There is no dispute that vaccines have played a monumental role in promoting
public health and safety for children and adults. My concern has been that
certain vaccines should not be forced fed or injected without more testing
and information given to the public. The papillomavirus (HPV) is one of
these.
In decisive bold back to back news releases on February 4, 2007, The
Association of American Physicians and Surgeons voiced their concerns and
issued an advisory statement.
BACKGROUND
Foreseen by parental rights advocates, the "recommendation" of human
papillomavirus (HPV) vaccine (Gardasil) was immediately followed by
legislative proposals to force 11-year-old girls to receive the vaccine as a
condition of school attendance.
Merck, which could make $1 billion per year in sales from mandatory
Gardasil, is funding lobbyists and funneling money through Women in
Government, an advocacy group made up of female legislators. A top official
from Merck's vaccine division sits on the Women in Government business
council. The company refused to disclose the amount of money it has donated
to that group or spent on lobbying.
Laws are proposed in at least 18 states, including California, Connecticut,
Michigan, Minnesota, and Texas. The bill was narrowly defeated in Michigan.
TEXAS HOLDEM
Gov. Rick Perry decided to override the Texas legislature, issuing Executive
Order RP65 requiring girls entering sixth grade, generally aged 11 to 12, to
receive Gardasil. The Executive Order stands until Perry or a successor
changes it.
"He's circumventing the will of the people," said Dawn Richardson, president
of Parents Requesting Open Vaccine Education. "There is no emergency except
in the boardrooms of Merck, where this is failing to gain the support they
expected."
A live vote by MSNBC News showed that 65 percent said "Š parents should
decide whether or not their daughters are vaccinated" in response to the
question "Should a state require that schoolgirls get the shot against human
papillomavirus?" There were more than 25,000 responses tallied.
Although there is a provision for parents to opt out for religious or
philosophical reasons, parents complain that the Order interferes with their
right to make medical decisions for their children, noted the Alliance for
Human Research Protection.
VACCINE EXPENSIVE
Pediatricians and gynecologists have been refusing to stock Gardasil because
of the $360 price for three doses and "totally inadequate insurance
reimbursement." Most will give patients a prescription to get filled and
bring back, but the cost to the patient is far more (AP 2/3/07).
According to the National Vaccine Information Center, a survey of pediatric
practices in Virginia revealed that parents could be charged between $525
and $930 for the series of shots.
According to the National Network for Immunization Information director
Martin Myers, "many of us are concerned that a mandate may be premature, and
it's important for people to realize that this is not as clear-cut as with
some previous vaccines." Although Myers says he's enthusiastic about
Gardasil, "It's not the vaccine community that's pushing for this"
(Immunization News 2/1/07).
Gardasil is not approved for use in boys, so it cannot be marketed for this
use, though physicians can prescribe it. It is hoped that Gardasil may
prevent anal cancer in homosexual men.
SUMMARY OF AAPS STATEMENT ABOUT HPV VACCINE
1. The vaccine is claimed to prevent cancer of the cervix. Pap smears
have already made advanced cervical cancer rare in the United States. Money
spent on this expensive vaccine could likely prevent more cancer if spent on
screening clinics for women unable to afford vaccine, Pap smears, or
treatment.
2. At best, the vaccine is only partly effective. No study has actually
shown cancer prevention, only a reduction in abnormal Pap smears. The
longest follow-up period in studies is about 5 years; it usually takes
decades for cervical cancer to develop. The vaccine only protects against 70
percent of the strains associated with invasive cancers. Vaccinated women
still need Pap smears.
3. Vaccine protection may only last a few years. Boosters may be needed
every 10 years, or perhaps every 5.
4. There is no public-health purpose for mandating HPV vaccine for
schoolchildren. It will not be transmitted at school unless statutory rape
is occurring or hygienic standards are so poor that the school needs to be
closed.
5. Proof of safety is lacking. The vaccine is claimed to be safe and
"well-tolerated," but studies have involved only a few thousand women, most
over 16 years of age, for less than 5 years. In one study, "arthritic
symptoms" occurred three times as often in subjects who got the vaccine,
compared to subjects who only got the control vaccine. An increased risk of
juvenile rheumatoid arthritis‹a deforming, devastating, lifelong disease‹is
being watched for.
6. Mandates are medically unethical. All medical procedures, including
vaccines, require informed consent, with rare exceptions. Concerning HPV
vaccine, the Department of Family Medicine and Clinical Epidemiology,
University of Pittsburgh School of Medicine, concluded: "given concerns for
autonomy, justice, as not all persons are at risk, . . . HPV vaccine should
not be mandated for school entry" (Vaccine 2006;24:4812-4820).
This writer concludes that until more testing and studies are performed and
the public has more knowledge of the safety and efficacy of the HPV vaccine
-- there is no need to rush to vaccination -- and certainly not mandatory
premature inoculation.
Editor's Note; This week's column was written by Michael Arnold Glueck, M.D.
