Days before Republican candidates began sparring over a vaccine to help prevent cervical cancer, a bill aimed at expanding access to the shot for California minors made its way to Gov. Jerry Brown's desk with little fanfare.
Assembly Bill 499, by Assemblywoman Toni Atkins, D-San Diego, would allow those 12 and older to seek medical care to prevent sexually transmitted infections without parental consent.
A coalition of parental rights advocates, vaccination opponents and conservative and religious groups is now rallying against the bill, characterizing it as an affront to parents' rights.
The presidential debates have called new attention to the issue, providing new ammunition for supporters and opponents of the shot.
They've flooded Brown's office with phone calls – so many that Californians calling the governor's public line can select a voice-mail box reserved for feedback on this one measure. Brown has not taken a position on the bill.
The California bill differs substantially from the executive order signed in 2007 by Texas Gov. Rick Perry, who is now under fire for the action from his rivals for the Republican presidential nomination.
Perry's order, ultimately overturned by the Texas Legislature, mandated the shot for sixth-grade girls, offering an "opt out" provision for parents who objected.
The California measure now awaiting action from Brown doesn't make prevention measures mandatory. It allows minors 12 and older to receive prevention services for sexually transmitted diseases without parental consent.
Such prevention services would include two vaccinations approved to protect against strains of human papillomavirus, or HPV, a virus that can cause cervical cancer. Hepatitis vaccinations and medication to reduce the risk of HIV infection after exposure would also be covered.
Supporters cast the bill as a logical, and potentially lifesaving, step to promote public health, pointing out that those as young as 12 have for decades been able to consent on their own to be diagnosed and treated for sexually transmitted diseases.
"What this adds is them being able to receive prevention … which is obviously a very important part of health care," said Dr. Dorothy Furgerson, chief medical officer for Planned Parenthood Mar Monte. "If you can prevent a cancer with a vaccine, shouldn't you do that?"
The bill sets the minimum age for the preventive services at 12 to align with existing law on treatment and conform with federal recommendations that the shot be administered around that age to maximize effectiveness and ensure protection prior to exposure.
But supporters say they don't expect many 12-year-olds or young teens to take advantage of the change if signed into law, in part due to the high cost of the shot, more than $300, and the need for multiple injections over several months.
"There probably is a little bit of an overblown fear that suddenly there will be a lot of younger teens coming in, when in reality it will probably be some of the older teens who are more aware of these issues, aware of these prevention measures," said Dr. Susan Philip, president of the California STD Controllers Association, the group of public health officials that sponsored the bill.
The possibility that middle school students could obtain the vaccine on their own has riled critics who worry youths will be pressured to get the shots without fully understanding the reason or potential side effects.
"It's just a matter of how can a 12-year-old possibly assess risk-vs.-benefit information and make a medical decision for themselves without the knowledge or consent of their parent," said anti-vaccine activist Dawn Winkler, who is executive director of Health Advocacy in the Public Interest. "As a parent myself, I would want my child to have to have my consent and I would want the knowledge of any medical procedure."
Supporters counter that parental involvement isn't always an option, arguing that ensuring greater access to preventive care is necessary to combat rising STD rates in teens.
"I don't disagree with how they would like the world to be," said Atkins, who previously worked at community reproductive health clinics. "I think it would be a wonderful thing if our kids talked to us and we were able to do these things together, but that's not always the reality."
Other critics say STD prevention is best addressed through abstinence-based education that starts with the parents. They take issue with the idea that the state, without parental approval, could help pick up the tab for teens eligible for state-aided health care coverage.
"You don't give tax-funded, bulletproof vests to gang members and say, 'Hey this will protect you.' You deal with the behavior," said Randy Thomasson, founder of SaveCalifornia. com. "A young girl is not a female dog in heat. A young girl is influenced by what she is taught."
Federal regulators have approved two shots, Gardasil and Cervarix, intended to prevent HPV, which is the country's most widespread sexually transmitted infection. Supporters have praised the shots as an important tool in combating cervical cancer, which affects roughly 12,000 women a year.
While claims that the shots are unsafe have been disputed by experts in the medical community, GOP candidate Michele Bachmann's recent attacks on Perry put the debate back in the headlines.
The Minnesota congresswoman went after Perry for his Texas executive order, saying "little girls who have a negative reaction to this potentially dangerous drug don't get a mulligan."
In later interviews, Bachmann cited a conversation with a woman who said her daughter "suffered from mental retardation" after receiving the shot.
Medical groups, including the American Academy of Pediatrics, have denounced that claim as false, saying there is no evidence that the vaccine causes such developmental issues.
Dr. Gary Leiserowitz, professor and chief at the Division of Gynecologic Oncology at the UC Davis Medical Center, said that while legitimate questions of whether the shots are necessary exist due to HPV's life cycle, evidence shows the vaccine is safe and has "remarkably few side effects."
"It is unfortunate that this vaccine has become mired in deeply moral and ethical values related to sexual behavior, although I suppose that it was inevitable because of the nature of the transmission," he said. "If you look at it strictly from the standpoint of trying to prevent diseases, it seems like it's actually a pretty remarkable breakthrough."