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http://www.prwatch.org/node/6232

Women in Government, Merck's Trojan Horse: Part 
Three in a Series on the Politics and PR of 
Cervical Cancer

Submitted by Judith Siers-Poisson on Tue, 07/10/2007 - 08:51.

In parts one and two of this four part series, 
<http://prwatch.org/node/6186>"Setting the 
Stage", and 
<http://prwatch.org/node/6208>"Research, Develop, 
and Sell, Sell, Sell", we've looked at the basic 
facts of Human papillomavirus (HPV) and its link 
to cervical cancer, and the Merck vaccine 
Gardasil that is touted as the first ever vaccine 
against cancer. We examined the PR and marketing 
push for Gardasil that began even before FDA 
approval, and two non-profit organizations that 
helped Merck exploit their current corner on the 
HPV vaccine market.

In this article, we'll analyze the push for 
mandated HPV vaccination of adolescent girls that 
is taking place at the state level throughout the 
U.S., and the non-profit organization, Women in 
Government (WIG). WIG has been Merck's non-profit 
front and direct channel to state-level 
legislators who are the key to enacting mandates.

The Push for Mandates, and the Pushback

As reported previously, Merck laid the PR and 
"education" groundwork for Gardasil well before 
FDA approval was granted in June 2006. But even 
with FDA approval and the strong recommendation 
of the Advisory Committee of Immunization 
Practices at the federal level, mandatory 
vaccination was not a given since the power to 
enact such requirements lies in the hands of 
state legislators. Merck was working behind the 
scenes on that front as well, and moved quickly 
to persuade policymakers with the authority to 
mandate vaccination for 11 to 12 year old girls. 
Within a few months of FDA approval, almost 
twenty states had legislation pending that would 
mandate vaccination against HPV. Merck must have 
felt like they had won the lottery when within a 
month, the Centers for Disease Control (CDC)'s 
Advisory Committee of Immunization Practices 
(ACIP) recommended that 11 and 12 year olds be 
targeted for routine vaccination, and all women 
12-26 years old be encouraged to be vaccinated. 
Merck and Gardasil were on a roll, thanks in 
large part to Women in Government.

According to their website, "Women in Government 
is a national 501(c)(3), non-profit, bi-partisan 
organization of women state legislators providing 
leadership opportunities, networking, expert 
forums, and educational resources to address and 
resolve complex public policy issues." The 
campaigns that they feature on their home page 
deal with kidney health, Medicare preventive 
services, higher education policy, and the 
"Challenge to Eliminate Cervical Cancer," which 
was publicly launched in 2004.

Molly Ivins liked to call him "Good Hair" 
Perry.Governor and Mrs. Rick Perry of Texas. 
Molly Ivins liked to call him "Good Hair" 
Perry.On February 2, 2007, Texas Governor Rick 
Perry, against the wishes of his conservative 
base and to the surprise of critics, signed an 
executive order mandating HPV vaccination for 
girls entering seventh grade. Then, unfortunately 
for Perry and Merck, details of his many 
connections with both Merck and Women in 
Government became public. Ellen Goodman of the 
Boston Globe noted, "It turned out that Perry's 
former chief of staff is now a lobbyist for 
Merck. Did that look bad? Whoa, Nellie. Did it 
look bad that Merck had funded an organization of 
women legislators backing similar bills? Whoa, 
Merck." USA Today reported that Perry's current 
chief of staff's mother-in-law, Texas Republican 
State Representative Dianne White Delisi, is a 
state director for Women in Government. Perry's 
wife, Anita, a nurse by training, addressed a WIG 
summit on cervical cancer in Atlanta in November 
2005. Perry also received $6,000 from Merck's 
political action committee during his re-election 
campaign.

