WSJ.com - A Vaccine's Promise

[Guest guest]

Don't know if this WSJ analysis on Gardisil was posted - it was

published about a week ago. Apologies if it was already posted.

Interesting observations on the next blockbuster vaccine, Gardisil, and

questions about mandatory vaccination for infants.

" Dr. Trent, a specialist in adolescent medicine at the s

Hopkins Children's Center, reminds us that what matters is getting

immunized before sexual activity begins. The age at which a particular

young person may become at risk, she says, is for doctors and parents

to determine.

If the government tries to take that choice away and mandates HPV

vaccinations for schoolchildren, it will be time to argue against

coercion. "

http://online.wsj.com/article/SB115344800370713284-search.html?

KEYWORDS=hpv & COLLECTION=wsjie/6month

A Vaccine's Promise

July 21, 2006; Page W11

In 1952, before the first polio vaccine was available, that paralyzing

disease killed more than 3,000 Americans, almost as many as cervical

cancer kills each year now. With last month's FDA approval of the first

vaccine to prevent cervical cancer, there is reason to hope that this

disease and a host of related afflictions may one day be as rare as

polio. So why isn't everybody cheering?

To read some news stories, you'd think that any controversy about the

new vaccine has emanated from " right wing " and " Christian " groups.

Actually, all sorts of parents were stunned when a panel of the Centers

for Disease Control recommended that the vaccine be given to girls as

young as 11, or even nine. The human papilloma viruses (HPVs) that can

cause cervical cancer are sexually transmitted, and the reality that

little children might be at risk is a dismaying reminder of the state

of our society. Not surprisingly, some people also read the CDC's

recommendation as an unwelcome and unwarranted suggestion that

everyone's young daughter is, or soon will be, sexually active and thus

in need of protection. Might this mean that in the future vaccination

will become mandatory?

Less fathomable in a way is the complaining in op-eds and other venues

by people who might be called liberals. They can't bring themselves to

fully celebrate a cancer vaccine because it won't be instantly

available to everyone. Women in the Third World, where cervical cancer

claims the bulk of its victims, can't afford a $360 course of HPV

immunization -- so only the rich people and pharmaceutical companies

benefit, one lament goes. And wouldn't more American lives be saved if

the government spent money instead on reaching more people with basic

health care?

Let's get real, starting with a little science. Dr. Keertie Shah, a

virologist at the s Hopkins Bloomberg School of Public Health, has

done crucial research linking HPV to cervical cancer. He told us that

he is excited about the new vaccine not only because it can block

cancer but because immunization can prevent the protracted (and

expensive) treatment that many women now undergo, amid great fear, to

deal with the results of problematic Pap smears, including so-called

precancers.

The new vaccine is made by Merck and called Gardasil. Dr. Shah believes

that it and other vaccines under development may also prove effective

against a range of genital cancers and, he adds, a rare but horrifying

condition that affects the infants of some HPV-infected mothers,

leaving the children to face perhaps 100 operations for wart-like

growths in their throat.

At the same time, Dr. Shah does not believe that states should or will

make HPV vaccination mandatory. That's not necessary, he says, because

the virus is not an infection, like measles, that can be spread by

casual contact. As for those 11-year-olds, Dr. Trent, a

specialist in adolescent medicine at the s Hopkins Children's

Center, reminds us that what matters is getting immunized before sexual

activity begins. The age at which a particular young person may become

at risk, she says, is for doctors and parents to determine.

If the government tries to take that choice away and mandates HPV

vaccinations for schoolchildren, it will be time to argue against

coercion. For now, we can predict only that the cost of delivering

cervical-cancer protection to willing women and families everywhere is

bound to decline as demand grows and experts develop more vaccines and

simpler ways of delivering them. That will be the next great news.