Texas Mandatory HPV Vaccination Update

On Monday, 23 April, the Texas Senate voted 30-1 in favor of its version of HB1089, a bill overturning Rick Perry's February executive order mandating that all girls entering the sixth grade receive the HPV (human papilloma virus) vaccine Gardasil. On Wednesday, 25 April, the Texas House approved the Senate version of the bill by a 135-2 vote. On Thursday, 26 April, the bill was sent to Governor Rick Perry, who has ten days to sign the bill into law, veto the bill, or do neither (which would have the same effect as signing the bill). Even if Perry vetoes the bill, both the House and the Senate have the necessary 2/3 majority votes to override his veto.

For more background on the bill and the vaccine, see here and here. This is pretty much the end of Rick Perry's executive order, although the new version of HB1089 is slightly more palatable than the version passed in the Texas House on 13 March, because it now goes into effect only for four years. Regardless, this is quite a public health setback as universal vaccination should prevent the vast majority of cases of cervical cancer.

Although this vaccine is about the closest thing to a "cure for cancer" we've seen to date, the Texas legislature has passed up a fantastic opportunity by instead bowing to naive conservative interests as well as engaging in a power struggle with the governor.

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Dangerous Government Spins Finds a New Target: Children

By Pam Martens

Does this sound familiar: a massive disinformation campaign is launched. Leading U.S. experts speak out against the contrived "facts." Their voices are either ignored or ridiculed. The manipulated game plan plays out. The U.S. loses credibility around the world.

Today, the United States has on its hands a dangerous debacle that could finish off what little credibility we have left on the world stage. It follows an almost identical play script to the Iraq occupation and involves Merck's vaccine, Gardasil, for treating human papillomavirus (HPV), a sexually transmitted disease and, ostensibly, preventing cervical cancer.

The disinformation campaign is rolled out as follows: A U.S. government agency, the Food and Drug Administration (FDA), issues a press release heralding the launch of a "New Vaccine for Prevention of Cervical Cancer. Except there is no evidence this vaccine prevents cervical cancer as illuminated April 16 in a front page story in the Wall Street Journal, "Questions on Efficacy Cloud a Cancer Vaccine." According to the article, In clinical trials, 361 of 8,817 women who received at least one shot of Gardasil went on to develop precancerous lesions on their cervixes within three years of vaccination, just 14% fewer than in a placebo control group.

Another government agency, the Centers for Disease Control and Prevention (CDC), approves the vaccine for the national Vaccine for Children's Program and over 20 U.S. states, under heavy lobbying by Merck, have legislation quickly introduced to make the vaccine mandatory for 11 and 12 year old girls. (The stated premise is that the vaccine should be given before the onset of sexual activity.) Except there are no studies to show the vaccine works in this age group and there are insufficient studies on its safety in this population, according to FDA's own documents.

Using the same heavy-handed and ethically questionable marketing tactics it used in the U.S., Merck has licensed the vaccine in 52 countries with Australia this month initiating nationally funded mass inoculations of school girls aged 12 to 18. The vaccine is under review for licensing in an additional 50 countries, according to Merck's web site.

In what strikingly resembles the Judith Miller affair in the lead up to the Iraq war, where Ms. Miller's writings in The New York Times effectively became the credible public voice of dubious government claims, The Times has, inexplicably, written two editorials advocating making this new, unproven, inadequately tested drug mandatory as a condition for entering public school for 11 and 12 year old girls. The Times went so far as to applaud the Governor of Texas, Rick Perry, for making the vaccine mandatory for school girls in his state while not mentioning that he had illegally bypassed the state legislature and issued an executive order. They suggested that "Other states would be wise to follow the same path." (A Vaccine to Save Women's Lives, February 6, 2007.) The Texas state legislature is in the process of overturning that order.

In the same editorial, The Times stated: "There is no doubt that Mercks vaccine against the human papillomavirus, given in three shots over eight months, is highly effective."

But far from "no doubt" there was massive doubt and it was coming from leading health experts with a chorus calling it an "experiment" on the public because of inadequate testing.

One of the very researchers who had been involved in the clinical trails for the vaccine, Dr. Diane Harper, a top level scientist and professor at Dartmouth Medical School in New Hampshire, stated the following in the Fort Wayne Daily News: "Giving it to 11-year-olds is a great big public health experiment...There also is not enough evidence gathered on side effects to know that safety is not an issue...It's not been tested in little girls for efficacy. At 11, these girls don't get cervical cancer -- they won't know for 25 years if they will get cervical cancer."

