Merck Encouraging States To Mandate HPV Vaccine For Middle-School Girls

Merck recently has been providing lobbyists throughout the country with information about its human papillomavirus vaccine Gardasil in an effort to encourage states to mandate that middle-school age girls receive it, the Baltimore Sun reports (Smitherman, Baltimore Sun, 1/29). FDA in July 2006 approved Gardasil for sale and marketing to girls and women ages nine to 26, and CDC's Advisory Committee on Immunization Practices in July 2006 voted unanimously to recommend that girls ages 11 and 12 receive the vaccine. Gardasil in clinical trials has been shown to be 100% effective in preventing infection with HPV strains 16 and 18, which together cause about 70% of cervical cancer cases (Kaiser Daily Women's Health Policy Report, 1/25). According to the Sun, since Gardasil's approval more than 12 states have introduced legislation requiring that girls receive an HPV vaccine. Merck also supports requiring private insurers to cover Gardasil, which costs $360 and is administered in three injections given over six months, as well as funding for programs that help defray vaccine costs for low-income and uninsured children, the Sun reports.

Advocacy, Reaction
Women in Government, a nonpartisan organization of female legislators across the U.S. that receives corporate donations from Merck, has been lobbying lawmakers on the issue. For instance, Maryland Sen. Delores Kelley (D), who introduced a bill that would require girls entering the sixth grade in the state to receive Gardasil beginning in September 2008, said she heard of the issue through Women in Government. Susan Crosby, president of Women in Government, said that the group receives "unrestricted" grants from Merck and that it determines the content of its educational efforts. Merck has its "own marketing team," Crosby said, adding, "We don't go hand-in-hand with a lobbyist to talk to a legislator." Some critics say that Merck is able to promote its products to lawmakers through a third party by donating to nonpartisan groups. Doug Stiegler, executive director of the Maryland Family Protection Lobby, said, "What I don't want is for Merck to come to the state and say we want to make millions of dollars from this, and we want you to mandate this for every schoolgirl who comes down the pike." Kelley and co-sponsors of the Maryland legislation said improving public health, not corporate interests, motivated them to introduce the legislation. Kelley added that parents who object to the vaccine for moral or religious reasons can opt out of the requirement. According to the Sun, some health experts have said mandating Gardasil is premature, and the American Academy of Pediatrics is advocating a "go-slow approach" that focuses on raising awareness of HPV and monitoring the safety of the vaccine. Jennifer Allen, a Merck spokesperson, said the company's goal is to "support state efforts to implement policies to ensure Gardasil is used to achieve what it was designed to do, and that's to reduce cervical cancer and other HPV-related diseases," adding, "It's a public health goal that everyone has" (Baltimore Sun, 1/29).

CBS' "Evening News" on Friday reported on legislation that would mandate girls entering sixth grade receive an HPV vaccine. The segment includes comments from Ken Alexander, a pediatric infectious disease expert at the University of Chicago, and Illinois Rep. Naomi Jakobsson (D), who has introduced HPV vaccine legislation (Bowers, "Evening News," CBS, 1/26). Video of the segment is available online in RealPlayer and Windows Media Player.

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