Vaccines and Corporate Influence

I confess that I'm flummoxed by the people who think that the only possible explanation for Rick Perry's decision to mandate Gardasil (HPV) vaccination--or the only likely one--has something to do with a minor campaign donation, or the fact that his former Chief of Staff ended up working for a pharmaceutical firm.  I like me a good Public Choice horror story as much as anyone, but can we really categorically rule out the possibility that Rick Perry thought that mandating Gardasil was a good way to fight cervical cancer, which claims the life of around 4,000 women every year?  A further 12,000 are diagnosed with it every year, and treatment is painful, frightening, and can permanently impair the fertility of the younger women who undergo it.  Is it somehow crazy to even think that a governor might have wanted to authorize a vaccine which could wipe out many of the most common strains of HPV?


I'm sure Rick Perry's former staffers turn up all the time with ideas that, for one reason or another, he doesn't follow through on.  Being a former staffer gets you a meeting.  It does not get you a politically costly decision that your former boss thinks is an objectively bad idea.

As it happens, the arguments in favor of Gardasil are pretty strong:

HPV causes most of the cervical cancer in this country.  Gardasil and Cervarix, the two approved HPV vaccines, protect against the two most common strains, which together cause about 70% of cervical cancer in this country, as well as the two strains most commonly found in genital warts

HPV is not rare; the CDC estimates that at least half of all people who ever have sex will get it.  You cannot protect your children from it by ensuring that they have strong moral foundations--unless you plan to also guarantee that the person they marry has never had sexual contact with another person.  Even devout Christians who are home-schooled and go to an evangelical college can have a moment of weakness--and of course, Christianity is supposed to welcome people who have found Christ later in life.

HPV is no longer confined to cervical cancer.  Presumably thanks to a boom in the popularity of oral sex, which has gone from a minority taste in the 1950s to part of the standard repertoire of most couples, HPV is now popping up in an increasing number of head and neck cancers, as well as anal cancers (mostly among gay men).  Unlike cervical cancers, we don't do routine screenings for throat cancer, so this may soon be a bigger problem than cervical cancer.

HPV may not even be a traditional STD much longer.  No one seems to know whether oral transmission is possible--I know that with oral gonorrhea, it's pretty rare, because the bacteria only infect the throat, not the lips and tongue.  But if the oral transmission route is possible--as it is with herpes--then your kid might get cancer through french kissing.

The primary purpose of vaccination is not necessarily to protect the vaccinated individual  Vaccines don't always take; they don't help people whose immune systems are suppressed by disease, cancer treatment, or the immunosuppressive drugs we give transplant patients; and immunity can wane over time (which is why you have to get booster shots for tetanus every few years).  Vaccination has been such a great success because it provides something called herd immunity: once 90+% of individuals are vaccinated, it becomes hard for the disease to survive, because the chances of finding a receptive host drop too low.  When vaccination rates fall below 80% or so, you create "reservoirs" of disease that can spread to vulnerable people.  Since schoolchildren were long the primary reservoir, requiring vaccination to attend school effectively eliminated diseases that used to kill significant numbers of children every year.  Even a fairly minor drop in vaccinations has already led to a resurgence of pertussis, which now kills dozens of people a year.

The vaccine is extremely effective, and the reported side effects incredibly low.  As Henry Miller of the Hoover Institution noted on National Review yesterday:

Some critics argued that the vaccine was too new to have been confirmed safe, while others said that Perry's order would preempt parental rights or give girls a false sense of security, possibly causing them to become sexually active at a young age.

Bachmann alluded to the Perry's executive order mandating the exposure of young girls to a "dangerous" vaccine and tried to distinguish Gardasil from other required pediatric vaccines that prevent infectious diseases. Note to Bachmann: The vaccine, Merck's Gardasil, prevents infection with the most common strains of human papilloma virus. Once established, these viruses can ultimately cause genital warts as well as cervical, anal, vulvar, and vaginal cancers. Thus, by preventing the infection, the vaccine prevents all those sequelae.

In the extensive clinical studies (on more than 20,000 girls and women) that were performed prior to the FDA's licensing of the vaccine, the vaccine was 100 percent effective, a virtually unprecedented result. How safe is the vaccine? No serious side effects were detected; the most common side effect is soreness, redness and swelling in the arm at the site of the injection.

Now, maybe you think that this wasn't compelling enough to mandate the vaccine.  As it happens I disagree--I think that preventing the transmission of communicable disease is a clear public health issue, and that frankly if this wasn't an STD, no one would even be questioning whether we should vaccinate for a disease that kills at least 3,000 people a year--more than died of measles in the late 1950s, by the way.  And of course, thousands of more have to go through invasive tests and treatments.


But even if your cost-benefit analysis differs, I don't see how this warrants the conclusion that the only possible reason Rick Perry could have supported mandatory vaccination was corporate influence.  I'm not saying that drug companies are always solid citizens . . . but they do, in fact, occasionally invent things that save peoples lives.  Which means that occasionally they're going to have a good argument when they suggest that the government should deploy their product.
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Megan McArdle is a columnist at Bloomberg View and a former senior editor at The Atlantic. Her new book is The Up Side of Down.

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