U.S. Citizenship STD Vaccination Requirement

Female immigrants find that U.S. citizenship has its price: An STD vaccination that critics say has a troubling record.

Almost three summers ago — she won’t say exactly when — 24-year-old Catalina and a cousin finally crossed the border.

She was happy enough, she says through an interpreter, back home in Mexico working at a fishery by day and clubbing by night. A regular, working-class twentysomething. But when her father took ill late one year and had to leave his job for nearly 19 months, her family — that’s her dad, mom and two younger sisters — needed more money than she could earn in Mexico. The state took care of the medical bills, but living expenses for the family of five added up fast.

Like millions before her, Catalina headed north to the United States in search of work and the money to help feed her family.

Today, nearly 650 miles separate her from life back in Guaymas, a sizeable fishing town and rising tourist mecca that rests where Mexico’s Sonoran beaches meet the Gulf of California.

Here in Las Vegas, Catalina says she’s worked the jobs typically reserved for a woman in her position: waitress, nanny, maid. Without documents, her choices are limited. But the money she wires home each week is more than she earned in Mexico and has kept her family afloat. Now, with dad in recovery and back at work and one sister bringing in cash from a new factory job, Catalina has options.

If President-elect Barack Obama and a Democratic Congress also bring change to the nation’s immigration laws, this petite woman with solemn eyes and a reserved yet determined manner says she hopes to stay here while applying for citizenship through some sort of amnesty program. If not, Catalina says she might go home and try to re-enter legally. Option No. 2 takes longer, she says, but being an American citizen will make it easier, eventually, to bring her parents to live with her.

“I’m here for the money, this is not what you call a normal life. I think about my family a lot. I miss my friends, and I miss my home. I don’t have papers, so I need to decide whether to go back. The longer I’m here, the higher my chances are of getting caught and deported. My mom says that, anyway,” she says.

On a recent weekend, the weight of her decision has led her to a swap meet near North Las Vegas. Rumor has it that official work documents — green cards, IDs good enough to fool the DMV — can be had here, if Catalina can afford it. After that, it’s a short path to a valid Nevada driver’s license and a chance to slip, unnoticed, into the great American melting pot.

Whether she opts for fake documents or the official thing, Catalina says she knows she’ll have to pay.

Reluctant to risk forged papers, Catalina says she’d prefer an official path to citizenship. But higher application and medical costs pose a real problem.

Government fees and the cost of a new vaccine called Gardasil, designed to prevent cervical cancer in young women who immigrate here, mean Catalina will have to scrape together thousands of dollars she doesn’t have and can’t raise without dipping into the cash she sends back to Guaymas.

That worries her, she says.

When asked if she’s aware that some legal and medical experts allege Gardasil has killed at least 20 young women just like her and sickened 8,000 more, Catalina is shocked.

“What? I don’t believe it,” she says.

After her friend translates some news reports and government documents brought along to show her allegations against the vaccine, Catalina grows quieter.

Asked how she’s feeling, Catalina shoots back, “scared.”

Change you can worry about:
Eight years after a border-state governor took the White House, American immigration policy still faces daunting obstacles. Although President George W. Bush has long favored a guest-worker program and an easier path to citizenship for some illegal immigrants, his own party has repeatedly killed legislation that would accomplish exactly that.

This administration, argue some activists, has never been serious about immigration reform.

The Bush administration has certainly drawn heavy fire in the wake of its decision this summer to expand cervical cancer vaccination requirements for female immigrants.

According to a rule change issued in July 2008 by the U.S. Health and Human Services, women 26 or younger who want to become U.S. citizens must now undergo a three-shot series of the Gardasil vaccine. While four other newly required vaccines have drawn little outcry, growing numbers of immigrants and their advocates claim that Gardasil is a public health risk that federal immigration officials should immediately rescind.

Most federal officials and the drug’s manufacturer, pharmaceutical giant Merck, insist the vaccine is safe, but both legal and immigration activists fear otherwise.

If American women aren’t required to take the vaccine, why should immigrants, they ask? Is the Gardasil requirement a case of prescient public policy or a government-approved medical experiment run amok?

Ironically, many left-leaning immigration advocates point to a June 2008 study from a conservative legal foundation as evidence that the vaccine has led to 18 deaths nationwide and has sickened thousands more.

Calling government statistics on Gardasil “a catalog of horrors,” Judicial Watch President Tom Fitton unveiled thousands of federal documents detailing what his organization claims is proof that Gardasil, a drug approved for children as young as 9, poses a very real health risk to those who take it.

