In 24 states, this issue is being fought out as a conservative versus liberal battle. The vaccine, Gardasil, helps prevents the spread of genital human papillomavirus (HPV). HPV can cause cervical cancer. In 24 states, there is a push going onto make vaccination with Gardasil mandatory, generally for girls 12 and older. Liberals are taking the position that some girls this age are having sex and therefore all girls should be vaccinated as a public health issue.
Conservatives are taking the position that their girls are not having sex and therefore do not need this vaccine---and don't want to be exposed to any potential risks from it. Based on this New York Times article---that fills very close to two entire pages of the newspaper---it looks like both sides are getting it wrong. This appears to be a massive scam by Merck to panic people into using an expensive vaccine only in countries where it is not needed.
In the developing world--- where cervical cancer is a major killer---the vaccine would be a major lifesaver. However, Gardasil is much more expensive than other vaccines---$1000 or more to provide protection for each person. Therefore, there is no talk of using it in the developing world at this time. The only current application for this vaccine is in the developed world---where cervical cancer is an extremely rare disease due to the near-universal use of Pap smears---and Pap smears will still be required for those who receive the vaccine. The fact that the New York Times decided to fill nearly two pages with a basically narrow technical article of this nature makes it very unlikely that they are trying to hide anything on this one.
"Drug Maker’s Push Leads to Vaccines Fast Rise" New York Times, Wednesday, August 20, 2008, p A1 and A18
One of the vaccines, Gardasil, from Merck, is made available to the poorest girls in the country up to age 18, at the potential cost to the United States government of more than $1 billion; proposals to mandate the vaccine for girls in middle schools have been offered in 24 states, and one will take effect in Virginia this fall. Even the normally stingy British National Health Surface will start giving the other vaccine---Cervarix from Glaxo Smith Klein--- to all 12 year old for girls at school this September.
At the time the recommendation was made that all 11 or 12 year old girls should have the vaccine, Dr. John Abramson, professor of pediatrics at Wake Forest University, was the chairman of the relevant committee at the Centers for Disease Control and Prevention. He said the pressure applied to the committee, from both the industry and political figures, was "incredible." Dr. Abby Lippman, McGill University professor and policy director of the Canadian Women's Health Network, says the publicity has got people "thinking they’re bad moms if they don't get their kids vaccinated."
In the United States, hundreds of doctors have been recruited and trained to give talks about Gardasil---$4500 for a lecture---and some have made hundreds of thousands of dollars. Politicians have been lobbied and invited to receptions urging them to legislate against the global killer. And former state officials have been recruited to lobby their former colleagues.
Merck's vaccine was studied in clinical trials for five years and Glaxo’s for nearly 6 1/2, so it is not clear how long the protection will last. Some data from clinical trials indicate that the molecules may wane after three to five years. If a 12-year-old is vaccinated, will she still be protected in college, when her risk of infection is higher? Or will a booster vaccine be necessary?
And why the sudden alarm in developed countries about cervical cancer, some experts ask. A major killer in the developing world, particularly Africa, where the vaccines are too expensive for use, cervical cancer is classified as very rare in the West because it is almost always preventable through regular Pap smears, which detect precancerous cells early enough for effective treatment. Indeed, because the vaccines prevent only 70% of cervical cancers, Pap smear screening must continue anyway.
This marketing push has helped turn Gardasil into one of Merck's best-selling products, with projected sales of $1.4 to $1.6 billion outside Europe this year, and considerable additional sales inside Europe.
Worldwide, the number two cause of cancer deaths in women is cervical cancer. Although there are 500,000 new cases each year, developing countries account for more than 90% of the cases. In 2006, women's deaths from cervical cancer totaled 274,000---but only 5% of those deaths were in the economically advanced countries where Gardasil and Cervarix are marketed. In the US, there are about 12,000 new cases of cervical cancer each year and 3600 deaths--- mostly among women who were not getting Pap smears.