Is the HPV vaccine a victory for women’s health or the triumph of aggressive marketing?
Canadian reporters struggle to shed light on a muddled debate that’s as much about business as it is about health.
When federal Finance Minister Jim Flaherty announced $300 million in funding for a program to vaccinate girls and young women against the virus known as human pappiloma, it was hailed as the most important development in women’s reproductive health since the Pill.
This vaccine promises to tackle more than the warts caused by certain strains of HPV. It is billed as the first-ever anti-cancer vaccine designed to prevent the vast majority of cervical cancer cases.
But it’s too early to tell whether this is just a victory for women’s health or also the triumph of an aggressive, multimillion-dollar marketing campaign that has infiltrated our living rooms and the political backrooms.
The process has been so tainted by one drug company pursuing its own commercial interests that it’s difficult to know whether financing the human pappiloma virus (HPV) vaccine is the right decision from a public health perspective. It might well be, but the heavy lobbying effort, from the prime minister’s former aide on down, muddles the debate.
In coming weeks, the Ontario government is expected to announce its financing of the vaccine, which in partnership with federal funds, is crucial to the establishment of an HPV vaccine program. The province, like Stephen Harper’s Conservatives, has come under intense drug company lobbying.
Meanwhile, we have seen health officials and women’s groups debate the merits of this vaccine on the front pages of newspapers. Many are in favour of the vaccine, calling it a revolution in health care, while others aren’t so sure it’s necessary and wonder if other health care needs are more pressing, such as reducing wait times for cancer surgery or the doctor shortage.
Parents have weighed in, admitting they don’t know whether they want their preteens and teens vaccinated.
Many people are confused. No wonder. This isn’t just a health story, it’s a business story, and when we look at it in that light, the urgency around the issue makes more sense.
The multinational drug giant Merck Frosst makes Gardasil, the only approved HPV vaccine available, and it has a lot riding on a successful launch of the vaccine.
According to last week’s Wall Street Journal, Merck faces patent expirations on other best-sellers and legal costs related to Vioxx, the withdrawn painkiller linked to heart attacks and strokes. Some analysts believe Gardasil’s annual sales could reach $2 billion U.S. or more by 2010.
Until its competitors can get their own versions of an HPV vaccine approved (GlaxoSmith Kline has one in the pipe), Gardasil is the only girl in the pageant. And that makes Merck quite keen to see a government program to finance wide-scale vaccination while it has the only vaccine on the market.
But in order to create a public appetite for the vaccine, it must convince us our daughters need this vaccine. It also has to deal with our lapses in medical knowledge (who knew a virus caused cancer?), as well as our squeamishness around an issue most of us don’t want to think about — our preteen girls one day having unprotected sex.
Sheila Murphy, spokeswoman for Merck, explained in an e-mail how difficult it is to explain Gardasil to the masses.
“The fact that a virus causes cancer, in this case anogenital cancers, is a big paradigm shift for many people,” she wrote, adding, “When I started working on the Gardasil team, I didn’t know that HPV was the reason I
was having a Pap test.”
She said it’s equally challenging to communicate to people that a vaccine exists to prevent those cancers.
“We are working with individuals and groups who share our desire to improve the wellness of Canadian women by communicating information on HPV.
“We are using all the channels of communication open to us to get the message about our cancer-preventing vaccine out.”
Gardasil is a three-course vaccination that prevents four strains of the human pappiloma virus, including HPV 16 and 18, thought to cause 70 per cent of cervical-cancer cases. While cervical cancer is common in developing countries, it’s relatively rare in North America. About 400 women will die of cervical cancer each year in Canada. Women already have a very effective method of prevention — regular Pap tests. During the past five decades, this exam has contributed to an 80 per cent reduction in cervical-cancer deaths. However, some critics argue the $300 million would be better spent ensuring Pap tests for immigrants, aboriginals and women who live in poverty — all disproportionately represented among cervical cancer cases.
It’s expected the vaccine will not only reduce cancer deaths but the number of actual infections, the developments of precancerous lesions and the need for biopsies. In Canada and the U.S., even before the vaccine was approved, Merck financed information campaigns that linked the little-talked-about human pappiloma virus with cancer.
Last April in the U.S., Merck began the “Tell Someone” advertising campaign featuring girls (actresses), in interview style, expressing surprise about the cause of cervical cancer and promising to tell other women.
These ads didn’t mention the vaccine — Merck wasn’t allowed because it hadn’t been approved by the Food and Drug Administration — but represented a first step in linking cancer with a virus. At the time, a Merck spokesperson denied the campaign had anything to do with the vaccine.
In Canada, women can consult www.tellsomeone.ca, which describes the link. It also tells viewers about a vaccine against HPV but, of course, Merck’s name isn’t mentioned because direct-to-consumer advertising for cancer therapies is not allowed.