Merck announced on February 20, 2007 that it 
would no longer lobby directly for vaccine 
mandates at the state level. The New York Times 
quoted Dr. Richard M. Haupt, executive director 
for medical affairs in Merck's vaccine division 
as saying, "Our goal is to prevent cervical 
cancer. Our goal is to reach as many females as 
possible. Right now, school requirements and 
Merck's involvement in that are being viewed as a 
distraction to that goal." Dr. Haupt did say, 
however, that Merck would continue providing 
health officials and legislators with education 
about the vaccine and would continue lobbying for 
more financing for vaccines in general. When 
asked how much Merck had spent on its Gardasil 
lobbying efforts, Haupt declined to name a figure.

Women in Government: Picking Up the Slack for Merck

So who is this group receiving Merck funding and 
pushing for vaccine mandates across the country? 
As noted above, Women in Government had 
identified cervical cancer as a focus of their 
work as early as 2004. Available on the WIG web 
site is a legislative policy toolkit. It provides 
legislators with sample legislation written by 
their colleagues in other states, maps showing 
states with cervical cancer related bills pending 
or laws enacted, WIG's fact sheets on HPV and 
cervical cancer, and a letter from WIG President 
Susan Crosby. While not focused solely on 
introducing and enacting HPV vaccine mandates, 
they are a main component of the WIG campaign and 
something by which they measure success. 
According to a map that WIG provides on their 
site, as of June, 2007, twenty-three states and 
the District of Columbia have introduced HPV 
vaccine mandate legislation, in addition to 
Virginia, which has already enacted legislation.

WIG's non-profit and non-partisan status has 
given them access, status and influence beyond 
the reach of Merck, the vaccine manufacturer. 
Debbie Halvorson, the Democratic majority leader 
of the Illinois State Senate, had a hysterectomy 
due to HPV infection. She told the New York Times 
that, "she would continue to press for the bill, 
but that it was a good idea on Merck's part to 
stop lobbying. 'If the people out there are 
thinking that Merck is doing all this, and 
pushing our buttons, they need to just step away. 
The fact that I'm doing what I'm doing has 
nothing to do with Merck.'" Halvorson is listed 
as a current member of Women in Government on the 
group's website. Health Policy Monitor, the 
website of an international non-profit network on 
health policy and reform, reports that in 
California in late 2006, Democratic Assemblywoman 
Sally Lieber introduced a bill that would require 
all girls entering sixth grade to be vaccinated 
against HPV beginning in July 2008. 
"Assemblywoman Lieber has publicly stated that 
she drafted the HPV mandate for California 
because of the unique opportunity it presented to 
prevent cancer with a vaccine-something that has 
never before been possible.  Merck 
representatives requested a meeting with Lieber 
before she introduced the HPV bill, but Lieber 
declined. Lieber did meet with Women in 
Government, unaware of their ties to Merck."

Straight From the President's Mouth: An Interview with Susan Crosby

In March 2007, I interviewed Susan Crosby, the 
President of WIG. Crosby first served on the 
board of WIG and then joined the staff as Deputy 
Executive Director in 2002. Crosby was a 
Democratic member of the Indiana House of 
Representatives for 12 years prior to her tenure 
with WIG. In 2005 Crosby's total compensation 
package from WIG was $123,925.

When asked what WIG offers its members, Crosby 
noted that besides the networking opportunities, 
WIG itself serves as a resource in several ways, 
including, "having legislators be able to call in 
and get totally unbiased information  to be able 
to make decisions that are the best for their 
state." She continued, "That's one thing that we 
at Women in Government have always tried to do, 
is try to give them the full picture, the 
balanced picture - the good, the bad, and the 
ugly. Because nothing's worse than to give a 
legislator, a woman legislator in particular, 
part of the story, and have her go back to her 
state, standing up at the mike, proposing 
something, and all of a sudden this question 
comes flying out of left field and she has no 
idea what it was."