Based on their yearlong study, Judicial Watch researchers claim Gardasil is not 100 percent effective against all forms of human papillomavirus, the most common sexually transmitted infection in the United States, with an estimated 6.2 million cases here and a known cause of both precancerous lesions and full-blown cervical cancer.

According to government figures, more than half of all sexually active men and women become infected with the virus at some time in their lives. On average, doctors diagnose more than 9,700 new cases of cervical cancer in the United States each year. Government reports attribute about 3,700 deaths to the virus each year. Worldwide, cervical cancer is the second most common cancer in women; and is estimated to cause more than 470,000 new cases and 233,000 deaths each year. This is the last kind of public health crisis the United States needs now, argue federal health officials.

About 25 million women are currently infected in the United States. There is no cure for HPV infections, and many who are infected are not aware that they are.

While acknowledging the controversy, federal, state and local health officials tell CityLife that Gardasil is effective against four types of the human papillomavirus that cause about 70 percent of cervical cancer in women.

Ihsan Azzam, an epidemiologist with the Nevada State Health Division, says he and other state authorities are thankful that doctors here can now administer Gardasil to citizen and immigrant alike. Nevada might have less than 24 deaths from cervical cancer each year, but one case is too many, according to the doctor.

Further, with Department of Homeland Security reports showing hundreds of thousands of illegal immigrants likely living in Nevada (the vast majority of them minorities), the more medical care directed toward those groups, the better, right?

“There is an unequal burden of this cancer among uninsured, underinsured and underserved minority women in the country. Minority women have higher rates [incidence and death] from cervical cancer and when diagnosed, cervical cancer among minority females is detected at more advanced stage,” says Azzam.

Azzam sees no current cause for alarm. He says he’s looked at the data so far and is satisfied that Gardasil is a step forward in women’s health.

“There is no clear pattern [of harmful side effects]. We looked further, and there was no common factor. I would say that Gardasil is a very good vaccine. However, it is not going to prevent cervical cancer. Regular screening has to continue,” he says.

View from the examination room:
Of the 22 area doctors authorized to administer Gardasil to immigrants as part of their required pre-citizenship medical treatment, only one physician, who asked to remain anonymous, could recall a patient refusing the vaccine, and that was on religious grounds.

Most local providers, like Dr. William Jacks in North Las Vegas, tell CityLife they know of no controversy surrounding the treatment. “I make them aware of the warnings, but I haven’t had any patient who refused the vaccine,” he says.

In addition to reports that scores of female test subjects who took Gardasil suffered complications, including respiratory illness, Guillain-Barré Syndrome (a rare neurological disorder that causes muscle weakness), miscarriage and spontaneous abortions, warnings from doctors and immigration advocates have taken on new validity and credibility as more researchers look into whether Gardasil works as advertised.

In the August edition of the New England Journal of Medicine, researcher Charlotte Haug questioned the long-term effects of the drug.

“A number of critical questions remained unanswered … ,” she writes. “For instance, will the vaccine ultimately prevent not only cervical lesions, but also cervical cancer and death? How long will protection conferred by the vaccine last? Since most HPV infections are easily cleared by the immune system, how will vaccination affect natural immunity against HPV, and with what implications? How will the vaccine affect preadolescent girls, given that the only trials conducted in this cohort have been on the immune response?”

In the press, representatives from both Merck — who were unable to respond to CityLife inquiries by press time — and federal health agencies point out that Gardasil was tested for years on thousands of human subjects. Why would they need further testing on a particular subset of the population?

In a statement, the Centers for Disease Control says, “To date, the manufacturer, Merck and Co., has distributed over 16 million doses of Gardasil in the United States. Given the large number of doses distributed, it is expected that, by chance alone, serious adverse events and some deaths will be reported in this large population during the time period following vaccinations. Our monitoring and analysis of reports, including in-depth medical review, are designed to detect serious events that occur at rates greater than expected, compared to what would be expected by chance alone.”

As of June 30, 2008 (the same time that Judicial Watch issued its report on Gardasil), federal health workers have logged 9,749 reports of adverse events following Gardasil vaccinations. Of these, federal officials classified 94 percent as reports of non-serious events.

Of the 6 percent of so-called serious events, a CDC spokesman says, “Concerns have been raised about reports of deaths occurring in individuals after receiving Gardasil. As of June 30, 2008, 20 deaths had been reported … There was not a common pattern to the deaths that would suggest they were caused by the vaccine. In cases where autopsy, death certificate and medical records were available, the cause of death was explained by factors other than the vaccine.”

