The pharmaceutical company Merck is promoting a vaccine called Gardasil, used to immunize against HPV, human papilloma virus. HPV causes cervical cancer. After FDA approval last June, Merck launched a marketing campaign to convince the CDC and state legislatures to make vaccination of pre-teen girls mandatory. The CDC didn’t bite but at least 12 states, including California, did.
At $300 a pop, Merck stands to make a boatload of money.
Advocates speak passionately about the thousands of lives that will be saved. Opponents, including representatives of the Christian Right, object to government interference with family decision-making.
Only a few opponents, like the National Vaccine Information Center, are talking about the flawed science behind this stampede. In an evaluation of Gardasil data from the FDA’s Vaccine Adverse Events Reporting System, the Center found much to cause concern. For example, “Nobody at Merck, the CDC or FDA know if the injection of Gardasil into pre-teen girls—especially simultaneously with hepatitis B vaccine—will make some of them more likely to develop arthritis or other inflammatory autoimmune and brain disorders.”
But isn’t the risk worth it if the vaccine saves thousands of lives?
Cervical cancer ranks twelfth among causes of cancer deaths in women. Interestingly, though, cervical cancer is distinctive among the top 15 cancers in its dramatic decline. Since 1975 the rate of cervical cancer has fallen by 2/3. An increase of routine Pap smears is one of the principle reasons.
But the vaccine will eliminate the virus that causes cervical cancer in the first place. Isn’t that better than screening for cervical dysplasias that can turn into cancer?
There are over 100 different types of HPV. Only four are associated with cervical cancer. Merck’s vaccine confers immunity against only two of those four, although those two account for 70% of cervical cancers. So even if vaccination was 100% and it was 100% effective, only 70% of women vaccinated would be protected. In 2002, 3,700 women died from cervical cancer. If they had all been vaccinated, 2,500 lives would have been saved.
Although that’s technically thousands of lives, the number of cases is falling, the vaccination rate won’t be 100%, the effectiveness won’t be 100%, and the full benefit won’t be seen for decades. So the number of lives saved would be significantly less than 2,500.
But isn’t every life worth saving?
There’s a concept in epidemiology called “herd immunity.” The idea is that you don’t need to immunize an entire population, only enough to prevent a communicable virus like HPV from surviving. I’m no expert at this, but by my calculations, HPV herd immunity could be achieved with a vaccination rate between 50% and 70%—hardly a goal requiring mandatory vaccination of pre-teen girls.
In fact, the focus on pre-teen girls is part of a well-orchestrated campaign of fear. What a surprise. The issue is not that pre-teen girls must be vaccinated or all is lost. The issue is that women of any age who are not infected by cancer-causing HPV types should be educated about immunization, including its risks. In other words, practical sex education that serves herd immunity, not fear that serves herd psychology and Merck’s bottom line.
As for pre-teen girls, why don’t we give them practical sex education and empower them to act on it?