But is WIG dedicated to giving women legislators 
unbiased, balanced information, or in giving 
WIG's corporate contributors access to the 
legislators that can significantly help or harm 
their interests at the state level? In 2004, more 
than 20 WIG funders were pharmaceutical companies 
or entities heavily invested in health care 
issues that could come before state legislators. 
A short list includes both Merck & Co., Inc and 
Merck Vaccine, GlaxoSmithKline (which will soon 
have the second HPV vaccine on the market), and 
Digene Corporation (which manufactures an HPV 
test). Other drug interests listed as donors to 
WIG include Novartis, Eli Lilly, AstraZeneca, 
Bayer Healthcare, Pfizer, Bristol-Myers Squibb 
(both the company and their foundation), and 
Pharmaceutical Research and Manufacturers of 
America, also known as PhRMA, one of the largest 
and most influential lobbying organizations in 
Washington representing 48 drug companies.

WIG's funding rosters for 2005 and 2006 have 
minor additions and deletions, but Merck, 
GlaxoSmithKline, and Digene remain constant. It 
appears that word has gotten around that WIG is 
ready, willing and able to cooperate with those 
invested heavily in health care policy -- their 
current list of donors for 2006 includes more 
than 40 companies or organizations involved in 
the health field.

How did HPV and cervical cancer rise to the top 
of the short list of issues that WIG prioritizes? 
Crosby said that health has always been a focus 
of WIG's work. "Four years ago we heard about 
HPV, and I must tell you, at that time we didn't 
know the difference between HPV and HIV. We 
couldn't even say 'Human Papilloma Virus' and 
they were saying 'Oh! This is the virus that 
causes cervical cancer.'" WIG created a task 
force to look into it and "found out about this 
test that, used along with your Pap test, could 
predict 99.9% whether you had this virus and we 
thought, 'Oh my golly! Talk about some 
opportunities here. This is unbelievable 
information and we need to make this available to 
all women!' They need to know, when they go in to 
their doctor, to say, 'I want an HPV test as well 
as my Pap.'"

When I raised the issue of Merck pushing for 
vaccine mandates when it is currently the only 
vaccine provider, Crosby responded that 
GlaxoSmithKline has now also presented their 
drug, Cervarix, for FDA approval. When I noted 
that Merck, GlaxoSmithKline, and Digene, were all 
WIG funders, Crosby responded "and so is Eli 
Lilly, Bristol Meyer Squibb -- you could go on 
and on because of the health issues that we have 
championed for years. Obviously, we are going to 
attract the attention of that particular 
industry."

WIG funders also include energy concerns, 
casinos, alcohol, telecom interests, Big Tobacco, 
and lobby firms - all of which could be either 
significantly helped or harmed by state-level 
legislation. Does Crosby feel such funding 
compromises WIG, or creates the impression that 
WIG might have divided loyalties or interests? "I 
don't," Crosby replied. "Because number one, I 
think it shows that there is not one single 
industry or one corporation that is driving Women 
In Government.  This is an affirmation that we 
are a totally unbiased, unprejudiced group, that 
we are trying to gain information - the pros and 
the cons - on all issues and being able to 
present that to our legislators for them to be 
able to make informed decisions on good public 
policy."

Crosby emphasized that the funding provided by 
corporations and industries are unrestricted 
grants. "To me," she explained, "I don't see it 
as a conflict of interest because they're not 
funding a particular legislator or a particular 
mission." But the funders are getting direct 
access to state legislators, in part through 
WIG's Legislative Business Roundtable. Crosby 
explained, "They are people that come together to 
help the women legislators identify what the 
cutting edge issues are. For instance, we might 
have someone from Verizon saying, 'OK, we're 
looking at telephone deregulation - this may be 
an issue you want to get more information on to 
help educate your legislators.' Because there's 
no way that we have the expertise to know what 
some of the coming issues are going to be. So 
they float those topics out there and we say, 
'Oh, that's something we definitely need more 
information on.'" I asked whether, since Verizon 
is a WIG funder, it is safe to say that funders 
are among the members of the Roundtable. Crosby 
confirmed that they are.

