Policy Wise

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The HPV vaccine issue in Texas is a classic policy example of ends versus means with a little bit of wacky ideological mixed in for good measure. The genital human pappillomavirus (HPV) is known to cause cervical cancer among women and the chances of an average person getting the disease is quite high. “Since it primarily spreads through sexual contact, at least 50% of sexually active people will get HPV at some point in their lives.

The United States alone accounts for 6.2 million cases every year” [via CDC.] However on the positive side, only 9,700 women with HPV are diagnosed with cervical cancer [in 2006] and at least 3,700 women will die as a result of this cancer. Merck recently introduced a revolutionary vaccine, Gardasil which protects against four types of HPV [70% of cervical cancers & 90% of genital warts]. The FDA approved the vaccine, given over 6-month period through three shots, for use in girls/women ages 9-26. Doctors and researchers recommend that this vaccine ought to be given before the girls are sexually active.

States around the U.S have started strongly recommending the vaccine and although like any vaccine that is newly introduced, the length of the vaccine protection is not known, studies have shown that women followed for fiver years post-vaccines still remain protected.

Texas governor Rick Perry went a step further and made the vaccination mandatory for all girls entering 5th grade mandatory. This unexpected decision shocked Texans and got out protesters of all hues and color right from the politically conservative mold that the government had no business meddling in individual decisions to the morally conservative bunch that the vaccine encouraged promiscuity. I’ll talk about the absurdity of that excuse later. Another accusation is that Perry was pandering to his donor base at Merck because making the vaccine mandatory in Texas which is solely made by the pharma company would reap billions for them. Such lobbyist links aren’t new to Perry as he has been similarly linked to the sale of the lottery with UBS employing his son and recommending the sale. The Texas House Committee has now rescinded his executive order and the legislature would vote on it soon. Chances of the order surviving look bleak.

First of all, is the vaccine really effective? Notwithstanding the ‘accusation’ that we don’t know how long the vaccine will remain effective after being inoculated, the results have been quite favorable. The science community and public health officials are fairly convinced that this vaccine effectively counters against contracting HPV and thus prevents cancer. The side effects, as in any drug, are minor. CDC dismisses these side effects as minor and say that there is no reason for this vaccine to make people more likely to faint. I am surprised that discussion of side effects is even a factor in arguing it. We see drugs for relatively smaller problems like sleeplessness and erectile dysfunction have many more serious side effects but we don’t see any heckles being raised. I guess not getting an erection is a far serious problem than dying of cancer.

Another legitimate concern is the cost. The vaccine costs around $250-350. So if it isn’t made mandatory and subsidized by the government, the poor will not get the benefit. And as opposed to other market goods, vaccines might be a borderline public good. At the same time, it takes billions in R&D for a new drug and Merck deserves its pound of flesh. But the question is, does the vaccine constitute that big of a public interest for the government to subsidize it? And even if it does, it is highly improbable that they would do so fully. The market forces that act to bring down prices will only work if the vaccine is widely available and alternative develop soon enough. Although theoretically, equilibrium would be achieved as soon as a product gain credibility and a market but big pharma tries its best to maintain monopoly for as long as it can and politics-business works against letting the market work as it should. So if ‘left alone’, we can be sure that Merck will try its best through legal or backdoor means to maintain its monopoly. Of course, the government subsidizing it will not help much but with being its biggest customer, it could influence them to be more open and allow for other players to enter the market.

Another rant against the order is vaccinating girls aged 9-12 encourages promiscuity and condones teen sex. I can smell the fear of parents that their children romping around in massive orgies now that they are immune to HPV. As if that was the reason that stopped them from having sex in the first place regardless of the fact that the numero uno of all STDs, AIDs is still ‘un-vaccinable.’ I fail to see how you can stop children from having sex by giving them a vaccine against a sexually-transmitted disease. You mean to say, that you rather have them threatened by a killer disease than have sex? Or sex is far worse than your child’s health or even possible death? Having an abstinence policy as a sole standard in prevention against STDs is as realistic as having ice-cream in onion flavor. You can have it but it just leaves everyone bitter.

Some protesters afraid of the sex-angle are using the libertarian angle to justify their opposition. Their basic grouse - how dare the government tell me what’s good for my children. Perhaps they are right; the government has no business meddling in personal affairs of their citizens but even in a relatively libertarian country like the U.S, the government plays a significant role and largely it have stayed out of the health sector. Every election cycle, the issue of national health care reform is rehashed and each time it fails to get momentum. But in this case, is it really the case of government ruling against individual rights? By an individual, I mean the rights of the children that are being vaccinated. The parents of course are exercising their right over their children thus it is safely assumed that children by their own have no right to make a decision on their own health. In spite of the advice of several expert health professionals , mind you there isn’t one Big Brother who says that the vaccine is good for you, parents believe that they know best.

In most matters, they might but in certain cases they do defer to the experts like when their child falls sick, they respect the knowledge of the doctor to give treatment or when they build a house, they acknowledge that the architect or the contractor knows best. They are encouraged to ask questions at all times but when asked for an expert opinion, most parents tend to trust the expert. So what is different in this case? Is it truly because that the effects of vaccine aren’t known over the long run or is it because it goes against the moral beliefs of the parents and they are using the libertarian excuse as a smokescreen. I would like to correlate the opinions of parents who oppose the vaccine on moral grounds and on libertarian grounds. I bet there is a strong correlation (mind you, not a casual one). Protesters against genuine science that has saved lives has always resorted to sensationalist (and untrue) gimmicks. Remember, the rumor in Uttar Pradesh and Nigeria that polio vaccines make you sterile?

Finally, the important issue of do ends justify the means or vice versa? If we assume that Rick Perry’s motivations behind mandating the vaccine are indeed linked to his dealings with lobbying firms with Merck, does that make his policy faulty? His methods of achieving the goals of public health might be dubious but certainly the larger-picture goals serve a greater public interest. Would you care if Merck made billions but ended up saving the life of your loved one? It boils down to what you dislike more - Merck making billions for a wonder drug or saving at least lives? Of course, the science hasn’t been perfected and there are bound to be exception and some will still die but as the drug develops and more alternatives are available, Merck’s billions will decline and lives saved will increase.

I am not advocating for or against Texas’s mandatory order for the HPV vaccine but simply pointing out the fallacies in some of the arguments against it. If I had a child and there was an option to prevent her from a killer disease, I would avail of any options that science provides us with. She may not be protected beyond five years but I’ll give science five more years to come up with a follow-up vaccine to make prevention complete. Doesn’t the cliche say, prevention is better than cure? We have cliches for a reason. Because they are, if nothing, true.

Technorati Tags: Human Pappillomavirus, HPV, health, Texas, vaccine, Merck, Gardasil, parenting

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