Even the FDA had doubt. Buried at the bottom of its June 8, 2006 letter to Merck licensing Gardasil, it indicated that it did not believe sufficient studies had been done to prove the safety of the vaccine on 11 and 12 year old girls: a sufficient number of children 11-12 years of age will be studied to permit an analysis of safety outcomes. The final study protocol will be submitted by December 31, 2006. Patient accrual will be completed by December 31, 2008.

Another health expert at a sister agency of the FDA, Joseph DeSoto, physician and scientist at the National Institutes of Health wrote an OpEd for the Charleston, West Virginia Daily Mail on January 23, 2007, urging the state not to mandate the vaccine for young girls: "... according to the data presented to the FDA, which I have reviewedthe risk for pelvic inflammatory disease, appendicitis and gastroenteritis is doubled... Here we are talking about forcing a person to undergo mandatory drug therapy (vaccination), when they have no disease..."

On April 4, the oldest newspaper in New Hampshire, the Keene Sentinel, ran a feature story on Gardasil in its Health section. Quoting Dr. Laura Scheinblum, an area pediatrician, the article stated: the HPV vaccine has shown few side effects except for some soreness at the site of the injection. In reality, the Federal governments own Vaccine Adverse Events Reporting System (VAERS) is publishing reports of seizures, convulsions, internal bleeding, loss of consciousness, life threatening swelling in the throat, loss of hair in children and hundreds of other adverse events.

The concentration of wealth, and its appendages of power and control of message, have reached unprecedented levels in America with tentacles now extending into the editorial pages of The New York Times and news pages of New England dailies. Children in Iraq have been dying for four years because of this unbridled disinformation and now children in America and around the world are threatened by it. What will it take to say, "Enough!"

--------------------------

Pam Martens is a public interest researcher living in New Hampshire.

Oh, Nick...none of it is irrelevant. The conversation was about a vaccine that has been on the FDA approval list since June 2006. Less than a year after that approval, 0n Friday before the Super Bowl, groundhogs day, the Governor of Texas (the republican guy that followed George), issues an very rare executive order that mandates that all 6th grade little girls receive three shots of a Merck/Sanofi Pasteur manufactured and distributed vaccine. The AmeriCares to Sanofi Pasteur connection should give everyone quivers � search AmeriCares and Prescott Bush. The same group got a very large government contract, $100 million to be exact for the Bird Flu vaccine. The politics and beliefs of this man and those who elected and celebrated his victory with him are extremely relevant on this one, see Ted Nugent. I live about 25 miles from the Gonzos� northern estate � before he migrated down to Waco. See ya Ted. Take friends with you.

Search words: Rick Perry and, Ted Nugent, Patriot Pastors, Christian Patriots, Non-christians, HPV and Focus on the Family, Council for National Policy, Tim Lahaye Ministries and the Left Behind fiction series.

Search also: Sanofi Pasteur and, AmeriCares, HVP marketing, $100 million Bird Flu

Focus on the Family was the loyal opposition to the HPV vaccine, advocating wide spread availability with an opt-out program for the Christian girls who didn�t need it if they followed the voice of Dr. Dobson, literally following the voice of Dr. Dobson �

Search words: Pat Robertson and, Christian Broadcast Network, Council for National Policy, FEMA, Operation Blessing, and medical distribution during the Iran-Contra conflict, see also AmeriCares and Operation Blessing.

In the preceding weeks, health officials in Texas, released a report titled Cervical Cancer in Texas, that said the Gardasil distribution priorities were the 32 counties along the Texas-Mexico border and urban populations � compares nicely to the low income census data. So after five years of researching vaccine distribution patterns using geographic information system technology (GIS), particularly those manufactured by Sanofi Pasteur and distributed by AmeriCares, I began mapping Medicare and state assisted deliveries, you know the free stuff. The vaccine is really not that expensive if you are of the right populations. Me, a working suburban white girl, would have to pay $360 bucks for my daughter�s doses. Here is some of my GIS work. http://tinyurl.com/petr6

I watched the first delivery go to El Paso County and the next �free deliveries� went to; New Jersey as it is the home of Merck, New Mexico, the southern counties of Arizona, and intercity Washington DC and New York. Thank you Bill Richardson for listening.