Once the FDA granted approval in the U.S. last June, a full-scale ad campaign began which Canadians are generally exposed to because these advertisements show up in our homes on American TV channels.
In one TV spot, girls skipping ripe on a sidewalk are chanting: “O-N-E-L-E-S-S.
I want to be one less. One less.” In another, a young women skateboarder faces the camera and says, “I could be one less. One less statistic.” The ads are poignant and gripping.
In Canada, we won’t be seeing the “One Less” type advertising. While direct-to-consumer advertising is generally allowed for vaccines, in the case of Gardasil, Merck cannot mention cancer in any ads. This has to do with the classification of the disease.
In the absence of the TV ads, Merck has to rely on various doctors and women’s groups to promote the product. It hasn’t been difficult.
A spokeswoman for the Society of Obstetricians and Gynecologists of Canada told the Citizen that Merck gave the doctors’ group a $1.5-million grant to educate people about HPV. The SOGC’s website on the issue (www.hpvinfo.ca) does not mention Merck, but serves the larger purpose of educating people about the cancer/viral link.
The society, which has come out strongly in favour of the vaccine, was only too happy to oblige when asked by Merck to educate the public about HPV. One of their main mandates is public education, said SOGC spokeswoman Kelly Nolan. Dr. Vyta Senikas, the executive vice president of the SOGC, said that aggressive marketing of products is a fact of life. She likened Merck’s marketing of Gardasil to Microsoft’s marketing of the video game system Xbox. She said physicians are smart enough to withstand any undue pressure and believes Canadians will receive unbiased information about a new product she thinks is revolutionary. She stressed that, despite Merck financing, all information coming from the SOGC is peer-reviewed and fact based.
Merck has also had to convince lawmakers of the vaccine’s value, which has been particularly difficult in some parts of the U.S., where the Christian right feared protection from a sexually transmitted disease might lead to promiscuity.
Still, with the U.S. Centers for Disease Control and Prevention recommending the vaccine for females between the ages of nine and 26, Merck, which has lobbied state-by-state to get vaccination laws passed, has had many successes. Twenty states are considering mandatory vaccination, while Texas* and Virginia required it for girls entering sixth grade.
In February, Merck halted its lobbying when it was learned that at least some of the lawmakers had accepted donations from the company. The Associated Press reported the Texas governor’s chief of staff met with key aides about the vaccine the same day its manufacturer donated $5,000 to the governor’s campaign. An organization backed by the company continues to push for similar laws.
In Canada, the campaign to make the vaccine a must-have for every preteen is more of a backroom affair.
Shortly before Flaherty announced funding for vaccination in the budget, Merck hired Ken Boessenkool, a former aide to Prime Minister Stephen Harper, to lobby the federal government. Boessenkool works for Hill & Knowlton, a giant public relations and lobbying firm. After his hiring was revealed by the Citizen, a Merck spokesperson said Hill & Knowlton
would help explain the importance of the new vaccine to policy makers.
Now, with the federal money committed, Merck is lobbying the individual provinces for matching funding and the establishment of vaccination programs.
Last month in Ontario, two lobbyists registered on behalf of Merck to lobby the health minister and others on “the proposed policy decision to support a childhood immunization program for HPV and funding related thereto.” Both men work for Hill & Knowlton. One of them, Jason Grier, was the former executive assistant to Health Minister George Smitherman.
Merck has also courted other groups with the power and potential to lobby the Ontario government. The seemingly innocuous health committee of the Ontario Chamber of Commerce, for example, is considering a resolution that, once passed, would urge the Ontario government to expedite funding of vaccines.
Why would this group have much interest — except as parents — in the funding of Gardasil? In fact, the committee counts as members representatives of the pharmaceutical industry, including one from Merck.
Another pharmaceutical industry representative on the committee — Jeff Connell, who works for the Canadian Generic Pharmaceutical Association — told the Citizen he has complained about Merck’s involvement in the resolution.
“Once I found out that the OCC Health Resolution was part of Merck Frosst’s international campaign to get governments to pay for Gardasil, I raised concerns with the OCC Health Committee,” he said.
Prior to this resolution, he said the issue of immunization had never been raised at the committee.
He said he told the committee, “I just can’t seem to shake the feeling that the immunization funding resolution represents the voice of Merck Frosst far more than the voice of Ontario business.”
Connell wrote to the group, asking them to reconsider the resolution, although he acknowledged it would still be passed.
So there you have it: A very small glimpse into the lengths Merck has gone in order to convince politicians and the people that millions of Canadian girls and young women need this vaccine.
Reprinted With Permission: Ottawa Citizen