WIG is also taking funding from the likes of 
Altria (formerly Philip Morris) and beer maker 
Anheuser-Busch. Not exactly stars in the health 
promotion pantheon. Referring back to her 
assertion that WIG wants to provide women 
legislators with the good and the bad, the pro 
and the con, of each issue, I asked if there is 
really a pro side to Big Tobacco, pointing out 
that on an archived web page listing previous WIG 
funders, they listed Altria Group just across 
from a box that read "November is Lung Cancer 
Awareness Month." Crosby replied, "We're putting 
the message out there, and it's up to Altria. 
They know that we are going to continue to give 
both the pros and the cons on that particular 
topic and they're not going to dictate to Women 
in Government, just like no business dictates to 
Women in Government.  It's up to Altria if they 
still want to come to the table and they do."

"Perceived" conflicts of interest are not enough 
for WIG to refuse corporate funding. "I'm sorry 
that it has happened," Crosby said, "but I would 
say that if you know our women legislators, ... 
you know that no one particular person or 
industry is going to tell them or dictate to them 
what they're going to do. It's just so sad that 
they've lost the focus that this might be the 
medical breakthrough of the century - a vaccine 
against cancer."

Crosby predicts that, when years in the future 
people look back at this debate, "All this hoopla 
will be moot." But some former WIG supporters 
disagree. In early January 2007 WIG held their 
annual state directors conference on San Marco 
Island, Florida. Two of those attending were 
Marilyn Canavan and Andrea Boland, both 
Democratic state legislators from Maine. Both 
were surprised by the tone of the sessions 
devoted to HPV, cervical cancer and mandatory 
vaccination. Canavan later told Terry J. Allen, 
who was writing for CorpWatch, 'The tenor of 
presentations - they were not discussions ... 
(they) seemed one-sided to me ... I remember 
thinking as I was leaving the meeting, 'I just 
don't want to do this ... we need to have public 
dialogue.'

"Boland also reported a 'pull to get on board 
[promoting vaccination]... and when I raised 
questions, the response was 'Do you want your 
daughter to die of cancer?'" As a first-time 
attendee, Boland was struck by the role that 
corporations played in determining the policy 
priorities for WIG. "'When discussing what the 
agenda for next year would be,' participants were 
told to 'wait to see who's funding things.' 
Similarly before fixing the program for next 
year, they 'had to see what the sponsors want.'"

Canavan, a four-term legislator and a WIG state 
director, resigned from WIG on March 2, 2007. "An 
organization that stands to profit, like a 
pharmaceutical company, shouldn't be driving the 
health agenda in the public realm. You see so 
many front organizations, I'm not going to say 
Women in Government is one, but it matters who's 
funding them." She concluded, "When we lose trust 
in companies like pharmaceuticals or a group like 
Women in Government, we start to become 
suspicious about everything. We need to have 
public dialogue. The point is not that the 
vaccine is bad, but that the public agenda has 
all been company-driven."

How It Plays Out in the States: Wisconsin as a Case Study

In Wisconsin, State Senator Lena Taylor, a 
Democrat representing Milwaukee, plans to 
introduce legislation that would ensure HPV 
education and would lay the groundwork for an 
eventual HPV vaccination mandate. Taylor is a 
long-time member of Women in Government.

One concern regarding Gardasil and mandating its 
use is the creation of a false sense of security 
for girls and their parents. For example, on 
Senator Taylor's website (see below) until June 
2007 was a statement boasting of the the 
introduction of legislation "that would add the 
vaccination for HPV, which is linked to 99.7% of 
cervical cancer cases, to the list of required 
vaccines for Wisconsin girls entering sixth 
grade. This legislation can end cervical cancer, 
which kills 3,700 women each year, in the next 
generation of Wisconsin women." Asked about the 
clear overstatement of the vaccine's benefit 
Taylor's Legislative Assistant Jeff Pertl 
conceded that the original posting was in error. 
"We've changed the language on that, to be 
candid.  The initial number we were given by the 
medical community was that 99.7% figure. The 
general number we've been seeing in the press is 
70%, which I think is a more conservative number, 
and that's number we've been using now. I would 
argue that I think it's higher than that, but in 
general we've moved to the more conservative 
number."

