To the Editor: Mr Gostin's Commentary questioned whether mandates for human papillomavirus (HPV) vaccination are effective enough to risk alienating the public.1 Data in studies he cites address this matter. In the 2 places that have adopted mandates, Virginia and the District of Columbia, coverage remains modest. Compared with 49% of female adolescents nationwide, just 54% of those in Virginia and 58% of those in the District of Columbia had received 1 or more doses of HPV vaccine by 2010 according to medical records.2 Existing mandates include generous opt-out provisions that, in the case of the District of Columbia, more than 40% of parents used to circumvent the policy.
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