So when I read your blog on a web banner called Scientific Activist, Reporting from the Crossroads of Science and Politics and read �although this vaccine is about the closest thing to a "cure for cancer" we've seen to date, the Texas legislature has passed up a fantastic opportunity by instead bowing to naive conservative interests as well as engaging in a power struggle with the governor.�

With statements like:

�Many people (including my wife) had fears of this because of bad information out there about side effects or concerns that side effects on the young hadn't been studied.�

and

�Yes, that fear mongering is about on par with fear mongering by prominent liberals regarding vaccines and autism.� http://tinyurl.com/2jcen6

I thought I would join in. I believe my blog, although containing many links, address those issues. Maybe not clearly, but all relevant if you take the time to do the research � follow my train of thought.

While it is only mandatory for girls age 9 to 26? 29? I opted out. If a girl is having sex (and that is how you get the HPV that cause cervical cancers) at 9 then there is a bigger problem there than a vaccine can cure.
These virus' are passed from males who don't have to take the vaccine. The vaccine was only tested and considered to last 5 years...so it would have to be taken again. It does not cover all HPV. It isn't a cure for cervical cancer which is very treatable if detected early. Papsmears are what is used to detect cervical cancer and are supposed to be taken every year until 30 years of age then every two years.
Regardless of the choice of opting out or taking it, it does not mean your child or young adult will be participating in intercourse. It doesn't stop STDs or pregnancy.
You would do better to make a blood test before marriage or a test to see if either partner had the HPV before having sex mandatory. That would put a stop to that or at least make it clear what a person has to deal with when having sex. Like any other sexually transmitted disease the more partners you have the more likely you will pick something up.
Oh, about opting out...I did for my two daughters and it was like playing 20 questions. They put you on a list like you are some sort of conscienscious objector. Be aware that it isn't a golden bullet. Once you have the STD the vaccine isn't going to change that and there are only about 8 HPV that cause the cervical cancers. This virus doesn't stop all of them. The only way to really be sure is to be abstinent. I don't think that should be a problem for a 9 year old -adult in which time they should be able to make their own decisions about this and other related topics.

They want a "cure for (a) cancer". They get it. Then they say they do not want it.

Is this stupidity or stupidity? The HPV vaccine is going to get young girls to have random sex more than a Hep A/B vaccine they take before going to Mexico would.

But then again, who cares, men do not get cervical cancer, do they?

Sorry, that should have read: the HPV vaccine is not going to get..etc.

By steppen wolf (not verified) on 28 Apr 2007 #permalink

Note that while I favor universal vaccination, I think folks have to have freedom to accept or reject a medical treatment. Many people (including my wife) had fears of this because of bad information out there about side effects or concerns that side effects on the young hadn't been studied. While it's fair to discount this as ignorance, the fact is that there have been drugs like that. And people hear about it on the news. They understandably don't have a blind faith in things like this. When politicians (whom they rightly have even less faith in) mandate a treatment it is understandable they react.

I think having the option to opt out is necessary. However strong education to allay the fears of people also ought be done so we can achieve near universal vaccination.

Casting this in terms of the admittedly silly fear that having a vaccine would increase sexual activity is a bit unfair. Especially when there has been fear mongering on liberal media like Rosie O'Donnal on The View which reaches many women. Yes, that fear mongering is about on par with fear mongering by prominent liberals regarding vaccines and autism. But we probably should realize that counteracting ignorance by force isn't exactly the wisest approach. I'm sure there are folks who reject vaccines out of some ridiculous ideas regarding causality and sexual activity. But I'm reasonably sure those are a minority.

I reject the HPV vaccine because the label insert clearly states: Reproduction studies have been performed in female rats at doses up to 300 times the human dose (on a mg/kg basis) and have revealed no evidence of impaired female fertility or harm to the fetus due to GARDASIL. However, it is not known whether GARDASIL can cause fetal harm when administered to a pregnant woman or if it can affect reproductive capacity.

The man that ordered the shot through an executive order, bypassing all legislative debate, is a Patriot Pastor elected official who believes all non-Christian�s will be doomed to eternal hell and a huge supporter of the politics of Ted Nugent.

