HPV Vaccine: Public Health Boon or Big Pharma Bull?

By Terry J. Allen

"Merck wants to make its new HPV vaccine mandatory for young girls, but the immunization's safety and long-term effects are unknown."

This legislation is premature. It's irresponsible to make something mandatory before all the proper safety checks and studies are in.

I think it's a little disappointing that no one seems to be mentioning the Washington State approach to the HPV vaccine, where the shot is made available for free but not required. That cuts out the argument that the people who need it most won't be able to afford it, and avoids the squicky idea of requiring a new vaccine in an entire population. What's not to love?

what's not to love? the fact that girls with religious fundamentalist parents and daddys who can't handle the concept of their daughters as sexual beings are not going to be protected. i agree that it is definitely a good short-term solution while the controversy dies down-- free for everyone is EXCELLENT. but long-term, something else has to be done.

This vaccine is effective for men, I assume?

yes, it is. i think that they should get the vaccine as well, both to prevent spreading HPV to women and to help them prevent genital warts, because who wants those? of course, in order to appeal to the mainstream, no one is talking about the fact that the vaccine will prevent genital warts. if we don't have STDs, how else will we keep sexual promiscuity in line? *rolls eyes*

Ok, just dug out my pharm tech books to review some stuff. I recall seeing on other threads that it takes about 10-12 years after initial exposure to HPV for cervical cancer to develop. I realize there are probably ways to detect the cancer earlier, but I don't think enough testing has been done to make mandated vaccines reasonable.

Companies are only required to test a drug for about 5 years on humans before the FDA approves them. Merck has tested this drug on less than 2k adolescent females. While the short term safety of the drug is not questioned, I don't think they have sufficiently proven long term safety or effectiveness. I hate to sound like an alarmist, but for all we know, we could be unwittingly sterilizing a whole generation of women. On the other side of the coin, this drug may be so safe, but ineffective, that you would be spending 360 on placebos. I doubt this drug is harmful, and I hope it's effective as a cancer preventative, but I'm not going to ignore the events surrounding Vioxx or Thalomide.

I'm also increasingly uncomfortable with health issues being determined by money issues. I understand why the drug could cost as much as Merck claims, as production of a new drug has to also consider the costs incurred from developing a new drug as well as many drugs that never make it to the public. As soon as Glaxo-Smith-Kline releases their own HPV vaccine, the costs will drop dramatically due to competition. Also, if the mandates could wait til Merck's patent expires, it will then be possible to purchase generics for a much smaller price.

Merck has also submitted studies of Gardasil in men. And Washingtion is not actually distributing the drug for free. If it's not being charged out of pocket or through health insurance, it's still coming from taxes. I don't disapprove of taxes being used to cover healthcare, but I don't think it's correct to assume the state is just gonna cover the costs or that Merck is providing the drug for free.

Great read, thank you!

I agree with yellownumber5 -- the problem with the religious fundie issue is, even in states where they make it mandatory they'll have a "religious" opt-out clause, and for some reason people have got it into their heads that the sanctity of the hymen is somehow "religious." (I missed that part of the Bible, but what do I know). This position itself, tenuous as it is, is somehow enough to translate into "my daughter shouldn't be innoculated against cervical cancer because then she might have premarital sex." And somehow, people will accept that this whole convoluted line of reasoning is "religious."

Anyway, getting back on track: what they need to do is make the decision personal to the girl. Have HER be the one to decide whether or not to opt in/out. If she's sufficiently under Daddy's thumb this year, maybe next year she'll change her mind, and she doesn't have to tell Daddy about it.

But, aside from that specific tinkering, I absolutely favor making it free and available to any woman of any age who wants it, while not mandating it for anyone. That suits me and my concerns of individual autonomy as well as affordable health care, just fine.

I agree with allowing access to the vaccine. I disagree, strongly, with making it mandatory.

One point NOT mentioned here is that cervical cancer usually appears around ages 50-55. We are hoping that the vaccines forced on 11-year-old girls now will still be effective 40 years from now (the vaccine against pertussis wears off about 30-40% of the time); if it is effective, that the HPV virus will not have mutated; and that the girls won't get one of the other forms of the virus and still have problems.

That's a lot to assume off a five-year study.

LawFairy: I don't think that "fundies" assume that getting the vaccine will cause sexual promiscuity; it's just not needed, and certainly not necessasry at age 11. If a parent won't let the girl get it, why can't she get it at age 16 or 18? I wouldn't want someone to force me to be vaccinated against the effects of smoking; it's my body. Someone has to decide what is best for kids, and I think that parents should do that, not the government.

I am certainly not against protecting girls (and boys!) from HPV. But there are several issues we don't know much about yet--long term effects, yes, but long-term effectiveness as well. We do not know how long the vaccine provides immunity--and if 9 year-olds get the vaccine (or 12-year-olds) will they still be safe at 14, 19, or 24? Very unclear. Who benefits from giving this vaccine very early? Merck. $300-500 per girl at 9, and another $300-500 when they at 19 and greater numbers will be sexually active. Now if I had a 19 year-old daughter would I encourage her to be immunized? You bet. If my 13 year-old were becoming sexually active? Yes. My nine-year-old? Less sure.

oenophile, lots of posts here have documented the "religious" objections to this vaccine. The fundies' primary concern IS that their daughters will - oh horrors! -- run out and start having sex if they get the vaccine (as though their daughters aren't having sex anyway, as though this vaccine would have ANYTHING to do with that decision).

