University of California
Type of paper: Thesis/Dissertation Chapter
New Vaccine against Cervical Cancer
According to the American cancer society, in the year 2008, “about 11,070 cases of invasive cervical cancer will be diagnosed in the United States.” (American Cancer Society). Close to a third of these women will succumb to cervical cancer making it to be one of the leading in cancer deaths. This indicates the magnanimity of the problem facing the society today, a problem that has become costly to address. An announcement made by experts in 2004 on the possible invention of a vaccine to prevent cervical cancer was treated with glee and huge expectations.
Human Papillomavirus (HPV) vaccine is aimed at the strains of the Papillomavirus that leads to cervical cancer. The raging controversy when this vaccine is mentioned is the insistence by the health experts that it can only be effective in women if it is introduced at a young age of below thirteen. The position of this paper, in spite of the recognition and appreciation of the gravity of cervical cancer, is that the HPV vaccine should not be given to young girls as it will create an impression that it is appropriate to engage in premarital sex.
Vaccination against cervical cancer has become a sensitive issue with possible political ramifications to legislators that are likely to support its being mandatory. Most of the informed criticism being leveled on the vaccine centers on its inappropriateness when it is carried out against young girls. It is important to note that the raging opposition against the vaccine does not centre on its ability to prevent cervical cancer but at the perception and the image it is likely to send to the young, sexually and emotionally vulnerable girls (Gilham & Matthews 48)
Gardasil and Cervarix are such vaccines that are currently deeply embroiled in this controversy. Gardasil is a product of Merck that seeks to protect women from four strains of cervical cancer. These strains are 6.11, 16, and 18. For it to be effective, it has to be given to a person in a period stretching to 6 months. A total of three injections are carried out.
Cervarix is a product of GlaxoSmithKline but its approval is still under consideration by the Food and Drugs Authority. Unlike Gardasil, it protects a woman against two strains only of Human Papillomavirus. These are 16 and 18. It is also carried out in three injections spanning over a period of six months. One important point to note here is that the efficiency of these two drugs as far as protecting women against the various HPV types is yet to be fully ascertained.
This is because of the existence of a high number of strains of HPV. This means that a third of all cervical cancer cases cannot be prevented. However, it is vital to point out that Gardasil has so far been approved by the FDA for being effective in arresting any infection on the strains that it targets (Lowy and Schiller 13).
The argument being made by those that advocate for its mandatory vaccination on young girls is on the basis of the fact that it can only be functional if given to women before they began engaging in sexual activities. According to the FDA, it is licensed for use by women between the age 9 and 26. There is an undeniable logic in this. A vaccine is preventative and not curative.
There are tentative reports on studies that indicate the possible manufacturing of drugs that will be effective even to women infected with HPV. However, the ones that have raised controversy are only effective to women that have not had any sexual contacts. It is hence undeniable that there is enough ground for this vaccination to be given to girls at a tender age; however this does not mean that it should be made mandatory on young girls even before the age of puberty (Elit and Froese 26).
Although fully understanding the benefits of such a vaccination and the possible averting of a cervical cancer related deaths, it is crucial to investigate the kind of perception that legislators would be sending to the young people by making it mandatory for school going girls to have cervical cancer vaccines. At the age of 12, girls are in their formative stage and on the verge of becoming sexually developed and mature.
Between the age of 9 and 25, they are likely to be tempted to engage in premarital sex not recognizing the risks that that they face from the immense sexually transmitted diseases. A vaccine against cancer given, at such a tender age, will send the wrong image that it is okay to engage in such activities. Rather than making it mandatory to have the vaccine carried out on all young girls, a more inexpensive campaign should be carried out to propagate for abstinence as the best strategy of avoiding HPV.
In these days of incurable diseases such as HIV/AIDS, the abstinence debate has been taken a notch higher and abstinence campaign groups have been formed reaching out the young people wide and far. The insistence by some policy makers and the drug manufacturing companies on the mandatory need to carry out the vaccinations is likely to sound a death knell to such campaigns. According to Rob Stein “Conservative groups say they welcome the vaccine as an important public health tool but oppose making it mandatory.” (AO3) This is a popular stand that is being echoed over time even as the Texas Governor issued the executive order making it mandatory to all school girls from sixth grade.
Taking a look at the raging debate of anti cancer vaccine would reveal the intensity of the criticism that stand over the order. On February 2, 2007 Texas Governor, Rick Perry went against the legislature and issued an executive order PP65 that would have made it compulsory for all six grade girls to undergo a vaccination against Human Papillomavirus.
In issuing the order, Perry managed to circumvent the possible opposition such a bill would be facing from members of legislature and the immense lobbying by conservative rights groups. The order would have required that from September this year, all females commencing sixth grade will have to get a Gardasil jab. By sixth grade, the governor is focusing on girls of a tender age between 11 and 12.
Perry has come out clearly in support of the vaccine saying that the issuing of the order was prompted by understanding of the economic benefits that it stands to bring. He said that, ‘the HPV vaccine provides with an incredible opportunity to effectively target and prevent cervical cancer.” (USA TODAY)
An analysis of the order brings out a number of controversial issues that point a finger against the vaccine. According to the pro-family groups, the executive order usurped the role and the powers of the legislature. This is a move that immediately prompted a bill in the legislature that has sought to rescind the order. It is important to note that by issuing the order, he has also usurped the role of the parents in deciding what is right for their children.
The financial implications of Perry’s executive order also need to be analyzed. Gardasil emerges as an expensive vaccine costing over three hundred dollars. This would be an expensive venture by a state that wishes to make it mandatory for girls to have the vaccine.
