Although regular pap smears and preventive treatment have helped make cervical cancer relatively uncommon in the United States—about 10,000 women are diagnosed each year and 4,000 die—the vaccine would have a significant impact in poor countries, where cervical cancer is a leading cause of death among women. With little infrastructure for the preventative pap smears, few women have a chance to detect and treat pre-cancerous changes in their cervix. However, Merck is not marketing or lobbying their product in countries like Africa, where there is little capital to invest in such an expensive vaccine.
“In developing countries, we need to look to philanthropic organizations like the Bill Gates Foundation, because the pharmaceutical companies are not going to provide it for low cost any time soon. Vaccines are expensive to develop and the companies want to make good on their investment,” suggests Ms. Hanson.
In this country, the main benefit of the vaccine may be the long-term reduction in health care costs associated with screening, treatment, and follow-up for pre-cancerous cervical changes. Women who would benefit most from the vaccine are low-income and uninsured women. These women do not have access to regular pap smears, so they are at the highest risk of developing cervical cancer. HPV can lead to anal cancer in immunocompromised individuals, like those with HIV, so they are another high-risk group that would benefit from HPV vaccination. However, high-risk populations are nearly impossible to identify in adolescence, when the vaccination would be most beneficial.
This was a similar case with the Hepatitis B vaccine. When it was first introduced, it was recommended for high-risk groups. However, doctors had a hard time figuring out who the high risk groups were and it ended up being recommended for all children. This resulted in a serious decline in the number of new hepatitis B infections, from 260,000 in the 1980s to 60,000 in 2004, according to the CDC. Likewise, it may be hard to predict which women will not have access to pap smears, or will have a partner that passes HPV to them. Broad vaccination will likely prove to be the most successful approach. Unfortunately, Merck’s overzealous push for mandatory policies has left many people cynical and suspicious of the HPV vaccine, when we should be celebrating an advancement in preventive medicine. Not offering the vaccine to girls would ultimately be a failure on society’s part, but putting profits before lives was Merck’s.