The manufacturing and marketing of this wonderful product is being coordinated by Merck and Sanofi Pasteur with AmeriCares distribution to Medicaid and state subsidized nine year old Mexican and minority girls. The first deliveries of this �cure of cancer� were sent straight across the Mexican border. I watched in amazement. http://tinyurl.com/2q2mpb

http://tinyurl.com/yv2njw The very first free HPV shipment went to El Paso County, Texas.

http://tinyurl.com/3x5otf

http://tinyurl.com/yto2rt January 19, 2007 Perry's Vision for Texas = Ted Nugent
http://en.wikipedia.org/wiki/Rick_Perry
http://en.wikipedia.org/wiki/Ted_Nugent
http://tinyurl.com/yhfbw4 November 6, 2007 Perry believes non-Christians doomed
http://tinyurl.com/ynsmce Texas: �Patriot Pastors� for Perry

http://tinyurl.com/2cafo5 From the White Patriot Website.
http://en.wikipedia.org/wiki/Christian_Patriot

It's not as if it hasn't been tried before.

http://tinyurl.com/2ew9kv May 29, 1995 Tetanus vaccine may be laced with anti-fertility drug. International / developing countries.

http://tinyurl.com/7u8qr HcG Vaccine for Population Control. They targeted only women of child-bearing or pre-child bearing years, and required multiple injections.

http://tinyurl.com/2w4l98 June 9, 2006 Sanofi Pasteur, Gardasil� approved in the United States and in Mexico

They are also recommending that the two clinical trials be terminated on ethical grounds, so that young women on placebo could receive Gardasil. How are long term studies conducted if they vaccinate the control group? http://tinyurl.com/266kgz Feb 27, 2007 Merck, Sanofi end Gardasil studies due to success

http://tinyurl.com/28njmq Mar 26, 2007 Gardasil, for Human Papillomavirus types 6,11,16,18, is the only licensed vaccine for the prevention of cervical cancer and other Human Papillomavirus diseases before cervical cancer and beyond the cervix. Gardasil has been developed by Merck & Co., Inc. and Sanofi Pasteur MSD. In Europe , the vaccine is marketed by Sanofi Pasteur MSD.

http://tinyurl.com/2fdngv Mar 25, 2007 Vaccination Campaign Funded By Drug Firm

http://tinyurl.com/23edh3 In the US, sanofi pasteur receives requests for emergency vaccines from Americares, a nonprofit disaster relief and humanitarian aid organization, which provides immediate response to emergency medical needs -- and supports long-term healthcare programs -- for all people around the world. We supply the requested donation upon availability of the requested vaccine and work with Americares to deliver them to healthcare and welfare professionals in 137 countries around the world.

http://tinyurl.com/34mbzz http://tinyurl.com/kslrq Americares But the most important link between AmeriCares, the CIA, and ultra-right organizations was the chair of AmeriCares -- from its founding in 1982 until his death in 1995 -- J. Peter Grace Jr., chair of W.R. Grace & Co. Grace is still listed posthumously as chairman of the AmeriCares Advisory Committee on the group's stationery. J. Peter Grace was the chair of the American Institute for Free Labor Development, the CIA's labor front, and a director of both Kennecott Copper Co. and First National City Bank -- now Citibank. His prominent role in the organization of the fascist coup that overthrew the Allende government in Chile is well documented. He is also connected to the Liberty Lobby, a racist think tank and militarist lobbying group based in Washington, DC. He served as chair of Radio Free Europe, Radio Liberty Fund. Grace was the key figure in Project Paperclip, which brought nine hundred Nazi scientists to the U.S. after World War II, many of whom had been found guilty of experimentation on humans. http://tinyurl.com/htp2p

http://tinyurl.com/2d9m4q Operation Paperclip

As for autism. The word is spelled - t h i m e r o s a l! http://www.9479.net/thimerosal.gif

The company is Eli Lilly. Daddy Bush went from (1976-1977) Director of the Central Intelligence Agency (CIA) to (1977-1979) Eli Lilly Corporate Director, appointed by the father of the future Vice President Dan Quayle who owned controlling interest in the corporation to (1981-1989) Vice-President George H.W. Bush under President Ronald Reagan.

http://tinyurl.com/fffhq
http://tinyurl.com/anukl
http://tinyurl.com/25p6kz (search Eli Lilly)

I can�t imagine why liberals are questioning the US mass vaccination program. Your wife sounds like a bright woman; you should listen to her when she speaks. And�my daughter will not be receiving her 3 shot HPV series and it has nothing to do with making her horney. You may do anything you like with yours.

