From yesterday's Boston Globe, an article on Governor Patrick's proposed public health spending:
"Increase spending on the state's universal immunization program by $24.8 million, a 67 percent increase over this fiscal year, to add three new vaccines recommended by the Centers for Disease Control and Prevention. According to the governor's office, the money would provide 71,334 infants with a vaccine for rotavirus, which causes severe diarrhea and vomiting; 108,188 children with a vaccine that prevents bacterial meningitis; and 72,126 girls between the ages of 9 and 18 with a human papilloma virus vaccine, which helps prevent sexually transmitted virus that causes cervical cancer."
I'm a bit on the fence on Garadsil, the HPV vaccine developed by Merck. I don't want to be "anti-science" of course it would be a good thing to prevent cervical cancer. However, I'm increasingly skeptical about Gardasil for a few reasons. First, there's Merck's push to make the vaccine mandatory:
"Just a few months after federal regulators approved a vaccine against a sexually transmitted virus that causes cervical cancer, more than a dozen states - including Maryland - are considering a requirement that girls entering middle school get it. One of the primary drivers behind the legislative push: Merck & Co., the pharmaceutical giant that manufactures Gardasil, the only vaccine for human papillomavirus, or HPV, on the market."
"The vaccine is expected to reach $1 billion in sales next year, and state mandates could make Gardasil a mega-blockbuster drug within five years, with sales of more than $4 billion, according to Wall Street analysts. State legislatures that are considering requirements for school-age girls to be vaccinated against HPV include California, Indiana, Kentucky, Mississippi, New Jersey, Texas and Virginia, according to the National Conference of State Legislatures."
State legislatures are requiring vaccinations? Unlike diseases like measles or the whooping cough, one acquires HPV from sexual activity, not from sitting next to another student in the classroom. Not all health professionals think it's a good idea:
"But some medical experts say lawmakers are moving too fast in their efforts to vaccinate all school-age girls. The American Academy of Pediatrics, for instance, is urging a go-slow approach, with an initial focus on raising public awareness of HPV and more monitoring of the safety of the vaccine, which had minimal side effects in clinical trials but hasn't been observed in larger-scale rollouts."
Is Merck using young girls as guinea pigs? Merck's clinincal testing was been done mostly on women, not on girls (20,541 women, and only 1,121 girls under 16). No one knows what the long-term effects are.
" 'A lot of us are worried it's a little early to be pushing a mandated HPV vaccine,' said Dr. Martin Myers, director of the National Network for Immunization Information. 'It's not that I'm not wildly enthusiastic about this vaccine. I am. But many of us are concerned a mandate may be premature, and it's important for people to realize that this isn't as clear-cut as with some previous vaccines.' "
And the American Academy of Family Physicians has come out against mandatory vaccinations:
"The AAFP feels it is premature to consider school entry mandates for human papillomavirus vaccine (HPV) vaccine until such time as the long term safety with widespread use, stability of supply, and economic issues have been clarified."
Gardasil offers protection against two HPV viruses (types 16 and 18) out of 36 "nasty" strains, which are believed to cause between 50% and 70% of all cervical cancers. It doesn't protect against other high risk (cancer causing) HPV strains not in the vaccine. Concentional screening and treatment programs will still be needed to reduce cervical cancer deaths. There are some excellent comments at this blog on its efficacy and the drawbacks of the vaccine.
Most people don't like to think about cost-benefit analyses when it comes to their health or the health of their children, but everything has its price. The millions of dollars that Massachusetts spends on this vaccine is money that won't go to other deserving, effective programs. Gardasil is the most expensive vaccine ever developed. It requires three vaccinations over a six-month period ($360 for the doses plus doctor's fees), with a booster shot needed every five years. A recent article in the Wall Street Journal examined the cost/benefit of Gardasil, and found it poor. Gardasil has a much higher cost than expanding pap smear testing, which is an excellent way to detect this treatable disease.
While it is very tragic that 3,700 women are expected to die of cervical cancer in the U.S. this year, rates of cervical cancer have been dropping for more than 30 years. (Not so overseas, far more women in undeveloped countries die of cervical cancer.) More than ten times as many women will die of breast cancer. Heart disease, the leading killer of women, will kill almost 500,000 women a year. Spending $25 million of tax dollars on those diseases, instead of on Gardasil, could save literally thousands more lives.
Yet because Merck has such effective lobbyists, many states (including Massachusetts) are considering mandatory vaccinations. I'm not liking that. I want publicly-funded medical interventions to be based on long-term medical studies and on a cost-benefit analyses, not on Merck's lobbyists.