09/14/2011 04:26 pm ET | Updated Nov 14, 2011

Rick Perry Campaigns In Virginia, Where HPV Vaccine Mandate Causes Little Controversy

WASHINGTON -- Beset by criticism over his executive order to mandate that underage girls in his home state receive the HPV vaccine, Texas Governor Rick Perry campaigned in Virginia on Wednesday, the one state in the country where that vaccine is actually mandated.

Perry's stopover in the commonwealth included a speech at Liberty University and a lunch at the Richmond Convention Center, where he raised funds with Virginia Governor Bob McDonnell (R). That he spent time in the one state that, along with Washington, D.C., institutes a policy similar to the one currently tripping up his presidential bid was purely coincidental. The McDonnell event, for one, was planned months in advance.

Still, it's a bit of awkward timing for Perry, who at Monday night's presidential debate was attacked by his fellow candidates for his 2007 executive order, which he says he signed in order to help prevent girls from contracting the sexually transmitted virus and developing cervical cancer. The executive order, which allowed parents to decline to vaccinate their daughters, was overturned by the Texas state legislature.

On the one hand, Virginia Republicans have sought to repeal their own mandate, casting it (as Perry's critics have) as a government intrusion in individual medical decisions. But repeal legislation has always fallen short in the state Senate.

On the other hand, Virginia's experiment with the HPV vaccine has proven that qualified mandates, like the one Perry envisioned, are rarely as draconian as some try to suggest. (Rep. Michele Bachmann (R-Minn.), for example, alarmingly referred to the vaccine as a "government injection" in Monday night's presidential debate.) Even some Virginia conservatives agree that mandating a lifesaving vaccine isn't necessarily incongruous with Republican principles.

"I'm a conservative Republican and I certainly do believe in limited government and limited interference of government into our lives. As we look at the function of government, I would put number one as being to protect its citizens," said Chris Stolle, a Republican member of the state's House of Delegates. "I think that a vaccination program for a disease that's epidemic falls very clearly within the realms of a small limited government."

Under Virginia's law, as with Perry's executive order, parents have the option of simply declining to have their daughter vaccinated. "[T]he opt-out in Virginia is global," said one top aide in the Virginia legislature. "Parents can just say no."

In addition, no long-term information is kept on who was immunized and who has opted out of the program. "We really don't have that data," said Sandra Sommer, the Quality Assurance and Policy Manager for the division of immunization at the Virginia Department of Health. The health department instead maintains statistics on the overall rate of HPV vaccination statewide.

"Virginia continues to progress on that front," said Sommer. "We are above the national average and the assumption is the mandate contributes at least partially to that."

That Virginia's HPV vaccination program has hardly been discussed, even with Perry's visit to the state, underscores that the controversy surrounding the issue is primarily driven by politics and not based on the program's merits. The law was slightly controversial in its original form; when it was passed in 2007, it made the HPV vaccine mandatory for girls before they entered the 6th grade. But then Governor Tim Kaine amended the bill to permit parental or guardian-sanctioned opt-outs. And because Virginia has one of the earliest generally assembly sessions in the nation, legislators were not subjected to the type of political pressures that lawmakers in other states faced over the issue that year. The result was bipartisan support in both chambers.

Since then, there have been regular efforts to undo the bill. This past winter, the House voted 61 to 33 in favor of repealing the mandate. But that effort, like those before it, died in the state Senate.

"There are some people in the House of Delegates who don't have any confidence in science," said state Sen. Janet Howell (D). "In the Senate we are more likely to value science and success rates."

Howell's colleague, state Sen. John S. Edwards (D), said that the mandate is not a source of discord.

"I think it is embedded in Virginia law," said Edwards, who supports the mandate. "I have not heard any controversy. I have not heard any opposition recently."

And so, the issue has been gradually pushed to the political back burner, with even McDonnell choosing, more or less, to ignore it. Howell said she couldn't recall the governor, who was elected in 2009, ever having discussed the vaccines. A newspaper archive search shows that the only press releases his office has put out on the matter stated that he hadn't taken a position. McDonnell did not respond to multiple requests for comment for this article.

And while Perry's ascension to the top of the Republican presidential ticket -- along with the heavy chatter that McDonnell could potentially be his pick for vice president -- may change that, the vaccination program will still have its defenders.

"I think we've taken what is a medical issue and politicized it, and it always bodes poorly for medicine when that happens," said Stolle. "We know that all the leading medical groups recommend that we get the vaccine, and so I think that when these issues come up, we need to rely on the medical experts to provide direction here and not politicize the issue. The silver lining on the cloud is that HPV is getting a whole lot of attention -- people are finding out the prevalence of it and the risks associated and that it can be vaccinated with a 70 percent success rate."