The government of Ontario just announced that it will spend $39 million to offer free, optional Gardasil vaccinations to girls in Grade 8. Gardasil, manufactured by pharma company Merck Frosst, is the commercial name for a vaccine that is supposed to protect women from contracting Human Papillomavirus (HPV), which can cause cervical cancer.
OHIP, Ontario’s health coverage, won’t pay for the vaccine, which is a pricey $400 per person! The high price tag for a drug that is being touted as a life-saver is not the only thing that has eyebrows raised.
An article in the Canadian Medical Association Journal has claimed that there isn’t an “epidemic” of cervical cancer that requires such widespread vaccination (in 2006, about 400 women died from cervical cancer), and that there are other, effective and less risky ways of preventing cervical cancer that don’t require an expensive and under-researched vaccine.
The Canadian Women’s Health Network has also expressed concern, noting that very few young girls participated in drug testing and that the vaccine might lead girls and women to believe they don’t need to have safe sex or get regular pap tests.
Then there’s the link to big pharma and the industry’s history of questionable practices, particularly when it comes to women’s health (well documented here, here, here, here and many other places).
The Toronto Star article linked above notes that Merck has been actively lobbying Canadian and US governments to create school vaccination programs and that, following a federal government decision to fund a national vaccine program for $300 million, it was revealed that a former aide to Prime Minster Stephen Harper is a Merck lobbyist.
The latest issue of Bitch magazine has an in-depth, critical look at the HPV ad campaign that is well worth a read.
I researched Big Pharma a while ago for an article revealing the myths and big bucks involved in convincing women they need a drug to prevent “female sexual dysfunction.” This HPV campaign seems to be a little similar, a little subtler.
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23 comments
I am in total agreement with the creepiness of Big Pharma and their dubious lobbying tactics.
Having said that, this statement makes me very uncomfortable:
"... there isn’t an “epidemic” of cervical cancer that requires such widespread vaccination... there are other, effective and less risky ways of preventing cervical cancer that don’t require an expensive and under-researched vaccine."
From what little knowlede I have on the subject, there is currently no other way to prevent the spread of HPV barring no sexual contact at all. The virus can be spread even without intercourse, can it not? I do realize that there are many different strains of the virus, and only a few lead to cervical cancer if left untreated, but I currently know of no other way to prevent the spread of HPV that isn't abstinence.
And we all know my feelings on abstinence only education...
I think OPTIONAL vaccination should be available to ALL WOMEN, without cost.
Also, doesn't the "they don’t need to have safe sex or get regular pap tests" comment sound a little bit like the "don't give them condoms or they'll have sex" argument? The rhetoric has me a little worried.
Posted by Stacey May
August 2, 2007, 2:30 PM
Now I can't say that I love big drug companies all the time or that I always endorse them, but in the case of this vaccine I'm pretty happy. Cervical cancer may not be an "outbreak", but it is a terrible cancer that does affect many women and it is unfortunately a cancer that is often not found until later stages of the cancer when many women have the abdominal pain and bleeding symptoms. Not to mention the thousands of women who have genital warts from HPV and must have them removed. Quite frankly, I think that a vaccine against cancer is a good thing. Not only cervical, as new studies are linking HPV to breast cancer too.
Finally, I'm a little disappointed by your mention of the idea that if young girl get this vaccine they will think they do not need to have safe sex. I think that girls are smarter than you are giving them credit for, and if they don't have safe sex because of this vaccine, it will be because of lack of sexcual health education, a whole other issue.
Posted by Evey
August 2, 2007, 2:34 PM
I think the CWHN's concerns about people not getting regular pap tests and taking safe sex seriously comes from the slick marketing campaign that positions Gardasil as a magical cure-all for HPV, a quick-fix that means you never have to worry about anything, ever, again.
I didn't mean to imply that girls won't bother because they're ignorant or easily fooled, and I certainly don't think that's what CWHN -- a feminist organization that believes women know best when it comes to their bodies and sexual health -- would imply that, either.
A big part of the concern over Gardasil is the way it's being marketed. There was virtually no talk of HPV and a vaccine for it a few years ago, then suddenly Merck-sponsored websites and snazzy ad campaigns were all over the place and everyone was talking about HPV and the government is spending billions on a vaccine. Surely women were getting cervical cancer before that?
