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The HPV Vaccine: Should it be Mandatory?

At the beginning of the twenty-first century, the human condition is light years ahead of where it was mere decades ago.

We have antibiotics that easily handle infections that were considered lethal fifty years ago. We have medication that spares the mentally ill from a life of derangement, fear and paranoia. We have medical devices that can keep a heart beating, replace crucial body functions, and spot tumors before they can become inoperable. We even have medication to handle our more peripheral ailments. We have pills and patches that can stop baldness and put us to sleep without worries over addiction.

Life is no longer, in the words of Thomas Hobbes, “..nasty, brutish and short.”

For this we have the medical establishment in general and the pharmaceutical industry in particular to thank. Companies like Pfizer, Merck and GlaxoSmithKline have quite deservedly made billions of dollars in profits over the years, and they will in all likelihood continue to do so. They provide necessary help for our ailments and allow us all to live longer lives.

But it seems that there has been a disturbing trend in recent years. These pharmaceutical giants, having made billons by manufacturing and providing the public with products that they need, have decided that there are also billions to be made in providing the public with products that they don’t need. To that end, they have engaged in a disturbingly high level of marketing and advertising to sell their products.

While we see no problem with engaging in advertising campaigns to sell products that cure sexual dysfunction or restore hair to the heads of balding men, there is something off-putting about watching the evening news and seeing practically all of the advertising time being used to sell pain relievers and anti-depressants to the American public. All of these commercials end with some variation of “Ask your doctor about (our product.)” It certainly seems appropriate to ask your doctor about a certain pill for erectile dysfunction, but pain relievers and anti-depressants that alter the very chemistry of your brain do not seem to be the sort of thing that should be marketed like so much car wax or floor cleaner. The anti-depressant commercials always seem to list symptoms that are maddeningly broad, and while that might sell more pills, it also encourages people with no medical training to diagnose themselves. For some reason, the doctors involved seem to have no problem with millions of Americans coming to them and telling them that they want to try a new drug that they saw advertised while they were watching CSI.

We have seen this “creating a need” method backfire on pharmaceutical companies before. Merck spent millions developing a pain reliever called Vioxx. This product was essentially nothing more than a “super aspirin” which was able to provide the same sort of analgesic relief for arthritis pain that one could get from aspirin, acetaminophen, or ibuprofen. The added selling point of this drug was that it wouldn’t cause an upset stomach in its users. This same claim could be made with ibuprofen or other over the counter analgesics, but none of these products had multi-million dollar advertising campaigns. Merck used this method to “create a need” for a product that was already widely available in non-prescription form.

The one major difference between Vioxx and its non-prescription counterparts was that Vioxx caused strokes and heart attacks in large numbers among the elderly consumers that used the drug.

Four years and millions of dollars worth of legal verdicts later, it appears that Merck has changed tactics. Rather than “create a need” by using mass advertising, the pharmaceutical giant was recently caught attempting to “create a need” by making one of their newer products mandatory for every female child in the nation.

Recently, Merck released a vaccine called Gardasil, which has been shown to block the human papillomavirus (HPV.) This is admittedly an astounding breakthrough, as the HPV virus is widely known to be a precursor to cervical cancer. Essentially, Merck has created a cervical cancer vaccine.

The HPV virus is a sexually transmitted disease, and this vaccine could not only completely diminish (if not eradicate) HPV, but also drastically reduce the cervical cancer rate. This is laudable. But there are some questions that are raised about the distribution of the vaccine. When would be an appropriate time to make this vaccine available? At what age? Should parental permission be required?

Merck had answers to all these questions, and the answers were “Right now, at age eleven, and these shots should be mandatory.”

Merck hired a third party to aggressively lobby on their behalf. There was a great deal of success. State legislators all over the country have introduced bills that would make the vaccine part of the mandatory package of shots that children receive before entering school. In Texas, Governor Rick Perry issued an executive order making the HPV vaccine mandatory for eleven year old girls. It is here that Merck’s efforts seem to go far beyond mere concern for public safety and start to reek of pure profiteering.

It is not the vaccine that we find troubling. We think it’s wonderful that such a vaccine is available. What bothers us is that Merck, in their quest for profits, have somehow made the sexually transmitted HPV into the same category as diseases like mumps and measles. School children should absolutely be vaccinated for theses diseases. They are easily communicable, and could spread very easily if let loose in an environment like a school. But HPV is only spread through sexual contact, and making it part of a mandatory package of shots seems overzealous at best. Is it likely that schools full of eleven year old girls will be engaging in sexual activity? Probably not.

Had Merck lobbied to let parents know that this vaccine was available and let parents decide for themselves, this would have been a non-issue. But instead they reverted to their old standard of “creating a need.” In this case, the “need” was “every American’s wish to have their daughters attend school.” After all, why make such a vaccine voluntary when there is so much more money to be made in making it mandatory? Each vaccine costs around $400. There are millions and millions of female students in this country. You are free to do the math. If the HPV crisis was so urgent that it has become necessary to make the vaccine mandatory, then surely Merck could lower the selling price. They have not offered to do so.

Merck recently suspended their lobbying efforts after coming under fire from several different quarters. We view this as a wise move. The vaccine has been given solid and impartial tests, and the results have so far been positive. It is unlikely that there will be another Vioxx-like episode here. And considering that the vaccine serves a good and practical purpose as a preventative treatment, we would not object to Merck engaging in an all out advertising blitz. But we do object to Merck removing the input of the parents entirely, manufacturing a medical need where there is none, and making billions of taxpayer dollars for pretending that there is no difference between one communicable disease and another.

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