PUBLIC HEALTH

Drugmaker Assists In Pushing for Mandate For HPV Vaccination

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By Amy Gardner
Washington Post Staff Writer
Sunday, February 11, 2007

RICHMOND -- In Virginia and 17 other states, lawmakers are considering requiring young girls to be immunized against a little-known virus that public health officials say is responsible for nearly 7,000 cases of cervical cancer each year.

Legislatures are doing so at the urging of New Jersey-based pharmaceutical giant Merck & Co., which in June earned approval from the U.S. Food and Drug Administration for Gardasil, its new vaccine against human papillomavirus (HPV).

Merck, which posted revenues of $22.6 billion last year, stands to earn hundreds of millions of dollars annually on Gardasil, according to Wall Street estimates. And the public, research shows, stands to reap the benefits of the first vaccine against cancer. It is one of those moments in the public discourse, say several advocates for the mandatory vaccine, in which the interests of a deep-pocketed private company converge with the public good.

"The medical community is very excited about having a vaccine that can prevent cancer," said state Sen. Janet D. Howell (D-Fairfax), who sponsored a measure that is nearing approval in the Virginia General Assembly requiring that all rising sixth-grade girls be immunized against HPV. "It's everybody's dream that we'll be able to get more vaccines and prevent more cancers."

HPV is a sexually transmitted virus that can cause cervical cancer, genital warts and a variety of other, less common forms of genital and oral cancers. It is remarkably prevalent: At least half of sexually active men and women will carry it at some time in their lives, according to the federal Centers for Disease Control and Prevention. Most will never know it, and the virus will go away on its own. But in some cases, the virus lingers, causing cell changes that lead to cancer.

There is little doubt that the HPV vaccine will prevent cervical cancer. In clinical trials leading up to its approval, Gardasil was found to be nearly 100 percent effective in preventing infection by two strains of HPV responsible for 70 percent of all cases of cervical cancer. The vaccine also prevented infection by HPV strains responsible for about 90 percent of cases of genital warts.

With a national TV advertising campaign underway, Merck has led the effort to spread such information. It has also fanned out across the country to push for two kinds of state action: mandated vaccines for young girls, proposals for which were introduced in 18 states and the District this year; and millions of dollars of state spending to purchase vaccines for use in health clinics.

In Virginia, for example, Merck, a longstanding contributor to political campaigns in the state, has spent nearly $40,000 in contributions over the past two years. It has also hired Williams Mullen Strategies, a prominent lobbying firm, to spearhead the company's efforts to persuade lawmakers in Richmond to vote for a mandatory vaccine. On the team is Sandra D. Bowen, a well-known Richmond lobbyist and Cabinet secretary under two governors.

"School requirements is one approach that has been used very successfully in the past to improve vaccine rates," said Margaret McGlynn, president of Merck's vaccines division. McGlynn added that a mandate tends to lead to state funding of vaccines for public health clinics, improving access for lower-income and uninsured girls.

In the District, council member David A. Catania (I-At Large) said that he introduced legislation requiring girls to get the vaccine after hearing about the issue in the news and that his efforts have nothing to do with Merck.

"I have had no contact with Merck," said Catania, who chairs the council's Health Committee. "Any benefit this would have on the pharmaceutical industry is unintended. This is good medicine and makes sense."

Merck is not alone in pushing for broad access to Gardasil, which costs $360 for the recommended series of three shots. The American Cancer Society, the Centers for Disease Control, the American Academy of Pediatrics and the U.S. Advisory Committee on Immunization Practices all have recommended that girls receive the vaccine. These public health organizations are encouraging states to spend millions on the vaccine to make it available through clinics that primarily serve the poor or those without health insurance. They are also encouraging private insurers to cover the cost of the vaccine.


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