Ever since legislation was introduced in the D.C. Council that would mandate vaccinations for the HPV virus, the issue has moved to the forefront of the public health debate around the country. With an increasing number of states considering a mandatory vaccine — at least 20 to date — debate has raged between advocates that believe that a vaccine could prevent a serious public health crisis, opponents who claim that it infringes upon the rights of families to determine what medical care their children should be forced to accept, and skeptics who question the vaccine’s efficacy.

Locally, the Virginia General Assembly recently mandated the vaccine for children entering the sixth grade, though Governor Tim Kaine has asked that a stronger opt-out clause be written into the law, though one currently exists. Kaine hasn’t yet decided if he’ll sign the law. Lawmakers in Maryland are considering establishing a taskforce to study the option, and in the District the council has yet to debate the measure introduced in January.

Will momentum swing towards the mandatory vaccine, or away from it? While the Post reports today that more women than originally estimated are infected with the virus — some 7.5 million women aged 14 to 24 — only 2.2 percent of those carry one of the two strains that causes cervical cancer. Of course, those two strains alone are responsible for 70 percent of all cases of cervical cancer in the United States, which on average kill 3,700 women a year. But the Washington Times is reporting today that the chairman of the Centers for Disease Control and Prevention’s advisory committee on immunization practices, Dr. Jon Abramson, opposes a mandatory vaccine for young women because it may not prevent HPV when they are most likely to contract it — in their late 20s and 30s. Abramson also noted that most mandatory vaccinations are reserved for diseases that are spread more casually, such as chicken pox and measles — but not HPV. And plenty of controversy has raged over the role of Merck, the producer of the vaccine, who until recently lobbied states to mandate its use, provoking questions as to whether they were more concerned with public health or profit. (In a particularly badly-timed revelation, Texas Governor Rick Perry, who signed a mandatory vaccine order into law, was forced to admit that his former chief of staff was a Merck lobbyist.)

Though doubts exist as to the efficacy of a mandatory vaccine, the District may have a better case to make than other states. The District’s rate of infection far outpaces the national rate –13.5 per 100,000 for D.C. versus 8.8 per 100,000 nationally — and the city has long struggled to track and manage serious communicable disease, HIV/AIDS chief among them. An aggressive step like this may be exactly what the District needs. Of course, both Councilmember Mary Cheh (D-Ward 3) and David Catania (I-At Large) have to address a number of concerns, including how long the vaccine will last and whether giving it to girls aged 11 to 13 is the best time to maximize the prevention of HPV; what type of opt-out clause will be used; and what type of educational campaign will be used to inform children that the vaccine does not protect against other dangers of sex. And, unfortunately, Cheh, Catania and other vaccine supporters will have to fight the opinions of people like Post columnist Courtland Milloy, who has compared the proposal to the Tuskegee experiments. It is a sad truth that two white councilmembers introducing a mandatory vaccine that will primarily target African American women — which account for 92 percent of all invasive cervical cancer cases in the District — will face an uphill battle in a place as insecure with race as the District can be.

But the debate should be had. Cheh and Catania are right in proposing the measure, even if it never comes to pass. At least someone is talking about it early on, which is more than can be said for the District’s HIV epidemic. It’s simply not worth waiting until the problem gets worse before jumping into action.