One commercial begins with a woman saying, “I have cervical cancer from an infection — human papillomavirus.” Photos of her as a young adult and a preteen flash by. “Who knew HPV could lead to certain cancers?” she continues. “Who knew that there was something that could have helped protect me from HPV when I was 11 or 12, way before I would even be exposed to it?”
It ends with a version of herself as a child looking up from a birthday cake festooned with candles and asking plaintively, “Did you know — Mom, Dad?” A second ad features a young man and ends with him asking the same haunting question.
The ads are starkly effective — too much so, according to some critics. Some people on Twitter labeled the commercials “bullying” and “super sketchy” and accused the company of trying to guilt-trip parents to bolster corporate profits. Vaccine skeptics repeated their long-standing questions about Gardasil's safety and effectiveness; one started a petition to the Federal Trade Commission to pull the ads. Even some people who don’t oppose the vaccine itself faulted Merck’s approach, as well as direct-to-consumer pharmaceutical ads in general.
“It’s kind of like Catholic and Jewish guilt combined,” said Susie Cambria, a public policy analyst and community activist who lives in Washington, D.C. “I don’t have any kids, but I can only imagine how badly it makes parents feel.”
Given the vaccine’s persistently low adoption rate, many doctors and public-health experts counter that it’s appropriate to make hesitant parents feel uncomfortable. As of 2014, only 40 percent of girls and 22 percent of boys had gotten the three-shot course, according to the Centers for Disease Control and Prevention — despite the vaccine’s endorsement from the CDC, the American Cancer Society, the American Academy of Pediatrics, leading cancer centers and others.
“I absolutely love the commercial,” said Jason Terk, a Texas pediatrician who has been at the forefront of HPV vaccination efforts there. Merck isn’t trying to shame parents, he said, but is showing that they make important decisions that will affect their children’s cancer risks years into the future. “We are responsible not only for our acts of commission but also for our acts of omission,” Terk said.
HPV infections cause cervical, vaginal, anal, throat and penile cancers. Experts say the best time to vaccinate against the virus is at ages 11 and 12, when children have the strongest immune response. That protects them before most kids become sexually active and at risk of being exposed to the virus. A CDC study published this year found the vaccine is having an impact: The prevalence of the virus has been significantly reduced among teenage girls. But research also indicates that many parents, as well as some pediatricians, avoid talking about HPV because they are uncomfortable discussing its mode of transmission.
Merck officials said they decided to run the new commercials because market research the company conducted last year showed that while 85 percent of parents were familiar with HPV, only 50 percent were aware of its link to cancer.
“We felt like that was a pretty startling fact and that it was time to get back out and make sure that consumers were well-educated about the link,” said Colleen McGuffin, Merck’s vice president for U.S. commercial operations.
The drugmaker ran a big TV campaign about HPV after Gardasil was approved for girls in 2006. That effort, though praised by some public health experts, also drew criticism as being heavy-handed and partly aimed at encouraging lawmakers to include HPV vaccination in the schedule of vaccines required for most kids to attend public school. Today, only Rhode Island, Virginia and the District require the vaccine.
Lois Ramondetta, a gynecologic oncologist at MD Anderson Cancer Center in Houston, said she likes the new ad campaign. “Although it does bring in a bit of fear, I think it is important for families to recognize their role in not protecting their children,” she said.
Jeffrey Kahn, director of the Berman Institute of Bioethics at Johns Hopkins University, called the commercials “awesome,” saying, “Let’s tell people, ‘These are the realities, and here’s something you can do to prevent cancer in your child, and it’s not very hard.’” He likened the commercials to graphic anti-tobacco ads that detail the damage wrought by smoking. “Really bad things will happen if you engage in this behavior, and you need to do something now,” he said.
But he also acknowledged that some of the controversy surrounding the commercials probably stems from their sponsorship by Merck rather than the CDC or a nonprofit entity. “You might have to separate the message from the messenger,” he said.
Noel Brewer, a psychologist at the University of North Carolina who specializes in health decision-making, especially involving vaccination, smoking and health screening, said the Merck ads build on research involving “anticipated regret.” That concept holds that contemplating the potential negative results of some decisions can help people make better ones.
“I respect parents who get mad about the [ads], but they should take that pissed-off feeling and ask their doctors about vaccinating their children,” said Brewer, who is chairman of the American Cancer Society’s HPV Vaccination Roundtable and has also advised Merck on HPV.
The drugmaker, he said, “is going to get criticized either way — from their critics, or from me, telling them they need to do more.”
McGuffin said the company has gotten a lot of positive reaction, with parents thanking Merck for reminding them about the importance of HPV vaccination. Some of the comments on Twitter were supportive:
Critics are not mollified. Aimee Gardiner, co-founder of a group called Rhode Islanders Against Mandated HPV, called the Merck ads a marketing gimmick, adding, “I do think the information and studies should be available to the public to do their own research, but not advertised.”
In response, McGuffin pointed to the fact that Gardasil has been extensively studied in the United States and abroad for more than a decade. “This product has been on the market for 10 years,” she said, “and we stand behind its safety and effectiveness.”