September 15, 2011
In his critique of the recent CNN/Tea Party sponsored Republican presidential candidates debate, The Daily Show’s Jon Stewart described the set as looking like the inside of Betsy Ross’s vagina. Crude but apt for a debate that saw two candidates stumble badly on the unlikely political football that the HPV vaccine has become.
As has been well reported, Texas Governor Rick Perry has been trying to distance himself from his highly publicized effort to mandate the vaccination of all girls in Texas because in addition to sounding like the dreaded idea of government interference in our lives which strikes maniacal fear in the hearts of Tea Partiers, it has served to highlight the large donations Perry has received from Merck, the maker of the HPV vaccine Gardisil. Michelle Bachmann, not wanting to be left out, then claimed that she had heard from a mother whose daughter became mentally retarded because of the vaccine, a claim that is questionable and certainly not proven. All of which has served to kick up some major dust in the absurd debate about whether it is un-American big government at its worst to mandate vaccinations as opposed to being un-American to not vaccinate children because it imperils public health.
Unfortunately, both stances not only lack subtlety, they completely miss the real issues involved that need to be addressed in regard to the HPV vaccine. In 2007, after Perry’s short-lived effort to mandate HPV vaccination, I pointed to some of the problematic issues in the debate about Gardisil:
Cervical cancer is only expected to cause 3,670 deaths in the U.S. in 2007, a miniscule percentage (less than 2%) of the 270,000 deaths from the disease worldwide and only 1% of the total annual number of deaths from all cancers in the United States.
While cervical cancer used to be one of the deadliest diseases for women in the U.S., 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, (spent) millions of dollars lobbying state legislators. In Texas… Gov. Perry received $6,000 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, the mother-in-law of his current chief-of-staff, and 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 U.S. 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.