The research published in the Canadian Medical Association, which the CWHN has posted on its site and is discussing, is cautious about Merck's research, and thinks there needs to be more research before a massive, national vaccine program is rolled out. Check out the list of concerns in their report, which I linked to. Number 7 says that the risks associated with the drug are still uncertain; number 8 expresses concern that Gardasil is positioned as the magical cervical cancer vaccination, implying that it eliminates all cervical cancer, which is incorrect.
Basically their thorough research expresses caution and takes into account the history of drug company marketing.
Posted by Nicole
August 2, 2007, 3:02 PM
Absolutely. It is a "HPV vaccine" and not a "cervical cancer vaccine." In fact, I don't think it even protects against the strain of the virus that causes genital warts, but I could be worng...
Posted by Stacey May
August 2, 2007, 3:17 PM
I agree that it is being marketed as a cure-all, which is incorrect. I wish more people would realize that drug companies aren't looking out for you, they're looking out for themselves, so we need to do the research to make informed decisions for ourselves. At the same time, the Society of Obstetricians and Gynaecologists of Canada, a group whose aim is "to promote excellence in the practice of obstetrics and gynaecology and to advance the health of women through leadership, advocacy, collaboration, outreach and education." recommends the following:
"...we are encouraging [all SOGC members] to consider providing the vaccination to your patients who currently fit the criteria" (Dr Ron Davis, President of the SOGC.)
The SOGC has been watching this vaccine from the start, and they are looking out for women's health, that is to say, my health. And that endorsement does mean something.
(all quotes from www.sogc.ca)
Posted by Evey
August 2, 2007, 3:24 PM
Oh, and Stacy May, the Merck vaccine protects against types 6, 11, 16 and 18, I believe. 16 and 18 are the two most dangerous strains, that cause cancer and 6 and 11 are the two most common strains; they cause the warts.
Posted by Evey
August 2, 2007, 3:35 PM
Thanks Evey - you're really informed!
Posted by Stacey May
August 2, 2007, 4 PM
I'm glad to be able to spread the information I Have :)
Posted by Evey
August 2, 2007, 4:07 PM
Does anyone know why women over the age of 26 are not approved to get the vaccine?
After my big HPV scare I want to get vaccinated but don't think I can, because I'm, well, old...
Posted by Stacey May
August 2, 2007, 4:21 PM
Ooo! Ahh! A topic I actually know a lot about because of my own health network job!
Gardasil may sound great at face value, but it's worth noting that numerous feminist health orgs. in Canada are extremely skeptical of it.
Gardasil's marketing has actually spread a lot of misinformation, and one of the most harmful things they've done is virtually equate HPV with cervical cancer. In truth most women who have HPV do NOT get cervical cancer. Even for women who contract a high-risk form of HPV, the majority of them do not develop cervical cancer.
The pap smear is still considered to be the best way to prevent cervical cancer, even post-Gardasil.
The fact that approximately 400 women a year die from cervical cancer has more to do with access - in the words of the CMAJ article it's "a failure in the adequate support of both the primary care and reproductive health services that would guarantee healthy living conditions for all women." It's not that we don't have the right tools - it's that not all women have access to them. And who is it who doesn't have access? The highest rates of cervical cancer mortality occur among Aboriginal women and low income women. That's a social issue, not a medical issue. And so if the problem is social, a $200 billion vaccine, while amazing and a scientific breakthrough, still ain't gonna fix our social issues.
And I'm not even going to go into the fact that HPV's been totally feminised (why aren't men being vaccinated?) and the shocking lack of resources on HPV for queer women...
I personally think that what Merck is doing is plan awful - they're actually misinforming people, and taking the focus away from the real issue, just to make a buck. If the focus is taken off social systems, the vaccine could actually worsen women's overall health.
Evey: it's not teenage girls and their ability to make good decisions that the CWHN is worried about! They're actually worried about sex educators and syllabuses - once the vaccine is introduced, there are fears that there will be less of an impetus to educate teenage girls about HPV and sex stuff in general, because there's a vaccine that's supposed to take care of it. How are teenage girls supposed to make good decisions without info?
Posted by Thea
August 2, 2007, 4:30 PM
Forgot to say: yes, boo, the only way to avoid HPV is to abstain from sex. So in that sense the HPV vaccine is great.
