Gardasil, a vaccine manufactured by Merck and Co., protects against the sexually transmitted human papillomavirus, or HPV, which causes cervical cancer and genital warts. As of July 1, 2008, the vaccine is required for females ages 11 through 26 who are seeking refugee status in the U.S., applying for an immigrant visa or adjusting status within the U.S. to that of permanent resident.

How Did It Become a Requirement?
The addition of Gardasil to the Technical Instructions for Vaccination for civil surgeons conducting medical examinations of aliens came as a result of recommendations from the Center for Disease Control's (CDC) Advisory Committee on Immunization Practices (ACIP). The Department of Health and Human Services (HHS)/CDC have the regulatory authority to set the requirements for medical exams, which includes vaccination requirements.

Controversy
Gardasil is given in three shots over a six-month period and costs about $400. It is one of the most expensive and controversial vaccines, mainly because it is given at such as young age and has shown to have serious adverse affects. Of the more than 16 million doses of Gardasil distributed nationwide as of June 30, 2008, there were 9,749 reports of adverse events following Gardasil vaccination. Of these, 6% were labeled as serious events which included 20 deaths, and 94% were classified as non-serious events. Both the FDA and CDC, however, continue to find that the benefits of Gardasil outweigh the risks and have said that Gardasil is a "safe and effective vaccine."

Concerns From an Immigration Perspective
The Gardasil vaccination requirement forces young, immigrating females into a difficult situation. In addition to concerns over possible adverse events, the high cost of the vaccination places an additional burden on already cash-strapped immigrants who are paying out hundreds of dollars on filing fees, medical exams, attorneys and moving expenses. What's most troubling, though, is while Gardasil is recommended by the ACIP, the vaccination is mandatory for immigrating girls and women but not for American citizens. Virginia is the only state in the U.S. that has added Gardasil to its list of vaccines required for schoolchildren.

Should You Be Concerned?
The good news is Gardasil may benefit millions of people. The FDA says that, "Each year, more than 12,000 American women are diagnosed with cervical cancer, and almost 4,000 women die from this disease. In addition, about 6.2 million Americans become infected with genital HPV each year. Worldwide, cervical cancer is the second most common cancer in women, with 233,000 deaths per year." The FDA believes that Gardasil is the vaccine that will change these numbers.

As is the case with all vaccines, you may request a waiver if there are religious or moral reasons why you cannot receive the Gardasil vaccine.