For local health officials who routinely administer the vaccine to both citizens and immigrants, Gardasil is a public health boon.

Stephanie Bethel, spokeswoman for the Southern Nevada Health District, says since Gardasil’s introduction in 2007, district workers have distributed more than 18,000 doses of the vaccine.

The worst reactions to Gardasil seen locally? Fever, nausea, dizziness or pain at the injection site.

“Vaccines are among the most studied healthcare products,” says Bethel. “[Gardasil] is a new vaccine, and the long-term efficacy is continually monitored by health officials. It is known to protect for at least five years and probably more. The HPV vaccine has been tested in thousands of women worldwide, and 11,000 girls and young women between ages 9-26 have received the vaccine. More than 2.1 million doses have been distributed. The health district has not received any reports from our clients that any of them have become ill or had an adverse reaction. If we had, the reactions would have been reported to the Centers for Disease Control and Prevention.”

Lack of concern?

In fact, the only Latinos whom CityLife found to be concerned about Gardasil were perhaps 5 percent of the total women interviewed. Those who did worry about Gardasil say they fret about the drug’s financial cost. Only four women living in Las Vegas illegally and interviewed by CityLife know about the allegations that Gardasil isn’t effective. They declined to be named for this piece or sit for photographs. All cited news reports in recent years that immigration officials arrested and later deported immigrants who spoke out publicly against current immigration rules. They didn’t want to be next, they said.

Perhaps more interestingly, if local doctors report almost no patients refusing the vaccine, local immigration lawyers report even less concern among their clients striving for eventual citizenship.

Even the American Civil Liberties Union, both nationally and here in Nevada, has yet to issue a formal position on Gardasil.

“I think it’s because this is a relatively recent requirement. I think most attorneys don’t pay that much attention to medical requirements,” says Chris Drinan, a local immigration attorney in the firm of Reza Athari, who could recall just one client raising concerns about Gardasil.

“They [immigrants] can get a waiver for the vaccination requirement, but it makes [earning citizenship] more difficult. I don’t even know how you go about challenging it, to be honest.”

But challenges to Gardasil are coming from groups that focus on smaller minority populations who, at least in the past 50 years, have raised few immigration complaints.

Priscilla Huang, policy director for the National Asian Pacific American Women’s Forum says she’s concerned with possible adverse effects from the vaccine. Immigrants, especially women and girls, should have some control about any medicines they’re asked to take.

“When it comes to mandates, families and girls should have a choice. In this instance, with immigrants, their ability to waive or opt out of these policies is very, very limited,” she says.

Still, a lack of local concern about Gardasil doesn’t mean the drug and its requirement for citizenship shouldn’t be examined in further detail, says one legal mind.

While he alleges no ulterior motives from government health and immigration officials, David Thronson, associate dean at the Boyd School of Law at UNLV and co-director of the university’s immigration legal clinic, says that just such a required treatment would offer regulators and pharmaceutical researchers an additional chance to observe its effects in human populations.

“This is an easy way to slip this in. You’ve got a population for whom the stakes are incredibly high. If you said, ‘The only way for you to come to the United States is to take this experimental drug,’ a lot of people would sign up for it,” he says.

Thronson also poses the possibility that federal officials are using Gardasil to replenish depleting federal coffers. If each of the estimated 4 million female green card-holders eligible to become U.S. citizens in 2006 (the last year for which data were available) paid an average of $500 for Gardasil, that would equal $2 billion in new revenue. Equally plausible, he says, is that federal officials are using Gardasil as a way to weed out indigent immigrants — those who would likely be a drag on social services in this country. Raising the price of admission to the land of the free would tend to keep out the freeloaders.

“We’ve never wanted the tired, the poor, the huddled masses yearning to breathe free. One of the first grounds for refusing citizenship is whether someone is likely to become a public charge. That’s been true in this country for a long time.”

Back at the weekend swap meet, Catalina has given up on doctored paperwork after more than an hour of talking to anyone who looks willing to make a deal.

Aside from her dreams and willingness to risk arrest in the hunt for forged documents, Catalina has almost nothing of what she really needs to start down the path toward citizenship: information.

“I don’t know, I don’t know.” Her mantra softly trails behind her as she leans on a friend for moral support. After an afternoon spent in the shadows, Catalina gives up.

“Maybe next month,” she says.