But this vaccine isn't being marketed as an HPV vaccine, it's being marketed as a cancer vaccine. If it was just a vaccine to prevent HPV (which is uncomfy and sucky, like IBS or allergies or many other chronic health conditions which are so frustrating to live with, but NOT life threatening), it wouldn't be getting crazy funding.
The fact is, cervical cancer can be prevented without the crazy funding (pap smears! whoohoo!). The funding for Gardasil is going to take resources away from other health programs. For a condition that isn't life-threatening? That just don't seem right.
Posted by Thea
August 2, 2007, 4:44 PM
Sorry, but I have to say I would rather not get HPV in the first place than deal with having it the rest of my life. I realize that "Paps prevent cervical cancer," but if abnormal cells are detected you do have to have treatment. Paps are about detection and not treatment.
If I can get a (safe) vaccine that reduces my risk of abnormal cell growth then I'm all for it - the cervical biopsy I had last year was experience enough for me to take any measures to prevent cervical cancer.
I realize that HPV does not mean cancer and cancer does not mean HPV, but IF a vaccine can reduce the risk and I think it's important not to shun it right off as Big Pharma.
This is about access: every woman should have access to the vaccine if they choose to. I'm actually surprised that you would label the government granting access to an optional vaccine for girls as "crazy funding."
As for the "what about boys? thing," I liken it back to the reason we can't get the development of oral contraception for men going. Although HPV can cause cancer in men, it is extremely rare, so it (like oral birth control) becomes a "woman's issue."
Posted by Stacey May
August 2, 2007, 4:59 PM
Sorry, by crazy funding I didn't mean that it was crazy to fund it! I should've said "colossal funding."
I think the big reason why HPV isn't funded for men is because men who have HPV don't get any symptoms. The problem with this, is that it doesn't stop men from giving it to the women they sleep with. In general HPV education and maybe even the vaccine is very heterosexist - it behaves as if only straight monogamous couples exist.
It's a tricky question - would you rather avoid getting HPV in the first place, and possibly cervical cancer, and having to undergo successful but painful treatment, even if it meant sucking funding out of other health programs?
I have IBS (I've got two colonoscopies under my belt. I wouldn't recommend them) and I wish someone would come up with a cure. I can't drink much, my bowels are constantly, uh , irritated, and I can get a dehabilitating stomach at any time. But I'm not sure that I would advocate coming up with a cure if it meant funneling funding away from diseases that do threaten lives, or maybe have heavier social ramifications.
I think there are still questions as to whether or not the vaccine is safe, I think there hasn't been enough testing yet.
If you haven't read it already, I totally recommend the CMAJ article, it's really interesting and not very long: http://www.cmaj.ca/cgi/rapidpdf/cmaj....
Posted by Thea
August 2, 2007, 5:17 PM
I don't know, Thea. Doesn't that open the door for the government to decide who is "worse off?" What diseases are "harder to cope with?" Who suffers more? The example that came to mind was funding for mental illness treatment and prevention - prevailing social stigmas prevent many from even recognizing mental illness as an illness as all. By the "maybe money should go to things that are really bad" logic I doubt funding would be allocated to groups that assist those living with mental illness...after all, depression, anxiety,etc. are not "life threatening" in the traditional sense. They're just "life ruining."
I see what you're saying, but if there is some way every girl can have access to the HPV vaccine and it will save a few lives, I'm all for it - even if it leaves a bad taste in my mouth.
Posted by Stacey May
August 2, 2007, 7:17 PM
You make a good point. What I meant was that if HPV itself isn't life-threatening, and if pap smears are still the best way to prevent cervical cancer, should an HPV vaccine be taking funding away from diseases that are life threatening?
You're so right that social stigmas shape our healthcare system. As a society, we tend to put band-aid cures on things instead of getting to the bottom of them. If the highest numbers of women who are dying from cervical cancer are Aboriginal women and lower income women, why aren't we dealing with that, and trying to figure that out, instead of (or maybe alongside) paying for the vaccine? The concern about Gardasil put forward by feminist health orgs. is that it's preventing us from getting to the bottom of things.
Big Pharm is bad - but that doesn't change the fact that its creations save people's lives all the time. In this case though, I think Merck could be doing more harm than good - especially when the long term effects of the vaccine are still unknown.
