the vaccine intended to prevent infection with href="http://en.wikipedia.org/wiki/Human_papilloma_virus"
rel="tag">human papillomavirus (HPV), was
controversial even before it was href="http://www.cbsnews.com/stories/2006/05/18/health/main1628221.shtml">approved
by the FDA.
rages on use of cervical cancer vaccine
Rob Stein, Washington Post
Monday, October 31, 2005
(10-31) 04:00 PDT Washington -- A new vaccine that protects against
cervical cancer has set up a clash between health advocates who want to
use the shots aggressively to prevent thousands of malignancies and
social conservatives who say immunizing teen-agers could encourage
human papillomavirus capsid
image from Wikipedia
It costs $360 to vaccinate one person. href="http://www.cancer.org/docroot/home/index.asp">American
Cancer Society statistics indicate that 9,700 women will
learn they have cervical cancer this year; there will be about 3,700
fatalities from the disease ( href="http://www.topix.net/content/ap/0327390426144130486839574768632179868587">reference).
About 70% of those cases will result from HPV infection.
The legislation proposed in Michigan was introduced by Senator
rel="tag">Bev Hammerstrom. (R-17th district).
It has bipartisan support. The bill would require
that girls receive the vaccine in order to register for sixth grade
(with some exceptions allowed).
Cancer Shot May Be Standard In 6th Grade
POSTED: 2:20 pm PDT September 12, 2006
A bipartisan group of Michigan lawmakers wants all sixth-grade girls to
be vaccinated against cervical cancer.
A Republican state senator who is the lead sponsor said it's the first
legislation of its kind in the U.S.
The vaccine was approved by federal regulators this summer and hailed
as a breakthrough in cancer prevention. The shots prevent infections
from strains of a sexually transmitted virus -- human papilloma virus,
or HPV -- that can cause cervical cancer and genital warts.
At the time, conservatives expressed concern that schools would require
the vaccine for enrollment. They argue that such mandates infringe on
parents' rights and send a message that underage sex is OK.
If approved, the measure would go into effect for the next school year.
The vaccine was approved for females between ages 9 and 26. In studies,
it was credited with preventing disease from the two types of HPV that
are responsible for approximately 70 percent of all cervical cancers,
according to Detroit television station WDIV.
The legislator who proposed the requirement noted that, as with all
other school-required vaccines, parents may opt out of this requirement
for medical, religious or philosophical reasons.
Early opposition to Gardasil was based on concerns it
could encourage sexual activity in the young. But that largely faded
away because of vaccine's potential for reducing cancer.
That may be overly optimistic. Perhaps not. It is
hard to imagine that anyone would seriously object to vaccination that
would prevent cancer. Although I could see a libertarian sort
of argument against the mandatory aspect, the fact is, if it is to work
optimally (to prevent the maximum number of cases) it would have to be
administered to a large percentage of the population.
There is also the pseudomoralistic argument that the vaccine might
increase the frequency of sexual behavior among those who receive the
vaccine. That seems rather naive. How many young
teens think about the risk of HPV at all? How many alter
their behavior due to such a concern? The vaccine does
nothing to prevent HIV infection. If the risk of AIDS does
not stop someone from having sex, is the risk of HPV going to have any
$360? I should buy stock in Merck. They have a monopoly (patent, right?) and if states are going to require vaccination, there's a big guaranteed market for them.
People have always been suspicious of vaccines, since vaccines started. There has always been opposition to mandatory vaccination. No different this time.
Here's what I wonder, though. Other cancer vaccines are in development. For instance, there is one to protect against liver cancer, a form of cancer with a much higher mortality rate than cervical cancer. Are we going to require that vaccine, too? What about all the other vaccines that may be developed? Would save a lot in health care costs and in human misery, but people will oppose a bunch of new vaccinations, especially if they come with high price tags.
Merck will have exclusive rights to the product for many years. But after that, the government (or any one else) could start making it and selling it at cost. So even though I often am critical of pharmaceutical profiteering, this does not bother me in the slightest.
Merck will make a lot of money on this product, but only for a while. The public good will continue for centuries. Assuming it works as promised. We will have to wait and see about that.
Yes, as more vaccines become available, there will be resource-allocation problems and cost-benefit issues to be settled. But that is commonplace in medicine. Vaccination is no different that any other public health initiative in that regard.
Yes, people will object. They will protest. Some may come up with valid reasons to complain. They can write to Congress. Maybe they will get their way, and stop the initiative. Does that mean we should not try?