Over the past few months, the media have paid great attention to the new cervical cancer vaccine, Gardasil. This vaccine protects against two of the strains of the sexually transmitted human papilloma virus (HPV) that cause much of the cervical cancer that kills thousands of women in the United States—and hundreds of thousands worldwide—every year.
Much of the attention Gardasil has gotten has been negative. Some of those who do not trust vaccines in general are doing their best to impugn Gardasil’s safety. Some suggest that the vaccine is being used to diminish parental rights, some others that it will turn young girls into sexual tramps, and still others that the vaccine is being promoted just so a big pharmaceutical company can turn a quick profit. Not only are these lines of argument irresponsible, if allowed to stand they will lead to hundreds of thousands of preventable deaths. Gardasil is the first of a new generation of vaccines made using genetic engineering. Basically, genes are taken from two cancer-causing viral strains and expressed in yeast. The resulting proteins are extracted and purified. Think of the process as a bit like brewing beer. The vaccine that results contains only harmless proteins to which the body’s natural defenses react, making antibodies that kill two of the strains of virus that cause cervical cancer.
What this new vaccine technology accomplishes is safety—incredible safety. There are no live or attenuated viruses involved. There is nothing in the vaccine that could harm or impair anyone. In eight years, no one who has gotten the vaccine anywhere in the world has had any sort of problem. There is no reason at all to suspect that safety profile will ever change. But making vaccines this safe and this effective is expensive.
And therein lies the real reason for much of the negative publicity surrounding this vaccine—cost. The company that makes Gardasil, Merck, has been lobbying hard to get it mandated in every state. Merck is charging $120 per shot, and three shots are required. To vaccine critics, and there are many vociferous ones, this looks like price gouging. Some critics of the vaccine have taken to calling Gardasil Merck’s solution to the costs it faces due to its recent problems and litigation associated with Vioxx. They say that HPV actually stands for Help Pay for Vioxx.
It is true that Merck has seen better days. And it is also true that, until recently, Merck has been lobbying in many states, promoting coverage for Gardasil. But, it is further true that the Centers for Disease Control; the Food and Drug Administration; medical authorities in the European Union, Australia, New Zealand, Taiwan, Mexico, and Brazil; and the American College of Gynecologists have recommended that all young women age eleven to twenty-six get the vaccine. It is safe to say that they don’t care one way or another about Merck’s woes or its profits.
It is possible to see a huge conspiracy behind the appearance of Gardasil. Evil Merck, battered with the huge costs of withdrawing Vioxx, conspires to get a dangerous vaccine into all young girls around the world. They do not care what their parents say, knowing that the girls will become promiscuous while the big pharmaceutical company and its political stooges in the governors’ offices and state legislatures get on the corporate gravy train by mandating the vaccine and laugh all the way to the bank. If this ridiculous scenario is allowed to dominate public discourse, hundreds of thousands of women will continue to die.
Surely, Merck wants to make money from Gardasil. The company made a huge push to get the vaccine covered by insurance plans and public programs, which, in our health care system, requires that vaccines be mandated. Many legislators took gifts from Merck to help promote attention to cervical cancer. This might not be the best way to push a safe and effective new vaccine, but, as is often true in our flawed American health system, battles over coverage for new treatments boil down to money, lobbying, and politics.
With a vaccine as incredibly safe and effective as Gardasil, and others that may soon follow for herpes simplex, melanomas, HIV, and malaria, this country cannot afford to let fear-mongering and crackpot suggestions of backdoor conspiracies be the basis for public health policy. Cervical cancer kills too many women in America and around the world to let that happen.
Arthur Caplan is the Emmanuel and Robert Hart Professor of Bioethics and the director of the Center for Bioethics at the University of Pennsylvania in Philadelphia.
CFI SUMMIT
OCTOBER 24-27 2013
TACOMA, WASHINGTON
Joint Conference of the Council for Secular Humanism, Center for Inquiry, and Committee for Skeptical Inquiry
The transnational secular humanist magazine
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