Anyways SM, I'm glad to hear all your thoughts on this! In my job with a feminist health org. I tend to be surrounded by people who think Gardasil is a bad idea - hearing your opinion is really helpful.
Posted by thea
August 2, 2007, 7:33 PM
Thea, the education comment was not directed at teens, but at the fact that sex ed isn't always what it should be. And we should continue improving it.
I totally agree with you that Pap smears are essential to ensuring you stay cervical cancer-free. The problem is many women (like women in Aboriginal communities, as you mentioned)do not get Pap smears and it is these women who are most likely to get cervical cancer. Much needs to be done, socially. To start, why don't we make sure all canadians are vaccinated? This is a huge break through in medical science. It is the first time in medical history that there is a vaccine against cancer -- and this is what it is. 90% of cervical cancer is caused by HPV and it is the second highest cancer killer of women, second only to breast cancer, which has also been linked to HPV.
As to why the vaccine isn't available to men -- it is likely that the vaccine will be available to men in the next 12 months. This delay is because HPV does affect women more than men (although men can get anal, testicular and penile cancers from HPV as well). It is not a "women's problem". It is a solution for women.
As for Merck's problems -- they are a Big Pharmaceutical company, yes, so they are out to make a buck and out for themselves. But it would be cutting off our noses to spite our faces to push this breakthrough away because it is coming from Big Pharm. To make Merck more socially concious, why don't we lobby them to donate vaccines to clinics where women who would never have access otherwise can get the vaccine? Women who will never get Pap tests, women who wear burkhas and chadors, whose husbands will never let them get Pap smears but who can get a needle and can protect themselves. I'm not trying to make sweeping generalizations, merely a suggestion. This vaccine can do so much good.
The idea that this is siphoning money away from other health issues frankly makes me a little annoyed, because this will in fact save so much money. As I said, HPV causes 90% of cervical cancer -- without that 90%, so much money will be saved in terms of expensive, stage IV cancer treatments, all the way down to the wart treatments that come with HPV. Maybe not immediately, but in the long term, this will save so much money.
This vaccine has been in developement for over 20 years and clinical trials for 5. It has recieved exactly as much scrutiny as all other vaccines before they go to the public. Clinical trials continue, it will be monitored on an ongoing basis -- just like every other vaccine. Why should we waste time over-scrutinizing when real lives can be saved. Scientific research on the long-term impact of the immune impact shows that if the vaccine is given to a 12-year-old, the immunity will be enhanced as time goes on. Why wait? We can help women. We can help an entire generation of teenagers, girls and guys. Why wait? Why put our cervixes on the line in order to "teach a lesson" to Big Pharm.? It is my body and as a socially-concious young woman, I feel my body will be of more use to any cause to which I want to lend it if I don't have cervical cancer.
The fact is, cervical cancer prevention is a women's issue -- so let's take control.
Posted by Evey
August 2, 2007, 9:02 PM
NEWSFLASH! This just in (via feministing):
"An epidemiologist and her research team has found traces of HPV in young men's fingernails. Yes, fingernails.
Laura Koutsky of the University of Washington suggests that these new findings could mean that HPV has other means of transmission, which could potentially put the "moral" debate of the HPV vaccine to rest. Unless, of course, they're anti-fingers too."
Posted by Stacey May
August 3, 2007, 8:38 AM
By the way, Thea, it's interesting that you say "in my job with a feminist health org. I tend to be surrounded by people who think Gardasil is a bad idea." I've been trying to get the vaccine ever since I had an abnormal Pap and was tested for the HPV virus strains that cause cancer. I requested it from three doctors and each one said "I didn't need it" because I was in a long term relationship and was "too old." I wasn't really satisfied with that answer, and it makes me wary to hear you say that feminist health org professionals are wary of the vaccine. It works both ways; I usually go to feminist and choice oriented health professionals so I can have a complete set of options, not so they can deny me the choice.
Posted by Stacey May
August 3, 2007, 8:54 AM
I don't think feminist health orgs are trying to deny women choices! I think you're right Stacey May when you say all women should have access to it - I think I would feel better about the vaccine if it was one of those things that the govt. will pay for, but not something that was introduced into schools en masse. That way, if you want the vaccine you can get it.