"I do not understand why we as a people would not take this opportunity to use this vaccine ... to the benefit of our children," Perry said.

Copy and Paste URL links...if necessary.

Yeah, but what caused a lot of backlash was misunderstanding that there was no opt out order. Once again in no part thanks to the press. (Especially Rosie O'Donnal and The View)

I'm sorry you decided not to post my response. I was hoping to join the conversation. You discounted this as ignorance. Counteracting ignorance by thought isn't exactly the easiest approach.

Sorry, Diana, it appears that your comment had been blocked by the spam filter (this often happens to comments with a large number of links). I have let it through now.

Some of that conspiracy theory stuff linking neoconservatives, pharmaceutical companies and the CIA seems a little loopy and tin-foily to me. As soon as I saw the word "Thimerosol" I think I got a gist of what was going on. There is nothing wrong with thimerosol and there is no link between it and autism. A lot of the claims anti-vaccine people like to make are founded on pseudoscience and emotional claims. Vaccines are not as dangerous as some crazies like to drum up.

Here is a link to a story from the New York Times and here is another.

As for Texas overriding mandatory HPV vaccines its the most retarded stuff I've ever seen. Why should everyone have to take it? Because 80% of women in Texas are infected and many don't even know it. There is no test for men. Its spreading to endemic levels and it needs to be put under control. From an epidiomology standpoint, public vaccination is a necessary if we're to control the disease.

Diana, I can't make heads or tails of what you expect us to get out of your links. Can you please provide a short narrative (link free if possible) that clearly outlines your position and the most important facts that led to your conclusion?

(note: I am asking in all honesty and have a particular interest in female reproductive health issues and the Right's interaction with them as I have personally been burned by their campaigns in the past)

Molly Ivins was right -- watching the Texas Lege is the best free entertainment in Austin, probably in the state.

There are too many argument vectors involved in this thing to lay it off to one cause or the other. Here are several reasons the Perry order is threatened with overturning:

1. Perry's order makes sense, from a health perspective and a morality perspective. Texas legislators are taught by Texas preachers that anything that "stands to reason" is probably also "standing against God." We have a similar problem with saving money and calling for help in this state -- preachers tell people if they have a healthy bank account they will go to hell, and people (generally poor people who need the ticket to heaven cheap) give their money to religious causes; preachers tell people its a sin to take government aid, and thousands of families refuse aid that would help them take care of their kids. So, since Perry's order makes sense, it must be sinful, according to many in the Lege.

2. The legislators individually and collectively don't like Rick Perry. Oh, they'll campaign saying he's a great guy, against a Democrat -- but there is no love to be lost between even the Republicans and Perry. The governor's office is weak, by constitutional design. If the governor were popular and funny like Ann Richards, or popular and venal like George Bush, they'd pay more attention. But what can Perry do to them? He acted and put them on the spot -- they'll teach him a lesson, hear?

3. Merck's aggressive "get the vaccine adopted" drive, complete with money that looks for all the world like bribes, was quickly discovered. Perry took contributions from Merck too close to his issuing the order. If there are any other reasons to oppose the action, this gives a hook to hang those reasons upon. Anti-vaccine forces claim they are "anti-corruption." (Merck suspended its campaign -- God save us when a pharmaceutical company must bribe public officials to do the right thing for the right reasons, and then such actions are called "corrupt.") There is a bit of jealousy here, too -- many of the legislators would have loved to have gotten a donation from Merck to "convince" them to vote for it. Perry intercepted their God-given share of the graft money. Legislators are not happy about that.

4. The vaccine is expensive.

5. Disease prevention is often based on evolution theory, as is much vaccine research -- Texans have been told that such applications of science are close enough to pure evil that they may lead one to tumble into the abyss. When families dutifully avoid polio and typhoid vaccinations, plus most of the others, avoiding one more that prevents cancer (which everyone else gets, "but not us") is an easy step. Make no mistake about it, tens of thousands of Texas kids do not have basic vaccinations. HPV is not considered basic.