On the issue of negative publicity caused by 
Merck's heavy-handed lobbying efforts, Pertl 
said, "We've consciously tried to keep some 
distance from Merck, you know they got some 
national attention, but they haven't really been 
involved here in Wisconsin.  We're trying to 
make this about the public health issue. Our 
bill's bi-partisan and we're trying to stay out 
of the quagmire wherever we can."

Regarding the links between the drug companies 
and Women in Government, of which Senator Taylor 
is a long-time member. Pertl dismissed a 
correlation between her membership and her work 
on this legislation. He said that "while Women in 
Government did push this issue in a lot of 
areas," Taylor's office had gotten more 
information and model legislation from the 
National Conference on State Legislatures (NCSL) 
than from WIG. "We didn't get a lot of contact 
from Women In Government, and it certainly wasn't 
like a lobbying effort, at least not that we were 
aware of. Again, I can't speak for the whole 
country, but I suspect it's a bit overblown, but 
it's hard to say." Like WIG, NCSL is also funded 
by corporations, including Merck and 
GlaxoSmithKline.

Did Senator Taylor disclose to her colleagues 
that she is a member of a group that receives 
financial support from those corporations? Pertl 
replied, "We didn't actually know that Women in 
Government receives funding from Merck until the 
news story broke, much like everybody else. We 
just didn't pay that much attention to the 
finances, quite frankly." Addressing the question 
of revealing WIG's funding to prevent any 
perceived conflict of interest, Pertl continued, 
"When we found out, we had a conversation with 
others - there are a lot of members of the 
legislature here that are members of Women in 
Government  it really wasn't a major concern 
here."

Pertl concluded with this point. "I think there 
are two things that are spiking concern right 
now, if I can be candid. One is that HPV is a 
sexually transmitted disease. If this were 
transmitted in any other way, we probably 
wouldn't be having this conversation.  The 
second problem is that if you pass the law today, 
the news story is today, even if the 
implementation is two years from now.  And I 
think that's why we might do an education bill 
first.  Because here's the most important thing 
- the public has to have faith."

Meaningful Analysis: Missing In Action

Legislative Aide Jeff Pertl touched on an 
important, and unfortunate, aspect of the HPV 
vaccine issue. Within a polarized political and 
religious climate, some conservative 
organizations and leaders are against the 
mandating of HPV vaccines due at least in part to 
a concern about encouraging promiscuity, and this 
has produced a knee-jerk reaction. Instead of 
carefully examining the issue, the response from 
some has been to endorse the vaccine simply on 
the grounds that if the Right is against it, they 
should be for it.

For example, in the Spring 2007 issue of Ms. 
magazine, this response, and the rampant 
oversimplification and misinterpretation of the 
HPV vaccines use and efficacy, is apparent. The 
author, Cindy Wright, discussed the overturning 
of Texas Governor Rick Perry's executive order 
mandating vaccination. But she credits the 
"firestorm" to social conservatives, not to the 
controversial ties between Perry, his wife, Women 
in Government, and Merck outlined above. In 
response to the $400 price tag quoted for the 
three shot regimen (and it might cost even more), 
she opines, "Even if I had to pay full price, how 
could I say no to the first-ever cancer vaccine? 
How could anyone? Who would consider not giving 
our daughters the best chance of avoiding a 
deadly disease?" In fact, regular Pap tests are 
still the best way to detect pre-cancerous 
conditions and to treat them well before they 
become cervical cancer. Wright's tone is 
reminiscent of George W. Bush claiming, "You're 
either with us, or with the terrorists." The 
implication is that if you're not running to get 
your daughter vaccinated, someone should call 
Child Protective Services.

The Ms. article ends with exactly the attitude 
that the Gardasil PR has encouraged, and Merck 
has been loath to correct. Wright concludes, 
"Meanwhile, my daughter has gotten her second 
booster. That's one less life-threatening illness 
to worry about." Is it any coincidence that 
Merck's crowning PR push was built around the 
phrase "One Less"? Let's hope that Wright's 
daughter does her homework more thoroughly than 
her mother and doesn't assume that she is now 
fully protected against cervical cancer. That 
misperception is what is truly life-threatening.