Evey - the vaccine isn't a cancer vaccine, it's an HPV vaccine. It only vaccinates against four types (the most common types, so that's great) but there are over 70 types.
Pap smears are free and available to all women, but not all women are getting them. The concern with the vaccine is that it will cost a lot of money for an already over-stressed system, but it may not even work - as in, it may get to the women who are already getting pap smears and protecting themselves against cervical cancer, but not to the women who really need it, as in the women most vulnerable to cervical cancer.
It's not at all about teaching a lesson to Merck - that would be, as you say, pretty childish! There's been loads of times in my life when I've taken pharmaceuticals. But I won't take pharmaceuticals that are just going to make things worse for my body in the long run.
My problem with Merck is that I think they're misrepresenting - I'm not sure the vaccine really is going to achieve what it's supposed to. And if it doesn't work, that's a really expensive mistake. That's why I think the vaccine should be available, but not introduced into schools just yet.
So let's just make sure, by considering the questions and reading up about the issues from both sides, that this is really a good thing for women's health.
Posted by Thea
August 3, 2007, 1 PM
Thea, there are actually well over 100 types of HPV, and yes this vaccine does not protect against all of them -- hence why you still need Pap tests, even with the vaccine. You say it is not a vaccine against cancer, but those two types of HPV -- 16 and 18 cause 70% of cervical cancer. This is effectively a vaccine against cancer. That's a lot less trauma for a lot less women.
If we make vaccines available, but not vaccinate through the schools, we'll end up with the same problem you mentioned about Pap tests being available to all women but not all get them. By vaccinating in the schools we ensure that everyone gets the vaccine.
This vaccine is not going to be bad for your body in the long run. In fact, its benefits continue to grow as more clinical trials are being done, connecting HPV to other types of cancer (and other places as Stacey May mentioned -- that made me laugh!)
I agree that we should all read up on this issue. Having done so, we could realize what an amazing breakthrough this truly is for women's health.
Posted by Evey
August 3, 2007, 2:11 PM
In Gardasil's product monograph, it is stated that Gardasil has not been evaluated for the potential to cause carcinogenicity and genotoxicity (page 15). On page 8 of the monograph, it is noted that each 0.5 mL dose of the vaccine contains approximately 225 µg of aluminum (as amorphous aluminum hydroxyphosphate sulphate adjuvant).
http://www.merckfrosst.ca/assets/en/p...
Amorphous aluminum hydroxyphosphate sulphate is another name for aluminum hydroxide. A recent study found that aluminum hydroxide used as an adjuvant can contribute to motor neuron death in mice:
http://www.ncbi.nlm.nih.gov/sites/ent...
Although Gardasil has not been on the market for very long, there are already over 2,500 adverse reactions or events listed to it on the VAERS database:
http://www.medalerts.org/vaersdb/find...
These are likely only a small percentage of actual adverse reactions, because it is estimated that only about 10% (or less) of adverse reactions ever get reported to the Vaccine Adverse Event Reporting System.
Posted by Aasa
August 7, 2007, 10:15 PM
The Globe and Mail has an interesting piece about Gardasil that explores some of the controversy and concerns we've been discussing: http://www.theglobeandmail.com/servle...
Posted by Nicole
August 12, 2007, 3:38 PM
One more interesting article about Gardasil (though unfortunately Gardasil is spelled wrong in it): http://lfpress.ca/newsstand/News/Loca...
- This quote relates to something I was worried about, i.e. the funding for the vaccine:
"Nisker said he welcomes the amount of money governments are prepared to pour into the vaccine, but suggested it might be better spent on higher-risk diseases such as inherited breast cancer.
'We are competing for scarce funding in women's health,' he said."
- And then this one refers to the SOGC (who Evey mentioned):
"Supporters of the vaccine have rebuked the medical journal and the authors, saying their questioning of the vaccine 'is not grounded in scientific evidence.'
'The comments . . . have created fear and skepticism about one of the most extensively tested vaccines and one of the most important health-care initiatives of the century,' said a statement issued by the Society of Obstetricians and Gynecologists of Canada."
It's amazing how mixed info is on whether or not the vaccine has been tested enough.
Posted by thea
September 5, 2007, 2:18 PM
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