HPV Vaccine: Not a Silver Bullet

I recently saw one of Merck's "One Less" commercials that depict ethnically diverse, physically active, and attractive women discussing the importance of being vaccinated against cervical cancer. All of these women want to be "one less" woman with cervical cancer. They urge everyone to share information about this vaccine with loved ones so that they too can be "one less" woman with cervical cancer.

The new vaccine, Gardasil®, manufactured by Merck Pharmaceuticals, has been approved by the Food and Drug Administration (FDA) for young women, ages 9-26. Clearly Merck is putting a lot of money behind promoting this vaccine to young women. But this captivating commercial can lull young women into a false sense of security about their reproductive health.

"Want to protect yourself against cervical cancer—don't forget to get your Guardasil® shots!"

Don't get me wrong, I support any medical breakthrough than can protect women from this tragic disease. Glamorous commercials aside, all young women need to educate themselves on the causes, symptoms and prevention of HPV-related cervical cancer. Women should know that the human papillomavirus (HPV) is a sexually transmitted infection (STI); only direct skin-to-skin contact is needed for transmission. They should know that there are over 100 strains or types of HPV, thirty of which are sexually transmitted and can infect the genital areas of both men and women. They should know that, according to the Centers for Disease Control (CDC), HPV is one of the most common sexually transmitted infections (STIs) in the United States. In fact, recent estimates by the CDC suggest that one-half of sexually active women will contract genital HPV infection in their lifetimes.

It is important to note that 90% of infected women will not have any symptoms and their immune systems will clear up the virus within two years. What does that mean for the other 10%? These women could potentially develop persistent infection that can increase the risk of cervical cancer. In 2002, 3,952 women died of cervical cancer. The majority of these women did not have access to routine gynecological care. They did not get annual PAP tests that would have detected abnormal cells indicating the strain of HPV that causes cervical cancer. The striking statistics show that HPV infection can affect all women. However, it is women who are poor and without access to health care that have the most negative health outcomes, including death.

How will this vaccine help them? Current estimates suggest that the recommended full series of three shots will cost approximately $360. How will poor and young women access the vaccine? How will the millions of women without health care coverage pay for the vaccine? Under the publicly funded Medicaid program, which provides care for extremely low income populations, vaccines are an "optional" benefit. This means that states can determine if they will provide the vaccine or not. For uninsured and low income women who do not meet federal poverty standards, Merck Pharmaceuticals has announced its "patient assistance program", an initiative which claims to provide vaccines at low or no cost. However, this program will only be administered through private practices where Merck vaccines are already provided. Just how Merck Pharmaceuticals believes low income and uninsured women can gain access to expensive private clinicians remains unanswered. While I do not deny the efficacy of and the need for the vaccine, I do not want reproductive rights activists or Merck Pharmaceuticals, for that matter, to forget that alarming disparities in health care access and a glaring gap in vaccine provision still exists. The fact remains that this vaccine will remain out of reach for millions of women including those most at risk from complications.

Other important issues include the questionable period of effectiveness.

We must develop a more comprehensive approach to help protect all women from many types of STIs, unintended pregnancy, and HIV. More widespread and comprehensive education about general gynecological concerns, how to tap into free and low cost health care services, and when to seek medical treatment are necessary ingredients to ensuring that all women receive the type of reproductive health care services that can prevent cervical cancer. Winning access to routine PAP tests for all women would help save lives. Something as "simple" as promoting consistent and continuous condom use to reduce the risk of contracting HPV would be an integral part of this endeavor.

I applaud the marketing professionals who created the "One Less" campaign—it has created a buzz about the vaccine. But as a sexual and reproductive rights advocate and woman of color, I cannot let the promise of a "silver bullet" deter me from fighting for a more equitable society that embraces the idea that all women, regardless of age or economic status, deserve quality and affordable health care. As activists, let's campaign not for "One Less," but for "no more."

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  • mernlar

    Another important thought is that getting the vaccine will not protect women against ALL strains of HPV that can result in cervical cancer–most, but not all, and therefore regular screening will still be an important part of reproductive health. Vaccination is still important, but unfortunately, the people for whom the vaccine could be most useful are the people to whom it is least accessible–women who can't afford or don't have access to basic reproductive health care.