In June, we talked about a new human papiloma virus (HPV) vaccine that was being opposed by a Christian group in Colorado on the grounds that it might promote premarital sex. HPV is a virus that commonly infects the female reproductive tract. It has many strains, and some of those strains confer a risk for cervical cancer.
Merck produced a vaccine to the high risk strains called Gardasil. It had been shown that for the vaccine to be effective in preventing infection in those strains it was important to administer the vaccine before the girls begin sexual activity -- HPV is transmitted sexually.
What's happened since then is that Merck went on an advertising campaign to try and encourage the use of their vaccine. Some states debated whether the vaccine should be mandatory for girls attending school.
There were pros and cons to the idea of mandatory inoculation.
For the pro side, this vaccine is demonstrably effective if administered early. If administration is widespread, we could reasonably expect to save thousands of lives of women from cervical cancer.
For the con side, the vaccine is very expensive; it costs hundreds of dollars and has to be administered three times I think. And there were still the objections by social conservatives as to the encouragement of promiscuous sex created by the protection for disease.
I put in my earlier post that I do not agree fundamentally with the arguments the social conservatives were making as to why this was a bad idea. Further, I would add that I think in the long-term, the vaccine is overwhelmingly worth the money -- do you know how much it costs to treat cervical cancer? A lot more than hundreds of dollars.
However, I also don't think it was a particularly great idea that Merck should be lobbying for mandatory inoculation. Partly that is because this is a big handout for Merck, and I don't trust corporate subsidies. But partly it is because it distracts from the benefits of the vaccine by making the company look like the bad guy. It also gives critics of vaccine a corporate bogeyman to use rhetorically.
This is why I was happy to see that Merck has decided to drop its lobbying campaign for mandatory adoption of the vaccine:
Merck & Co., bowing to pressure from parents and medical groups, is immediately suspending its lobbying campaign to persuade state legislatures to mandate that adolescent girls get the company's new vaccine against cervical cancer as a requirement for school attendance.
The drug maker, which announced the change Tuesday, had been criticized for quietly funding the campaign, via a third party, to require 11- and 12-year-old girls get the three-dose vaccine in order to attend school.
Some had objected because the vaccine protects against a sexually transmitted disease, human papillomavirus (HPV), which causes cervical cancer. Vaccines mandated for school attendance usually are for diseases easily spread through casual contact, such as measles and mumps.
"Our goal is about cervical cancer prevention and we want to reach as many females as possible with Gardasil," Dr. Richard M. Haupt, Merck's medical director for vaccines, told The Associated Press.
"We're concerned that our role in supporting school requirements is a distraction from that goal, and as such have suspended our lobbying efforts," Haupt said, adding the company will continue providing information about the vaccine if requested by government officials.
Merck launched Gardasil, the first vaccine to prevent cervical cancer, in June. It protects against the two virus strains that cause 70 percent of cervical cancer and two strains that cause most genital warts.
Sales totaled $235 million through the end of 2006, according to Merck.
Gardasil is fully capable of standing on its own merits. It is a good idea without Merck's lobbying, and they were just going to confuse things anyway. I think this is a good call on their part.
UPDATE: Here is a good NYTimes article about the controversy:
Ms. Halvorson is also a director of Women in Government, a national association of state legislators that has embraced the fight against cervical cancer and has received funding from Merck. The group has posted model mandatory vaccination legislation on its Web site, www.womeningovernment.org. The rush for mandatory inoculation -- most of the state proposals have been introduced since the beginning of the year -- is unusual. It was only last June that federal regulators approved the vaccine, called Gardasil.
Typically new vaccines, like the one for chicken pox in the mid-1990's, have been rolled out gradually in this country, with public health officials endorsing mandatory use only after several years of experience have shown the new products to be generally safe and effective.
Even before the vaccine's approval, though, Merck had begun laying the political foundation in state legislatures to promote widespread vaccination of young girls.
Gardasil and another vaccine under development by the drug maker GlaxoSmithKline are aimed at the human papilloma virus, or H.P.V., which is known to be the cause of cervical cancer. Analysts see a potential $5 billion a year market for H.P.V. vaccines, and some say that Merck is intent on inoculating as many girls as possible before the introduction of Glaxo's product, which could become available this year.
Merck's main partner in the vaccination campaign, Women in Government, also receives funding from Glaxo, as well as Digene, a company that makes a test to detect the presence of H.P.V. Over the last two years, Women in Government has been holding a series of luncheons and conferences nationwide to discuss its fight against cervical cancer, including the use of vaccines.
Opponents of mandatory inoculation include anti-vaccine activists, who argue that the vaccine has not been tested in enough young girls and who have listed various side effects reported among users, which have included dizziness, nausea and fever. Others include conservative Christian groups who oppose mandatory H.P.V. vaccination on moral grounds, and those who are generally distrustful of the pharmaceutical industry.
Here is a link to the Women In Government campaign.
Asking a legislature to mandate a vaccine in 1925-1950 would have been easy. The epidemics of polio, whooping cough and diptheria were widespread and did not involve sexuality. The simple fact that this is a longterm solution to a very expensive problem, a women's problem at that, and it is involved with matters sexual, will make legislators cringe at the choice they must make. They might not get reelected either way they vote. The vote is more important than public health in present day American politics.