. Constitution and the Constitution of the State of New York. This includes the rights to personal autonomy, privacy, and equality that are the foundation of reproductive freedom. Given our extensive work in the area of minors’ rights to consent to confidential reproductive and sexual health care, the NYCLU is well positioned to provide testimony in support of this resolution.

HPV is the most common sexually transmitted infection in the United States and its deleterious impact on public health cannot be understated. Certain forms of HPV can cause cancer, including vaginal cancer, cervical cancer, penile cancer, and anal cancer. Close to 12,000 women in the United States are diagnosed each year with cervical cancer alone, and approximately 4,000 women die each year as a result of the disease.¹ And HPV’s impact is felt widely. Indeed, most sexually active men and women have the virus at some point in their lives, and as many as half of these infections are among adolescents and young adults ages 15 through 24 years.²

Despite its dire consequences, there are tools to prevent HPV that are both effective and safe. The Food and Drug Administration (FDA) has approved two HPV vaccines: Gardasil, which is approved for both males and females between the ages of 9 and 26, and Cervarix, which is approved for females between the ages of 9 and 26. These vaccines prevent cancer and genital warts caused by HPV. Notwithstanding widespread support in the medical community including the American Academy of Family Physicians and the American Academy of Pediatrics, vaccination opponents are working to spread misinformation about the safety of the HPV vaccines. Numerous clinical trials and post-licensure monitoring data demonstrate that HPV vaccines are not only critical as preventive care measures, but are also safe.³ Further, while opponents charge that the HPV vaccines will put minors at risk by encouraging sexual activity, recent studies show that there is no connection between receipt of the vaccine and sexual behavior.⁴

Allowing competent minors to consent to HPV vaccination is a critical measure that will help prevent the spread of HPV and its devastating consequences. Despite the fact that most parents are involved in their children’s health care decisions, not all minors have healthy, safe family relationships, and some are unable or unwilling to involve their parents, especially when it comes to reproductive and sexual health care. Studies show that many adolescents will not seek out reproductive and sexual health care services if confidentiality is not guaranteed, although, importantly, these same teens will remain sexually active and therefore exposed to health consequences that can devastate their futures. Thus, while it is ideal to have a parent involved, mandating parental consent can delay and deter critical preventive health care services. For these reasons, public health experts and professional medical associations, including the Society for Adolescent Health and Medicine, the American College of Obstetricians and Gynecologists, the American Medical Association, the American Academy of Pediatrics, the American Academy of Family Physicians, and the American Public Health Association, strongly support the provision of confidential reproductive and sexual health care to minors who are able to provide informed consent.

The laws and policies of the state of New York recognize these realities and permit minors to consent on their own to confidential reproductive and sexual health care. The law includes a specific provision that permits minors to give informed consent to testing and treatment for sexually transmitted infections. However, the New York State Department of Health has taken the cramped – and, we believe, unfounded – position that this law does not encompass preventive treatment such as vaccination for HPV. It defeats the purpose of the statute to exclude preventive care from the definition of treatment and thereby permit a minor to be tested and treated for HPV without parental consent, but not to take steps to avoid infection in the first instance. Thus, while some providers administer the vaccine to sexually active adolescents who are capable of giving informed consent, other health care providers are unsure whether minors may provide informed consent for the vaccine without parental permission. As a result, many minors are unable to access this potentially life-saving treatment.

As this resolution rightfully recognizes, our State Legislature should pass a law that clarifies once and for all what both logic and legislative intent dictate: that minors who – on their own – are able to provide informed consent to get tested for STIs and to get treated once they find they have an STI can give informed consent to preventive STI treatment, namely the HPV vaccines. Allowing access to such preventive care without obstacles is consistent with both good medical practice and public health principles.

In conclusion, the NYCLU strongly supports this resolution and the passage of legislation that makes clear that qualified health care practitioners may administer HPV vaccines without fear of running afoul of the law to minors who have the capacity to provide informed consent without parental consent.

Footnotes

1 Centers for Disease Control and Prevention, HPV Vaccine Information for Clinicians – Fact Sheet, available at http://www.cdc.gov/std/hpv/STDFact-HPV-vaccine-hcp.htm (July 2012).
2 Id.
3 Centers for Disease Control and Prevention, Human Papillomavirus Vaccination Coverage Among Adolescent Girls, 2007-2012 and Postlicensure Vaccine Safety Monitoring, 2006-2013 — United States, 62 MMWR 591, available at http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6229a4.htm?s_cid=mm62 29a4_w (July 2013); N.P. Klein, et al., Safety of quadrivalent human papillomavirus vaccine administered routinely to females, 166 Arch. Pediatr. Adolesc. Med. 1140, available at http://www.ncbi.nlm.nih.gov/pubmed/23027469 (Dec. 2012); B.A. Slade, Postlicensure safety surveillance for quadrivalent human papillomavirus recombinant vaccine, 302 JAMA 750, available at http://jama.jamanetwork.com/article.aspx?articleid=184421 (Aug. 2009); Centers for Disease Control and Prevention, Information from FDA and CDC on Gardasil and its Safety, available at http://www.cdc.gov/vaccinesafety/Vaccines/HPV/HPVArchived.html (July 2008, last updated Feb. 2011).
4 See, e.g., Robert A. Bednarczyk, et al., Sexual Activity–Related Outcomes After Human Papillomavirus Vaccination of 11- to 12-Year-Olds, 130 Pediatrics 798 (Oct. 2012), available at http://pediatrics.aappublications.org/content/early/2012/10/10/peds.2012-1516.full.pdf+html.