It is possible to be supportive of the vaccine 
and widespread access to it without favoring 
mandated vaccinations. And it is certainly not 
just the Religious Right that opposes HPV vaccine 
mandates being put in place at the state level. 
In February 2007, the American Academy of Family 
Physicians cautioned that it was "premature to 
consider school entry mandates" for Gardasil 
"until such time as the long term safety with 
widespread use, stability of supply, and economic 
issues have been clarified. USA Today quoted 
Joseph Bocchini, chairman of the American Academy 
of Pediatrics' Committee on Infectious Diseases, 
as affirming Merck's February 2007 announcement 
to discontinue its direct lobbying efforts in 
favor of vaccine mandates. "At this point," 
Bocchini said, "we really don't know whether we 
even need to consider a mandate. We need to get 
some data over time."

Even though middle school girls were not the 
focus of the research and development stages, 
they have become the target for vaccine 
mandates.Even though middle school girls were not 
the focus of the research and development stages, 
they have become the target for vaccine 
mandates.Dr. Diane Harper, whom I quoted at 
length previously in this series, has serious 
concerns about mandating the HPV vaccine for 
middle-school aged girls. Dr. Harper was involved 
in designing and implementing clinical trials for 
both Merck's Gardasil vaccine and 
GlaxoSmithKline's Cervarix. According to Dr. 
Harper, eleven- and twelve-year olds have had 
safety testing, but not efficacy testing. This 
means that there is no way to tell how long 
Gardasil will provide protection, or when a 
booster shot might be needed.

So why focus on that age group? "That age range 
was targeted because the manufacturer has this 
vaccine, and they need to recoup their R&D 
(research and development) costs. ... But how do 
you administer this vaccine? How do you package 
it and put it out there so that it makes sense to 
the public and so that the right public health 
programs and different sub section of the medical 
community 'own' the vaccine?"

Part of the answer is that mid-adolescence is a 
good age because vaccinations given in early 
childhood are coming due for a booster, and there 
is a growing realization that many risky 
behaviors and conditions, like smoking, 
depression, and obesity, are emerging at the that 
age as well. The manufacturers and the CDC 
decided to add the HPV vaccine to a platform of 
vaccines to give at that age, including 
meningitis, pertussis and tetanus updates, 
pneumococcal vaccine." Dr. Harper continued, "I 
think that's a very noble thought, and that it's 
a thoughtful way of thinking of where to place 
the vaccine. The problem is that in so doing, you 
lose the concept of what the vaccine was for, the 
actual power of the vaccine. It gets folded into 
the bigger purpose of helping adolescents have a 
better health life. But you lose the fact that 
women continue to get HPV infections throughout 
their lives -- there is no one age when cervical 
cancer stops. It pigeon-holes the vaccine into 
something for twelve-year olds, it also 
pigeon-holes it into a wedge to start talking 
about sexuality."

I asked Dr. Harper to explain her opposition to 
mandating the vaccine when she was prominently 
featured on the agenda of a Women in Government 
summit on cervical cancer held in Bay Harbor, MI 
in July 2005. She replied, "My talks and 
discussions at that meeting were identifying the 
benefits (not the limitations) of the HPV 
vaccines as they were being developed. My talks 
served as an educational platform so that the 
benefits scientists were seeing from the clinical 
trials could be explained to the legislators in a 
way they could take back to their legislative 
bodies." She continued, "At the time I was 
working with WIG, the concept of mandates was 
either not discussed or very embryonic in form. 
... There was not consensus on the age at which 
to vaccinate women with the HPV vaccine, this 
would not come from the ACIP until November 2006 
with the wording that 11-12 year olds would be 
targeted for routine vaccination, and all women 
12-26 years old would also be encouraged to be 
vaccinated. The Merck representative to WIG was 
strongly supporting the concept of mandates later 
in the WIG meetings and providing verbiage on 
which the legislators could base their proposals."

