The rapid introduction of the most expensive vaccine for public use in Canadian history has sparked a great deal of debate. Safety, effectiveness and moral debates about Gardasil are popping up everywhere. Mothers are worried, trustees are worried, clergy are worried and even us doctors were caught off guard with how quickly this program was launched, paid for and shipped off to our schools.
Human Papillomavirus (HPV) has been around for eons, and 96% of the varieties are harmless. It is spread by close intimate contact of mucus membranes. There are over a hundred varieties of HPV. To acquire a genital subtype, you need susceptibility and intimate contact with a carrier. Now if you are only fishing for types 16 or 18, then statistically, you need a lot of varied contact. This is the basis of moral arguments.
Like many other things we humans carry, sometimes HPV is invisible making those carriers hard to spot. Other times, it may result in the growth of a fleshy wart. These warts are caused by HPV types 6 and 11, and are not linked to cancer. But types 16 and 18 have been linked to some types of cervical cancer. Gardasil targets these 4 HPV types.
In Ontario, cervical cancer is ranked 11th as a cause of death. Theoretically, it is almost totally preventable if all women participated in regular PAP screening, since precancerous stages can be identified and destroyed. Gardasil will not eliminate or cure cervical cancer, but it will probably lower the number of cases we see. When Health Canada approved it for use in 2006, the selling rhetoric was that it may eliminate the need for PAP tests. That is not true, and even the manufacturer stresses the need to continue PAP testing.
Gardisil is made by one company with no market competition. The market price is close to $500 for all 3 shots. The National Advisory Council on Immunization (NACI) is the body of experts that evaluates vaccines. Their mandate is scientific and noble, but many members receive funding from pharmaceuticals. It is a part of academic life on the promotional lecture circuit.
NACI rates Gardasil as a safe vaccine with side effects comparable to other routine vaccines and only released its recommendations in February 2007. In a few short months, the provincial government endorsed administering it to grade eight girls only. Vast quantities of money emerged to purchase pricey vaccine and pay for administration in schools. There was no feedback sought from family doctors, and the uncanny timing just before an election is a little suspect.
I have no idea what this program costs, and am concerned for the great number of young women in my practice that have been excluded. Many young women, if given $500 for healthcare, would prioritize it to other health concerns. There is also nothing wrong with giving Gardasil to young men. They may not have a cervix, but are an integral part of transmission.
I am not anti-vaccination by any means. I have a visit to Dr. Gindis travel clinic and two sore arms to prove it, as I made an informed decision to prepare for my trek in the Andes. Not all vaccines need a massive immunization strategy to be effective. It worked with smallpox, and the results were stunning. Rabies, Hepatitis A, Typhoid are examples of educated choice being effective alternatives.
Avoidance of HPV or any sexually acquired infection is a topic worth discussing with young people. Morality is an integral part in this type of discussion. In the case of HPV, I suppose advocating moral ideals is an alternative to vaccination.
More importantly, I believe that in a social based health care system, the tax-payer should have more say in how we devote our funds. With the advent of recombinant DNA technology, we can expect a plethora of other vaccines to soon appear. We need to make some hard choices about how best to devote our limited resources.
The Gardasil program is a done deal, bought and paid for. Few doctors will advocate against it at this point. At this juncture, our role is to encourage open discussion, even though this program will continue to confound my ability to maintain accurate vaccination records since family doctors are left out of the loop.
WARNING! 10 Things You Might Not Know About Gardasil! From Care2. "1. The vaccine only decreases your chances of getting cervical cancer, it doesn’t eliminate the risk . . . 3. Gardasil is one of the most expensive vaccines ever, at about USD $360 for the series of three shots, plus the cost of doctor visits . . . 5. There have been no long-term studies done on the effect of the vaccine after 5-10 or more years, and testing on young girls has been extremely limited . . . 8. Gardasil is one of many vaccines containing aluminum, and there is increasing evidence suggesting that aluminum-based vaccines can have harmful effects . . . "
Gardasil from Wikipedia, the free encyclopedia. "Gardasil (Merck & Co.), also known as Gardisil or Silgard, is a vaccine proven to prevent certain types of human papillomavirus (HPV), specifically HPV types 16, 18, 6, and 11."
What went wrong with Gardasil by Shelley DuBois, reporter, September 7, 2010, from CNN Money/Fortune. "Gardasil grossed over $1.1 billion within nine months of hitting the market, Merck had distributed 13 million doses of the vaccine, and it had been approved in 86 countries . . . Since then, Gardasil sales have been flat or declining, with analysts expecting the drug to pull in $1 billion in sales for years to come . . . The main problem with Gardasil seems to be the equivalent of a design flaw. To be completely immunized, women have to get a series of three shots over six months. Many women don't . . . "
What Really Went Wrong with Gardasil. "The following adverse reactions and deaths have been reported to the Vaccines Advent Reporting System (VAERS) as of September 2, 2010: ADVERSE REACTIONS: Gardasil - 18,461, Cervarix - 426, HPV Vaccines - 137, TOTAL - 19,024. Deaths: Gardasil 77, Cervarix 4, TOTAL - 81."
What is Wrong with the Gardasil Girls: Kahlia’s Story. "North Hollywood, CA, September 13, 2010 — Norma Erickson, journalist for Examiner.com recently wrote an article about a 17 year-old from New Zealand adversely affected by Gardasil."
Irish Mothers Unite to Stop HPV Vaccine Assault on Their Children . "North Hollywood, CA, September 7, 2010 — The Mothers’ Alliance Ireland (MAI), a committee of Christian Democrats the Family First Party dedicated to protecting the rights of parents and the welfare of children, has spent almost a decade researching the HPV/cervical cancer link and is now actively protesting mandatory vaccination of adolescent girls."
Gardasil from MedLibrary.org. "Gardasil prevents HPV infections, but does not treat existing infection. Therefore, to be effective it must be given before HPV infection occurs. Some HPV strains are sexually transmitted, and HPV-16 has a 60% per-couple transmission rate." History, Clinical trials, Indications and prevalence, Use in males, Administration, Ingredients, Biotechnology, Efficacy, Safety, Public health advantages, Long-term impact and cost-effectiveness, Political controversy.