I'm agreeing with you that the girls should get control over their own damn bodies, but I think that means OVER AND ABOVE their parents' control of their bodies. To the extent the parents' objections are based on promiscuity concerns rather than legitimate testing concerns, it's foolhardy to withhold the vaccine from your daughter. E.g., parents can't prevent their kids from being raped; if they could, children would almost never be raped. I'd say your values are skewed if you're more freaked out at the thought of your daughter having consensual sex, than at the thought of her dying from cancer.

You're more likely to die in a car crash than from cervical cancer. You're much more likely to die of a heart attack, but the government doesn't mandate that parents feed their children tofu.

Frankly, I'm not sure where anyone gets off a) being a mindreader and saying, "Oh, THIS is the definitive reasoning!" and b) injecting a mens rea requirement into parental decision-making. Parents should be able to give their kids values. If you were to have kids (I know you don't want them, but hypothetically), you would DEFINITELY impose values upon them: those of respect for women, homosexuals, and the idea that premarital sex is no worse than marital sex. How is that better than a parent who imposes her own well-thought out values upon her children?

As for posts on Feministing about how "fundies" think... yeah, right. That is hardly definitive proof. There's an assumption that y'all know exactly how conservatives think, and most of the time, you're wrong. The conservative anger is either libertarian or based on the idea that we shouldn't assume that 11-year-olds are having sex.

If we mandate Gardasil, why not Deprovera? After all, isn't it sick to put values ahead of preventing pregnancy?

oenophile, first off, I didn't say that I think this should be mandatory. If you had read my prior comments on this or other threads about this issue you would know that. I have a strong civil libertarian streak running through me and I'm a big proponent of bodily integrity.

Second, I DO know what many many conservatives think because I grew up fundamentalist. I was homeschooled using this curriculum. My parents are close with some fairly big names in conservative circles (not James Dobson level -- but people you would know if you were a highly political fundamentalist), and I used to be on a first-name basis with many of these people (probably technically still am -- but I haven't spoken with many of them for quite a long time, and it's probably best we keep it that way). I put in YEARS of my time working for fundamentalist organizations. I spent years being trained how to think/argue/etc. for fundamentalist beliefs. I was as far right as they come before they stop speaking English.

So, yeah, oenophile, I think that in this case, I AM qualified to say what they think. Unless all those years they were lying to me about what they thought because they were secretly hoping someday I'd turn into a radical feminist and attribute those beliefs to them, all so they could shoot back "ha! You don't know what we think! You're wrong! We DON'T care if our daughters have sex!" Yeah... I think they have bigger fish to fry than me.

oenophile, what's your basis for saying "most of the time" we are "wrong" about what conservatives believe? Are you deeply enmeshed in conservative politics such that you can speak to it with authority? Bear in mind you're speaking to (among other things) the former Vice Chair of the College Republicans.

one of the main reasons that this is being targeted towards women/girls on the younger end of the spectrum is not just because it potentially preventing infection to these strains of HPV before any potential exposure, but also because a young woman has greater surface area on her cervix that is vulnerable to HPV. the place where the two parts of the cervix meets is called the squamo-columnar junction, and it sorta recedes into the os as a woman ages. so i think the reason, well one of the less problematic reasons, let's say, that this vaccine is being targeted to girls that might be younger than 'moral' folks might want their daughters having consentual sex is simply to protect that vulnerable part of the cervix in the time that it is most receptive to hpv.
i think the idea of the shots being free for those who opt to get them is a good solution to all the bickering, and until longer term considerations are taken into account and there is less corporate greed tooting its own "public health" horn.

I find it incredible that ANYONE, conservative, liberal, whatever, would be opposed to something that may prevent cervical cancer.
Of course it shouldn't be compulsory.

Off topic slightly: TLF, your upbringing sounds fascinating!
What brought you over to the "dark" side?

"You're more likely to die in a car crash than from cervical cancer."

I guess we should ignore every disease which kills fewer people than car crashes. That would include AIDS and polio even in its most deadly year pre-vaccine. Try getting your kid into school without a polio vaccine.

"Try getting your kid into school without a polio vaccine."

My state has a philosophical exemption for vaccines. My kids are exempt, no vaccines. My first son suffered vaccine damage, so we stopped after his six month shots. My younger one hasn't had any, not one single one, and yes, I am extremely proud of that fact!

And check out South Dakota, yes, South Dakota:
http://www.argusleader.com/apps/pbcs.dll/article?AID=2007703110329

http://www.argusleader.com/apps/pbcs.dll/article?AID=200770306004

Gotta give SD its props after all the abortion ban stuff.

You're speaking to a chair of her school's Federalist Society. You're speaking to someone who is very active in her local Republican chapters (I don't join the school ones but work in the town). But I guess that's not enough for you. Heaven forbid I express an opinion that actually makes conservatives look like humans instead of hooved creatures.