State health officials are requiring public school sixth graders to be immunized with a controversial vaccine before the start of the next school year or risk being excluded from enrolling in middle school.

There are 13,221 sixth-grade students in public schools, including charters, affected by the new rule. Parents will need to provide proof that their child received one dose each of Tdap (tetanus, diphtheria, pertussis vaccine) and MCV (meningococcal conjugate vaccine) and two doses, given six months apart, of HPV — the vaccine for the human papillomavirus, the most common sexually transmitted disease known to cause cancers in the cervix, penis, anus, mouth and throat.

HPV infects nearly 80 million Americans — 1 out of every 4 people — with more than 41,000 projected to be diagnosed with an HPV-­related cancer each year.

“Like in anything brand new there’s always going to be push back. The issue more than anything else is that we’re talking about disease and we’re talking about trying to prevent cancer,” said Ronald Balajadia, state Department of Health immunization branch chief. “We spend so much money in trying to find cancer cures and how to stop cancers because of the fact that we’re seeing so many cases and we have vaccines that can prevent some of those things. We want to provide them protection before they’re exposed to these diseases … because that’s where they’re going to be the most effective.”

A 2018 study by the University of Hawaii Office of Public Health Studies found that only 35% of girls and 19% of boys had received the recommended shots of the vaccine. Among the concerns of some parents was that it could contribute to promiscuity among children, authors of the study noted.

The Department of Health’s Vax to School campaign will run public education announcements on television, radio and in print publications on the new seventh-grade attendance requirements that take effect in the 2020-2021 school year.

Shayna Kusumoto, a 43-year-old mother of three school-aged children, said she is not against vaccines but is cautious because of the chemicals that are used to preserve the drugs, which also contain live viruses.

“Vaccines are good for the masses and good for controlling (disease) … so it doesn’t affect the whole population of Hawaii but it’s not necessarily good for the individual,” said the Kaimuki resident. “In general I’m against vaccines that are optional. HPV is different because it’s so common. This is one vaccine that I think I would want my kids to have before they do anything dumb and they get it themselves. I will opt for them when it comes to protecting my children against a relevant … immediate risk. I think it would be a great idea but that it shouldn’t be forced on any parent. Everybody feels differently.”

Starting on July 1, the state will require additional immunizations for students entering childcare or preschool, kindergarten, 7th grade, and post-secondary schools, and all students entering Hawaii for the first time, unless they have a medical or religious exemption.

The Health Department is asking parents of sixth graders to schedule HPV vaccinations as soon as possible so that both doses can be administered before the new school year begins. The requirement doesn’t apply to children in higher grades in the public school system.