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Demand is high for the cervical cancer vaccine Gardasil across Mississippi, despite the controversy surrounding it.

“In the last quarter, we’ve administered almost 6,000 doses in the entire state,” said Liz Sharlot of the Mississippi Department of Health. “It’s available at all 82 of our clinics for women ages nine-18 for a fee of $10.”
At clinics which don’t receive government subsidies to make the shots so affordable, it can cost $120 a dose, or $360 for all three required doses, which are given over a six-month period.

Dean Cromartie, MD, said there are many requests for Gardasil for young gynecological patients of all social and economic levels at the Women’s Pavilion of Wesley Medical Center in Hattiesburg.

“Even I see a lot of it and I’m 61 years old and a lot of the kids I delivered are coming in with their own children and even grandchildren,” Cromartie said. “The concern is, what we have to be careful of, is to tell the patient that this vaccine protects against only four strains of cervical cancer.”

The vaccine protects against strains 6, 11, 16 and 18 of the human papilloma virus. Two of those strains cause 70 percent of cervical cancer cases, and two cause 90 percent of genital warts. Although many strains of HPV are innocuous, some can cause cancerous lesions on the cervix, making them the primary cause of that cancer in the United States. Each year, more than 10,000 women in the U.S. are diagnosed with cervical cancer, and more than 3,700 die from it.

In Mississippi, dozens of women die each year from cervical cancer, according to the MDH.

Cervical cancer is preventable, and if caught early, there is a much greater chance of it being treated successfully. The cancer develops slowly and there are no obvious symptoms. Annual Pap tests are recommended for women to detect the cancer early enough for treatment. The Pap test detects changes to the cervix that may be signs of cancer. All women should have a Pap test within three years of becoming sexually active, or by the age of 21, according to the MDH. Its Breast and Cervical Cancer Early Detection Program offers free cancer screenings to women who qualify.

The official Gardasil Web site says the vaccine should be given between the ages of nine and 26. The manufacturer, Merck & Co., said the most common side-effect is swelling at the injection site. CNN reported on July 7 that the Centers for Disease Control has received 7,802 reports of “adverse reactions” to the shot, including nausea and paralysis.

The vaccine is not a live virus, but contains virus-like particles, empty shells with immunity-stimulating particles on the outside and no viral machinery inside.

GlaxoSmithKline is developing a competing vaccine, Cervarix, which targets two strains of HPV, 16 and 18, which are the ones most commonly linked to cancer.

Merck recommends that girls get the shot just before puberty to make sure they are protected before they become sexually active. That’s where the controversy comes in. Conservatives and even some parents fear that giving the shot to their daughters will encourage sexual promiscuity.

“That same argument was used against birth control pills,” Cromartie said.
Advocates say giving young girls the vaccine will prevent thousands of malignancies.

“If you really want to have cervical cancer rates fall as much as possible, as quickly as possible, then you want as many people to get vaccinated as possible,” Mark Feinberg, Merck’s vice president of medical affairs and policy, told the Washington Post in October 2005, before the vaccine hit the market. He noted that “school mandates have been one of the most effective ways to increase immunization rates.”

Making it mandatory for girls to have the vaccination is going too far, some opponents say. They want it left up to parents to decide if their daughters should have the shot.

“While we welcome medical advances such as an HPV vaccine, it remains clear that practicing abstinence until marriage and fidelity within marriage is the single best way of preventing the full range of sexually transmitted diseases,” the conservative Family Research Council said in a statement quoted in the same Washington Post article.

Merck’s Feinberg said there is no evidence to suggest that the shot would promote sexual activity. “It is not our intention in any way, shape or form to promote our vaccine as a substitute for any other prevention approach, be it abstinence or screening,” he said.

A Hattiesburg mother, who was uncomfortable talking on the record about the vaccine because it involved her daughters’ sexuality, said that she is glad they won’t have to get the vaccine for a few years because she wants to make sure it’s safe first — it was approved by the Food and Drug Administration in June 2006 — but she said she does plan to make sure they get the vaccination.

“I hope they will wait for marriage before they have sex, but better safe than sorry,” she said.



August 2008

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