When the issue of Perry’s executive order is raised, there are a number of factors that are brought to the surface as likely to have contributed to the issuing of the executive order. This however is not to undermine the importance of the vaccine and the benefits that such an executive order can reap. There have been connections that have been drawn between the Texas governor and the Gardasil manufacturers, Merck. Importantly, Merck is said to have contributed 6000 dollars to his campaigns. The drug campaign chief lobbyist was Perry’s chief of staff. This may be a non pertinent issue but it is a strong indicator of the influence wielded by the drug manufactures.
Another issue that would come up to discredit the order is the cost of distributing the vaccine to the school girls in Texas. Taking a look at the provision of health services in Texas paints a grim picture. Texas is among the states in the United States that has the highest rate of people not under any medical insurance cover. Governor Perry’s Executive Order may have been a positive move of curbing the spread of cervical cancer but it would have been appropriate if the resources that could have catered for the vaccination be channeled towards the provision of basic health to children outside the insurance cover.
A look at the above also brings an important issue on the table in regard to the vaccine. The role that the manufacturing companies play in influencing important and sensitive policies also needs to be analyzed. Merck, Gardasil manufacturer, has spent huge amount of money in lobbying for the passage of state laws that would make it mandatory to have schoolgirls between the age of 11 and 12 be vaccinated against HPV. It would not be an ill advised move to regard big pharmaceutical companies with suspicion in regard to pushing for a policy that would increase their sales.
Though not to disregard important role that Merck is playing in the fight against cervical cancer, it would not be inappropriate to note that Merck’s move was driven by financial and economic considerations. Merck owns the patent and the rights to exclusively produce and distribute Gardasil, the only vaccine mandated by FDA to prevent cervical cancer.
With such exclusive rights and monopoly, there is an understanding that should the government make it mandatory to vaccinate all schoolgirls in their sixth grade, Merck stands to reap huge profits. It hence would not be farfetched and off the mark to argue that Merck’s move to lobby and urge the government to legislate on the vaccine was not driven by health considerations but purely by the desire and the need to increase their sales.
The National Vaccine Information Centre has also managed to bring out an important point in its criticism of the vaccine. National Vaccine Information Center is a non profit oriented body that has invested heavily on informing and educating the public on the negative sides of vaccinations. The organization noted that Gardasil injections may have adverse effects that may require medical attention. This also brings an important point in the criticism of the vaccine. The vaccine has only been in the market for only a few months, a short period of time to judge the impact that it could have on the bid to curb cervical cancer.
Judicial Watch, a non governmental organization purporting to check government corruption sued the United States Food and Drugs Administration (FDA) for licensing the use of a vaccine whose side effects and other impacts have not been thoroughly established. Judicial Watch claims that there have been “1824 reports of adverse reactions to the vaccination for the Human Papillomavirus (HPV)” it further claims that there have been so far eight deaths that have been directly attributed to the vaccine (Judicial Watch).
It is essential to appreciate the efforts played by the Food and Drug Administration, but it would be imprudent not to criticize any move that would make it mandatory to vaccine school girls, understanding the risks that this could be putting them into. The adverse effects revealed by health experts in regard to the vaccine are a powerful indicator that there is a need to be either halt the vaccine or regulate it.
There are a number of criticisms that have been leveled against the vaccine especially centering on its said efficiency. The proponents of the HPV vaccine claim that the vaccine has ability to 100 percent curb over 70 % incidents of cervical cancer. There is still a knowledge gap that exists in this. Experts opposed to the vaccine have brought up important points that cannot be ignored.
One of the points made is that it is not possible to establish whether there will develop a new strain of HPV that will be resistant to the vaccine. The compatibility of the vaccine to other immunizations has also not been established. Key to note here is that the effectiveness of the HPV vaccine has not been appropriately established. The argument that stands in this is that that the vaccine was not fully tested on the young girls and that the tests conducted on the adults were assumed to apply to the young girls’ scenario.
Proponents of the vaccine insist that there are no conducted studies on the claim that the vaccine can in any way lead to the increase in promiscuous behaviors in the vaccinated girls. Though this is an argument that may hold some water, it is important to note that there is no study that has been conducted proving otherwise.
It has to be understood that making it mandatory for sixth grade to be vaccinated will create a false notion that they are secure and are protected from other sexually transmitted diseases. This is a likely scenario considering the haste with which the vaccine has been carried out disregarding the need for adequate education and the need to emphasize on the importance of abstinence.
Rob Stein. Cervical Cancer Vaccine Gets Injected With a Social Issue
Some Fear a Shot For Teens Could Encourage Sex. Washington Post. October 31, 2005; Page A03. Retrieved on June 2, 2008 from washingtonpost.com http://www.washingtonpost.com/wpdyn/content/article/2005/10/30/AR2005103000747.html
USA TODAY .Texas governor orders anti-cancer vaccine for schoolgirls
Updated 2/2/2007. Retrieved on June 2, 2008 from http://www.usatoday.com/news/health/2007-02-02-texas_x.htm
Judicial Watch. Judicial Watch Uncovers New FDA Records Detailing Deaths in 1,824 Adverse Reaction Reports Related to HPV Vaccine. 2007. Retrieved on June 2, 2008 from http://www.judicialwatch.org/6428.shtml
Peto, J; C Gilham, O Fletcher, FE Matthews. The cervical cancer epidemic that screening has prevented in the UK.”. Lancet 364 . 2004; 49-56
Lowy and Schiller .Prophylactic human papillomavirus vaccines. Journal of Clinical Investigation . 116 (5);2006 , 7 -16
American Cancer Society .Detailed Guide: Cervical Cancer
What Are the Key Statistics About Cervical Cancer? Retrieved on June 2, 2008 from http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_are_the_key_statistics_for_cervical_cancer_8.asp
Laurie Elit, and Jean Chamberlain Froese. Women’s Health in the Majority World: Issues and Initiatives. Nova Publishers. 2007; 23- 34