Conservatives, skeptics balk at cancer vaccine

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Conservatives, skeptics balk at cancer vaccine

Health experts worry that the proponents have pushed too far too fast in advocating HPV shots.

By Stephanie Saul and Andrew Pollack, The Austin American-Statesman, February 17, 2007

Racing to embrace a new vaccine, at least 20 states are considering mandatory inoculation of young girls against the sexually transmitted virus that causes cervical cancer.

But a roaring backlash has some health experts worried that the proponents, including the vaccine's maker, Merck & Co. Inc., have pushed too far too fast, potentially undermining eventual prospects for the broadest possible immunization.

Groups wary of drug industry motives find themselves on the same side of the anti-vaccination debate with unexpected political allies: religious and cultural conservatives who oppose mandatory use of the vaccine because they say it would encourage sexual activity by young girls.

Even some who support the use of the vaccine question the rush and the vaccine's high cost: about $400 for the three-shot course.

"The decision to make this mandatory this early has created a significant controversy over things that have nothing to do with the vaccine," said Dr. Joseph Bocchini, chairman of the infectious diseases committee of the American Academy of Pediatrics.

Like most other public health experts, Bocchini advocates the vaccine's use. But many say the rush toward mandatory inoculation could prove counterproductive.

Most of the proposals call for vaccinating girls before they enter the sixth grade.

Gov. Rick Perry issued an executive order Feb. 2 that Texas girls be vaccinated.

But some legislators are trying to overturn the order, with some opponents complaining that the governor's former chief of staff is now a lobbyist for Merck. Merck contributed $6,000 to Perry and $38,000 to legislative leaders last year. Lawmakers are scheduled to hold a hearing Monday on a bill to rescind that order.

In Illinois, a bill introduced by a legislator who had the virus targeted by the vaccine prompted a conservative group's blog to speculate that she had been promiscuous.

"I'm offended by their ignorance, but if I have to take a hit to educate people, I'm willing to do it," said Debbie Halvorson, the Democratic majority leader in the Illinois Senate.

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 rush for mandatory inoculation -- most of the state proposals have been introduced since the beginning of the year -- is unusual. It was only in June that federal regulators approved the vaccine, called Gardasil.

Typically, new vaccines, like the one for chickenpox in the mid-1990s, have been rolled out gradually, with health officials endorsing mandatory use only after several years of experience have shown the new products to be generally safe and effective.

An advisory panel of the Centers for Disease Control and Prevention recommended last summer that girls and women ages 11-26 be vaccinated with Gardasil. But members of the panel say the recommendation is not equivalent to calling for mandatory vaccination.

Even before the vaccine's approval, Merck had began laying the political foundation in state legislatures to promote widespread vaccination.

Gardasil and another vaccine under development by the drug maker GlaxoSmithKline PLC are aimed at the human papilloma virus, or HPV, which is known to be the cause of cervical cancer. Analysts see a potential $5 billion a year market for HPV vaccines, and some say that Merck is intent on inoculating as many girls as possible before the introduction of Glaxo's product, which could be become available this year.

Merck's president for vaccines, Margaret McGlynn, acknowledged a sense of urgency. But she said it was motivated by the need to eradicate the disease.

"Each and every day that a female delays getting the vaccine, there is a chance she is exposed to human papilloma virus," McGlynn said.

Gardasil protects against two strains of HPV that cause about 70 percent of the cases of cervical cancer as well as two other strains that cause genital warts.

In approving the vaccine in June, the Food and Drug Administration said that in the United States each year there were an average of 9,710 new cases of cervical cancer and 3,700 deaths attributed to it.

The disease's toll is higher in other parts of the world than it is in the United States, where most women get Pap smears to detect early precancerous changes in the cervix. Worldwide, cervical cancer is the second most common cancer in women.

The controversy worries public health experts like Bocchini, who is chief of pediatric infectious diseases at the Louisiana State University Health Sciences Center.

He is concerned that the outcry might make the public mistrustful of a vaccine that would otherwise be beneficial.

"If the public had enough experience with the vaccine and had enough knowledge about HPV, the question about whether to get the vaccine or give it to their daughters wouldn't be an issue," Bocchini said.

Groups on both sides of the debate appear to have been energized by Perry's order mandating vaccination. Opponents have pounced on Perry's ties to Merck and Women in Government, suggesting his action was driven by some ulterior motive.

Dr. Carol Baker, a professor of pediatrics at Baylor College of Medicine in Houston, said that two other vaccines for adolescents that were approved in recent years, against meningitis and whooping cough, have not yet been mandated in Texas.

"To mandate just one, in my view, is a little odd," she said.

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