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A decade after first becoming available, the HPV vaccine is still a hard sell.

A new study finds that only 21 percent of parents believe that a law requiring vaccination for attending school is a good idea, and 54 percent disagreed with the notion of such a requirement for school entry altogether. What might make them change their minds? Well, 57 percent reported that they could live with the requirement, but only if there is an opt-out provision.

The results suggest that such legislative requirements may accomplish very little. “Opt-outs lead to a large number of parents choosing not to vaccinate their children, and that makes requirements ineffective in raising vaccination rates,” said Noel Brewer, a coauthor and associate professor in the UNC Gillings School of Global Public Health, in a statement.


So far, just two states — Rhode Island and Virginia — and the District of Columbia, require HPV vaccination for entering school. To what extent such legislative efforts will spread around the country seems unclear. Only New Jersey has such a bill pending, while legislation died recently in Hawaii and Maryland, according to the National Conference of State Legislatures.

“It would be hard for lawmakers to enact a policy that has 21 percent support,” Brewer acknowledged. We should note that the study was funded by Merck, which sells the Gardasil HPV vaccine, and that Brewer has received HPV vaccine-related grants from or served on paid advisory boards for Merck.


Interestingly, the study also found 32 percent of parents felt the vaccines are promoted to make money for drug companies, and only 40 percent believed the vaccines are effective in preventing cervical cancer. (The vaccines are designed to thwart human papillomavirus, or HPV, which can lead to cervical cancer). More than 1,500 parents of 11- to 17-year-olds were queried, by the way.

The findings, which were published late last week in Cancer, Epidemiology, Biomarkers & Prevention, underscore the difficulties that public health officials have encountered since Gardasil, the first HPV vaccine, was approved by the US Food and Drug Administration a decade ago.

From the start, some parents objected to the cost of the treatment, which requires three shots, costing a total of about $530. Others expressed concerns that getting an HPV vaccine may lead teenage girls to think it may be safer to have casual sex, although a subsequent study found there is no evidence to suggest the vaccines — GlaxoSmithKline sells another called Cervarix — leads to risky sexual behavior.

Those anxieties were initially fueled by a surreptitious Merck marketing campaign. Even before regulators approved Gardasil, Merck tried to persuade lawmakers to require school districts to make vaccination mandatory. The effort failed and created lingering distrust of the company, which only two years earlier was ensnared in scandal over its withdrawal of the Vioxx painkiller amid controversy over the extent to which side effect data about cardiovascular risks was properly disclosed.

Most of all, the vaccines have been plagued by numerous reports of side effects. The issue prompted European regulators to investigate although they did not find evidence the vaccines cause chronic pain or dizziness. Earlier this month, meanwhile, 63 young women in Japan filed a class-action lawsuit seeking $9 million in compensation from the central government and the manufacturers over side effects, pain in various parts of their bodies, difficulty walking, and impaired eyesight.

Physicians have also been affected by the criticisms. A study last fall, which was based on a survey of 776 US doctors, found that a quarter did not strongly endorse the need for HPV vaccination with parents of 11- and 12-year-olds under their care.

Consequently, uptake has been slow. The US Centers for Disease Control and Prevention reported that about 7 percent of girls and 22 percent of boys aged 13 to 17 years of age had completed all three recommended doses as of 2014.

The low vaccination rates have frustrated public health officials, as well as Merck, which earlier this summer began running the first Gardasil television ad campaign in several years. The ads, however, have generated some controversy of their own. Instead of specifically promoting the product, the message tugs on parental heart strings by focusing on the hazards of contracting HPV.

Merck began the ad campaign amid declining Gardasil sales in the United States. For the first six months of this year, the vaccine generated $770 million, down from $785 million during the comparable period in 2014. On an annualized basis, the figures suggest sales may lag behind the $1.9 billion in revenue that Gardasil generated in 2015.

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