So, what would you expect from a legislature that is knee-jerk responsive against most advances in science; against health care that really helps people later in life; against health care that might protect people from themselves (tobacco and alcohol sorta excepted); against an action that makes a governor they really don't like, look good; against action that doesn't line their own pockets; against action that is "reasonable" rather than "based on faith."

Within five years we'll start hearing the stories from oncologists about men who plead with them to give their daughters, sisters, mothers and wives, "that evil vaccine" in order to help them against cervical cancer. Of course, such pleas will be way too late to do much good. And not even the oncologists will have any joy in telling the stories.

I would like to answer in all honesty and have a particular interest in female reproductive health issues and the Right's interaction, but I believe I have been blocked from the discussion.

Diana,

You are encouraged to participate in a discussion, and I hope that you will. I apologize for the spam filter picking up your post earlier. This happens sometimes, although the spam filter overall works pretty well. As long as you don't include too many links, it should go through without a problem.

Since the links are important, I am breaking up my post. You really do have to come to your own conclusions on this one, becasue truth is stranger than fiction and I am attempting to counteract ignorance by thought which isn't exactly the fastest approach.

So, there is nothing wrong with thimerosal? Every time you read thimerosal, say Eli Lilly. You may inject anything you so desire into your children. I would like to reserve the right to just say "Oh Hell No!"
http://tinyurl.com/fffhq http://tinyurl.com/anukl

http://tinyurl.com/yt9x5w
http://tinyurl.com/qoavg
http://tinyurl.com/2cqyr8
http://www.9479.net/thimerosal.gif

As for your link Brad assuring me that 187mg of injected ethylmercury in the first six months of life does not cause harm, "It's really terrifying, the scientific illiteracy that supports these suspicions," said Dr. Marie McCormick, chairwoman of an Institute of Medicine panel that examined the controversy in February 2004.

As a researcher, I personally attended the February 2004 IOM Meeting. What I witnessed was not reflected in the final IOM report. Dr. Marie McCormick should be, in lieu of a trial and at the very least, fired.

http://www.nomercury.org/iom.htm Meeting Nine - Vaccines and Autism, February 9, 2004
http://www.aapsonline.org/vaccines/iom.htm
http://www.iom.edu/?id=26925

Dr. Marie McCormick, Chairman of the Immunization Safety Review Committee, stated back in 2001... "we are not ever going to come down that it is a true side effect." "[CDC] wants us to declare, well, these things are pretty safe on a population basis." Three years later, she did.

My problem with the autism/thimersoal story is that I do not believe it was accidential or solely about greed?

Pharmaceutical companies and the CIA seems a little loopy and tin-foily to me...

The MKULTRA-Eli Lilly connection is well documented. Every time you read LSD, say Eli Lilly.

There is one Eli Lilly piece of history so bizarre that if told to many psychiatrists, one just might get diagnosed as paranoid schizophrenic and medicated with Zyrprexa. http://tinyurl.com/zwqyl http://tinyurl.com/gn6hu http://tinyurl.com/3cr4dh

http://tinyurl.com/25p6kz (search Eli Lilly)
http://tinyurl.com/bl9gw
http://en.wikipedia.org/wiki/Human_experimentation
http://en.wikipedia.org/wiki/Eli_Lilly_and_Company
http://tinyurl.com/h5eyw
http://en.wikipedia.org/wiki/MKULTRA
http://tinyurl.com/2d9m4q
http://tinyurl.com/26kndc Testing and Use of Chemical and Biological Agents by the Intelligence Community
http://www.mk-resistance.com/mk_ultra.html
http://www.wanttoknow.info/050626mkultra
http://tinyurl.com/z332u

You may inject anything you like in to your children thimerosal to Gardasil. My daughter will not be getting the executive order shots. I would simply like to see Gardasil vials tested for HCG hormone that produce antibodies against hCG to prevent pregnancy along the Mexican border review Ted Nugents inaugural comments. Vaccines containing the hormone immunize women not only against HPV but also against pregnancy by inducing the body's immune system to attack the hormone needed to bring an unborn child to term. Its not as if it has not been tried before. http://tinyurl.com/2ew9kv

Good point, and I agree. I think the rationale right now is that women are most affected by HPV (with the result of cervical cancer), so they have a vested interest in getting the vaccine. From a public health perspective, though, it seems that it would be more effective to mandate the vaccine in both boys and girls, and I know that Merck is currently testing the vaccine in men.