February 07, 2007

The Politics of Gardasil

Every now and then an issue pops up on the radar screen that 
scrambles what we've come to expect as the natural political order. 
Mandating human papillomavirus (HPV) vaccines for eleven and twelve 
year old girls is that type of issue.

Here's the brief backstory: HPV is the most commonly transmitted 
sexual disease in the United States. According to news reports by the 
AP and others, some 20 million people are currently infected, and 
some 6.2 million people contract the infection each year. Certain 
strains of the virus can lead to cervical cancer which killed some 
3,700 women in the U.S. last year (even though it is a disease on the 

Last June the FDA approved the vaccine Gardasil, hailed as a 
breakthrough in protecting against four strains of HPV that are 
responsible for 70% of cervical cancer cases. In January, Gardasil 
was put on the 2007 "recommended immunization schedule" issued by the 
American Academy of Pediatrics, American Academy of Family 
Physicians, and the Advisory Committee on Immunization Practices of 
the Center for Disease Control (CDC). As a result, certain state 
legislatures have begun debating bills that would make Gardasil a 
state-mandated vaccine.

Last Friday, Rick Perry, the conservative two-term Governor of Texas, 
issued an executive order requiring all sixth grade girls to receive 
the three-shot vaccination series (which costs about $120 per shot), 
though the order does allow parents to "opt out" for religious or 
philosophical reasons, but only if they file a written affidavit.

Perry has come under fire, not only from conservatives in Texas who 
argue that the vaccine will increase sexual promiscuity, but also 
from doctors in Texas who believe it's way too early to mandate such 
a new vaccine.

Others, like the editorial board of the San Antonio Express-News have 
taken issue with Perry's order, saying that while "the health of 
Texas girls is paramount, you have robbed citizens of the chance to 
hear the issue discussed during the normal legislative process."

But even in those states currently considering legislative action on 
mandating HPV vaccinations there are serious concerns and objections. 
Yesterday, both the Chicago Tribune and the Chicago Sun-Times 
editorialized against the Illinois state legislature passing a 
mandate right now. Even Christine Gregoire, the very liberal Governor 
of Washington state, said she was unwilling to go as far as Perry in 
issuing a mandate:

"I told the medical association that I was reticent to dictate when I 
think there is a lot of public education that needs to go on," 
Gregoire said. "To go out and start just saying everybody mandatorily 
has to have this is a little bit troublesome for me."

Given all this, it may or may not be surprising to note that the one 
organization rushing to hail Perry's decision was none other than the 
New York Times editorial page which wrote yesterday:

Congratulations to Texas for becoming the first state to require 
vaccinating young schoolgirls -- ages 11 and 12 -- against a sexually 
transmitted virus that causes cervical cancer and genital warts. 
Other states would be wise to follow the same path.

On one hand, it makes sense the New York Times would find this to be 
a "wise" decision, since it involves the government getting behind a 
policy that the Times' editorial writers obviously favor. Notice, 
however, the Times congratulates Texas for "for becoming the first 
state to require vaccinating young schoolgirls" without ever making 
mention of the fact it was done by executive order.

Here's another twist: the Times does mention the fact that the HPV 
vaccination, Gardasil, is made by Merck & Co. What they don't say is 
that Governor Rick Perry's former chief of staff is now a lobbyist 
for Merck and that the company contributed $6,000 to Perry and 
$38,000 to Texas state legislators last year. You can bet those are 
two facts that would not have escaped the NY Times editorial writers 
had they been opposed to Perry's decision.

Furthermore, the push for state mandates for HPV vaccinations is part 
of an intense lobbying effort on the part of Merck, as the Baltimore 
Sun reported last week:

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.

Again, the point here isn't about Merck's lobbying efforts or even 
the merits of the policy, but rather the blinding hypocrisy of the 
New York Times editorial page. The Times is always willing trash big 
pharma or to rail against executive power when it suits its needs, 
and it's easy to see how the Times editorial page editors would have 
cast the issue if had been something they didn't agree with.

Editorial pages are supposed to have a certain point of view, but 
they should also be consistent, intellectually honest, and persuade 
through argument rather than glossing over facts they're unwilling to 
deal with or find politically inconvenient.

For a good example of what I'm talking about, go read this 
editorial("Perry's power play aside, HPV vaccination is wise thing to 
do") from the Austin American-Statesman. The Statesman ends up in the 
same place as the Times but does so in a much more balanced way that 
gives its readers the full scope of the issue before coming to the 
conclusion that however the fight over Perry's executive order comes 
out, "parents should have their girls vaccinated to guard against 
cervical cancer. And the government should make those vaccinations 
available to families who are uninsured or can't afford it."