Los Angeles school district planning to offer Gardasil to students

A very interesting story in Monday's Los Angeles Times -- "Schools to Offer STD Vaccine" -- explains that the Los Angeles Unified School District will make Gardasil available to students in its schools in as little as six months, administering vaccines provided by the federal Vaccines for Children program. Here are three noteworthy excerpts from the story:

"Karen Maiorca, who retired two weeks ago as L.A. Unified's director of nursing services, said the vaccine would be offered each year at dozens of clinics that the district operates. The district's 600 school nurses will be responsible for spreading the word. And though the Vaccines for Children program is designed for uninsured and underinsured children, she said, no student will be turned away."

While turning no student away is an admirable policy, it would seem that such a practice would run afoul of the eligibility requirements of the VFC program. Likewise, Gardasil's manufacturer, Merck, must not be thrilled to learn that students with adequate insurance to cover the cost of vaccine could receive doses sold to the government at significantly reduced rates as part of the VFC program.

"[Peter] Kerndt, [director of the county health department's sexually transmitted disease program], said he will soon recommend to county supervisors that all female adolescents in Los Angeles County receive the vaccine unless their parents opt out."

Only a recommendation at this point, Kerndt's 'opt out' comment seems to suggest creating a presumed consent policy for HPV vaccination, rather than requiring active parental consent to vaccinate. Again, this would presumably be an effective strategy to deliver the vaccine to as many girls as possible, but it would seem that the county would likely face legal opposition to such a policy, the resolution of which is unclear.

"County and L.A. Unified officials said they have not received opposition to the idea of providing the vaccine to students. But they have not yet publicized its availability and a number of groups said they were not aware of the school district's plans.

'Wow, that really is different,' said Linda Klepacki, a spokeswoman for Focus on the Family in Colorado Springs, Colo., who originally believed that the vaccine would be available only through private physicians and government welfare agencies."

The use of schools as a vaccine distribution mechanism is not particularly common in the U.S. today, but in a recent paper in Lancet Infectious Diseases (which we wrote about here), school vaccination programs were suggested as a way to increase Gardasil's uptake among African-American populations disproportionately impacted by HPV infection and cervical cancer mortality.