Dr. Harper reiterated her position to "fully 
support the use of the HPV vaccine for women of 
all ages, and support health insurance, third 
party payers to cover this for preventive women's 
health care. I do not support the concept of 
mandates for 12 year olds that keep children from 
school if there is insufficient access to the 
vaccine." She also indicated that she feels 
strongly that individual women legislators have a 
genuine concern for women's health.

WIG Isn't Alone: Other Ways to Buy Access to State Legislators

Women in Government is not alone in providing its 
corporate funders with direct access to the state 
legislators that can help or harm their corporate 
interests through state-level legislation. The 
National Foundation for Women Legislators, which 
works with women in all levels of elected 
offices, unabashedly outlines the access to 
legislators that Corporate Membership levels, 
ranging from $5,000 to $50,000, will buy. At the 
$50,000 President level, corporate members can 
"host (a) conference call with key legislative 
members on policy issue" and can also mail to the 
NFWL membership list four times during the year. 
President and Senator ($35,000) level corporate 
members can also participate in NFWL leadership 
activities. NFWL stopped listing its corporate 
funders on its website in 2002, but at that time, 
they included Merck, Pfizer, SmithKline 
(pre-merger with Glaxo), PhRMA and other 
pharmaceutical interests, not to mention Philip 
Morris, Enron, the Chlorine Chemistry Council, 
the National Rifle Association, and Exxon. In a 
1999 fundraising mailer sent to tobacco company 
Philip Morris, now Altria, NFWL promises that "by 
joining the Corporate Leadership Circle of the 
National Foundation for Women Legislators, you 
will have the opportunity to lend your expertise 
and point-of-view to lawmakers at a number of 
high-profile, yearly events."

The NCSL Foundation, which is the 501 (C) 3 
non-profit that raises funds to support the 
programs of the National Conference of State 
Legislatures, outlines the benefits on becoming a 
gold ($10,000) or silver ($5,000) sponsor of 
NCSL. Benefits include varying levels of access 
to the NCSL leadership and to the member 
legislators, including being able to serve on one 
of the Conference's sub-committees. The NCSL 
Foundation lists its funders as including the 
usual suspects of pharmaceutical firms (Merck, 
GlaxoSmithKline, Pfizer and others, including the 
lobby group PhRMA), in addition to energy, 
telecom, and other deep-pocketed interests. NCSL 
has a briefing page on HPV and what is happening 
at the state level, but does not appear to have 
yet taken a pro-mandate stance.

The American Legislative Exchange Council, a 
network of conservative legislators that pushes 
legislation that favors big business and 
rollbacks of environmental regulations, also 
provides direct access and influence to its 
corporate funders. ALEC's Health and Human 
Services task Force lists individuals from 
GlaxoSmithKline, Bayer Health Care, and PhRMA as 
private sector representatives. At their April 
2007, Task Force Summit meeting, the co-chairs 
announced the formation of a one-time Health and 
Human Service Working Group on HPV vaccination 
mandates. This working group will present on the 
mandate issue at the ALEC annual meeting at the 
end of July in Philadelphia.

What Have We Learned?

These first three articles on the Politics and PR 
of Cervical Cancer have attempted to untangle the 
issues surrounding an important health care topic 
as it has played out in the U.S. We started with 
a basic analysis of the facts around cervical 
cancer, and what Merck has to gain by having the 
first vaccine on the market. We've looked at the 
award-winning PR campaign that Edelman produced 
for Merck and the non-profits, Cancer Research 
and Prevention Foundation and Step Up Women's 
Network, that helped create a culture of fear 
couched in the empowerment of women and girls. 
We've looked at the lobbying efforts to push for 
state mandates of HPV vaccination which has been 
channeled through industry-funded non-profits 
like Women in Government. And we've outlined the 
concerns that all the hype and spin are a grave 
disservice to women's health. Merck's greed, and 
the willingness of its partners to go along with 
an industry driven campaign, have compromised the 
actual promise of the vaccine.

In the fourth and final article, "Profit Knows No 
Borders, Selling Gardasil to the Rest of the 
World," we'll examine developments in other 
countries around the issue of HPV vaccination.