While cervical cancer used to be one of the deadliest diseases for women in the US, the number of deaths it causes has dropped dramatically (by 74% from 1955-1992) and it continues to drop). Why then are so many states considering mandating a vaccine that costs $300-$500 per patient for a type of cancer that is already largely under control in this country and which can be almost entirely prevented by regular gynecological checkups and Pap smears?

Merck & Co., the giant pharmaceutical company that makes the vaccine Gardasil, is spending millions of dollars lobbying state legislators.  In Texas, where Merck recently doubled its lobbying efforts, Gov. Perry received $6000 from Merck’s political action committee during his last campaign. One of Merck’s key lobbyists in Texas is Perry’s former chief-of-staff and the mother-in-law of his current chief-of-staff is the state director of Women in Government, a national advocacy group of female state legislators that has received substantial funds from Merck. 

It is important to note that low income women and women who do not have health insurance are most at risk because they are less likely to get regular Pap smears. More than half of the diagnosed cases of cervical cancer are in women who have not had a Pap smear in three years. While Gov. Perry has mandated that the state of Texas foot the bill for those who can’t afford the expensive HPV vaccine, it is unclear where those funds would come from either in Texas or in other states that are considering making the vaccine mandatory. And obviously the cost of the vaccine makes it prohibitive in the countries where it is most needed and would potentially do the most good.

What is clear is that Merck has a substantial financial interest in the vaccine becoming mandatory even though the added benefit to public health is both minimal and costly.  With more than 10 million girls in the US between the ages of 10-14, the drug company stands to make billions of dollars preventing a disease that  is already treatable in the targeted population. Since the vaccine does not eliminate the need for regular Pap smears, it would appear that a far more appropriate and  cost effective first step would be to make regular gynecological healthcare  available for all women regardless of income and medical insurance, particularly since this step by itself would go a long way in reducing the few cases of cervical cancer that still occur in this country.

There is however another significant public health concern in regards to the HPV vaccine, namely that it is a very new drug with no history.  We are of course being told that it is perfectly safe and has few side effects, but we were also told that about Thalidomide, DES  and Hormone Replacement Therapy. Negative health concerns have also been raised about other children’s vaccines and the Anthrax vaccine given to those in the armed forces as well as drugs like Vioxx, another Merck drug.

And in an essay published in the New York Times in July 2006, Roni Rabin points out that most of the subjects in the Merck trials were women over the age of 16.  Rabin found that the vaccine was only tested on 1,200 girls under the age of 16. In addition, the vaccine is so new that it is not yet known for how long it will be effective or whether a booster will be required.  It is also important to note that Merck’s own literature states that  Gardasil, “has not been evaluated for the potential to cause carcinogenicity or genotoxicity.”

It is not that guarding against HPV is not a good idea, in theory of course it is a great idea, but a healthy dose of skepticism is appropriate when it comes to believing the promises or stated motives of pharmaceutical companies. It seems unconscionable to mandate the use of a vaccine that has the potential to put the lives and health of an entire generation of girls at risk for the sake of preventing a cancer that is a risk to so few young women in this country and which can already be prevented by other less risky means.

Additional Reading

“A New Vaccine for Girls, but Should It Be Compulsory” by Roni Rabin, New York Times, July 18, 2006.

“Achieving Universal Vaccination Against Cervical Cancer in the United States:  The Need and the Means”, Guttmacher Policy Review, Fall, 2006, Volume 9, Number 4.

Woman to Woman gives Gardasil guarded reviews.” www.womentowomen.com.

“Merck lobbies states over cancer vaccine” by Liz Austin Peterson, Seattle Post-Intelligencer, January 20, 2007.

“New cervical cancer vaccine should not be mandatory” by Maryann Napoli, Healthfacts, November, 2006.