The chairman of the federal panel that recommended the new cervical-cancer vaccine for pre-teen girls says lawmakers should not make the inoculation mandatory, as the District and more than 20 states, including Virginia, are considering.
Dr. Jon Abramson, chairman of the Centers for Disease Control and Prevention’s advisory committee on immunization practices (ACIP), also said he and panel members told Merck & Co., the drug Gardasil’s maker, not to lobby state lawmakers to require the vaccine for school attendance.
“I told Merck my personal opinion that it shouldn’t be mandated,” Dr. Abramson told The Washington Times. “And they heard it from other committee members.”
Dr. Abramson said he opposes mandating Gardasil, which prevents the cervical-cancer-causing human papillomavirus (HPV), because the sexually transmitted HPV is not a contagious disease like measles and he is not sure states can afford to inoculate all students.
“The vaccines out there now are for very communicable diseases. A child in school is not at an increased risk for HPV like he is measles,” Dr. Abramson said.
In addition, Dr. Abramson said a discussion about making the vaccine mandatory should not be had until states show the money is available to vaccinate every child, adding, “I don’t see that yet.”
Taken in a series of three shots at $120 each, Gardasil is the most expensive vaccine on the market. About 45 percent of children would be eligible for free vaccines from the federal Vaccinations for Children program, while the other 55 percent would depend on the state programs and insurance companies.
The ACIP, a 15-member panel charged with developing vaccine schedules and dosages, recommended Gardasil for 11- and 12-year-olds in July, spurring Merck’s lobbying efforts and the legislative push to make the HPV vaccine mandatory for sixth-grade girls.
Merck suspended its lobbying efforts last week amid criticism from parents, who said it would interfere with control over their children, and from conservative groups that said it would encourage premarital sex.
Merck responded yesterday to Dr. Abramson’s comments with a statement it had made previously.
“We have had ongoing discussions with a number of key public health experts and listened to their thoughts regarding the timing for school requirements of the HPV vaccine. We do not want any misperception about Merck’s role to distract from the ultimate goal of fighting cervical cancer, so Merck has re-evaluated its approach at the state level and we will not lobby for school requirements for Gardasil.”
Gardasil is nearly 100 percent effective against two strains of HPV that lead to 70 percent of cervical cancer cases in the United States. Nearly 11,000 cervical-cancer cases occur in the U.S. each year, killing more than 3,700, according to the American Cancer Society.
But cancer data show that lawmakers looking to force pre-teen girls to take Gardasil, the lone vaccine on the market, are targeting the wrong age group.
Middle-school girls inoculated with the breakthrough vaccine will be no older than 18 when they pass Gardasil’s five-year window of proven effectiveness — more than a decade before the typical cancer patient contracts HPV, The Washington Times reported last week.
Infectious disease specialists and cancer pathologists say the incubation period for HPV becoming cancer is 10 to 15 years — meaning the average cervical cancer patient, who is 47, contracted the virus in her 30s and would not be protected by Gardasil taken as a teen.
Dr. Abramson said the panel thinks the vaccine will last for at least 10 years. Even if it provides 10 years of protection, it would still leave girls given the inoculation in the sixth grade vulnerable during their late 20s and early 30s, when most cervical-cancer patients contract HPV. At that point, another round of Gardasil would be necessary.
Merck is still studying Gardasil’s longevity and the potential for a booster shot.
ACIP is the only entity in the federal government to issue immunization recommendations and does not recommend a vaccine be made mandatory; those decisions are left to the states. But the committee’s recommendation on the use of a vaccine often plays the lead role in whether states will act to make it part of their mandatory vaccine list, said Barbara Fisher, president of the National Vaccine Information Center, which is opposed to laws making Gardasil mandatory.
“They are the signal for states to act,” she said. “The committee knows that and I think they see people getting upset about it.”
Earlier this month, Texas became the first state to enact an HPV vaccine law when Gov. Rick Perry bypassed the state Legislature and signed an executive order mandating all girls entering sixth grade be inoculated.
Mr. Perry, who drew fire when it was revealed that his former chief of staff, Mike Toomey, lobbies for Merck, said his order is based on the CDC recommendation.
The Virginia General Assembly last week approved legislation that would require that girls receive the Gardasil before entering sixth grade starting Oct. 1, 2008. The legislation allows parents to opt not to have their daughters vaccinated.
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