After a long political struggle, the Food & Drug Administration has approved Merck’s cervical cancer vaccine Gardasil. That should be good news, because 20 million Americans—men and women—carry the HPV virus that causes the cancer, and about 250,000 women die around the world from cervical cancer every year.
But approval of Gardasil—likely to be followed quickly by approval of a Glaxo SmithKline product called Cervarix—was fought every step of the way by some on the religious right, who worry that providing the vaccine to girls as young as nine could encourage them to become sexually active.
“We would oppose any measures to legally require vaccination or to coerce parents into authorizing it,” says the Family Research Council. “Care must be taken not to communicate that [the vaccine] makes all sex safe.” Focus on the Family, meanwhile, continues to oppose FDA approval: “We can prevent [cervical cancer] by the best public health method, and that’s not having sex before marriage,” says a spokeswoman.
Both Merck and Glaxo have been in discussion with fundamentalist groups, worried that even though the drug has approved, efforts by conservative groups could lead many people to reject treatment.
“The next big challenge with this vaccine will be to assure widespread availability and use,” explains Deborah Arrindell, vice president of policy at the American Social Health Association. “Some people may be reluctant to receive the vaccine or to approve their young daughters receiving it because of the stigma associated with sexually transmitted infections. We need to overcome these concerns and protect all our young women.”
We asked some of the leading healthcare public relations professionals what advice they would offer the companies involved. All agreed that the public health benefits should outweigh any moral concerns, and several expressed the belief that the real moral question involved saving lives rather than preaching abstinence.
Ame Wadler, chair of the global healthcare practice, Burson-Marsteller: “It’s always a shame when healthcare becomes politicized but it’s not unusual. Manufacturers of everything from contraception to antidepressants (remember Scientology) to breast implants (everyone from NOW to members of Congress) have been marketed successfully despite opposition from special interest groups, religious or otherwise. Companies who manufacture these products need to ensure that their efforts include building a base of support from constituency groups who recognize the need and value of the healthcare solution they are offering. This will include engaging in open dialogue to make sure that these groups appreciate the medical need, the value of the solution in question and that there is receptivity to feedback that enables the manufacturers to understand how their efforts may be viewed by specific audiences.
“In the case of the cervical cancer vaccines, manufacturers would be wise to recognize that the end-user is not the only audience necessary to reach. Balanced education needs to be provided to both the end-user as well as the parents of these (likely adolescent and teen) young people. Additionally, it is important to provide education that goes beyond the traditional pharmaceutical fair balance…. It is not necessary, or even appropriate, for the manufacturers to engage in the dialogue regarding abstention outside of the medically accepted standards for education regarding STD prevention. In this particularly case, guidance from the American College of Obstetricians and Gynecology as well as the adolescent medicine sections of the American Academy of Pediatrics can be helpful in shaping the medically accepted point of view. Partnering with groups like the American Social Health Association who have long dealt with the politics of STD prevention can also help to balance the education.
“At the end of the day, my counsel would be to focus on the medical need; engage the educators and influencers that reach the end-user to educate them on the pros and cons of the vaccine while also ensuring that they provide balanced education to position the vaccine in its appropriate space; provide parents with the tools they need to get educated and receive guidance on how to engage in a sensitive dialogue with their child and ultimately healthcare provider; and use targeted media that allow for personal interaction, and appropriate anonymity, to educate the end-user.”
Peter Pitts, senior vice president of global health affairs, Manning Selvage & Lee: “The message here is pretty straight forward: it’s the public health, stupid. I don’t believe that any group, no matter how God-fearing or fundamentalist, would raise Cain over a vaccine that prevents cancer. These same groups do not oppose the use of condoms (that position is reserved for another organization), nor do they oppose the use of birth-control pills or other methods of pregnancy prevention. It is beyond plausible to believe that teenage girls will in any way alter their sexual behavior because of a vaccine they received when they were even younger. There is zero research that shows that the fear or cervical cancer is in any way a deterrent to promiscuous sexual behavior.”
Laura Schoen, president of the global healthcare practice, Weber Shandwick Worldwide: “Approval of the first vaccine to prevent cervical cancer, the second leading cause of death among women worldwide, should be a time for celebration, not debate. Each year, this disease kills some 233,000 of the 470,000 women affected, almost 4,000 of them in the U.S. The approval of Merck’s vaccine—and the anticipated approval of a vaccine developed by GlaxoSmithKline—is being hailed by The American Cancer Society and others as a major advance in women’s health. The marketing message, therefore, is clear: We have found a vaccine that is safe and effective against a deadly cancer: a cancer that results in enormous economic costs to society and devastating personal costs to at-risk young women and their families.
“Companies should not be hijacked by lifestyle issues boiling up around the vaccine. The goal of pharmaceutical R&D is to eradicate disease. Therefore, it is critical to highlight the benefits of a scientific breakthrough that promises to reduce the toll of a deadly cancer. Denying access to those who would benefit from the vaccine is almost criminal. Partnering with a coalition of health and women’s groups will help vaccine marketers humanize a disease that kills without bias, while enabling acceptance of a pharmaceutical innovation that provides a safe alternative. Pharmaceutical companies should never lose sight of their mission—developing and marketing drugs to save lives—or of their primary responsibility to the health and well-being of patients.”
Kate Cronin, managing director, Ogilvy Public Relations Worldwide: “In the case of the first HPV vaccine, the key to wading through the murky waters of morality is transparency and fostering an open dialogue with advocacy groups. By meeting with conservative groups and explaining the rationale for the HPV vaccine, Merck helped change the opinions of many vaccine skeptics and defused protests that might have arisen at the time of approval.
“But winning over advocacy groups is half the challenge. The next hurdle will be in the doctor’s office, where physicians and nurses will need to broach the topic with parents. This will be even more challenging if states don’t make HPV immunization mandatory for school registration. At this stage, a company would need to initiate a broader public and professional education campaign that arms parents with information to help them make informed decisions about HPV immunization; provides physicians and nurses with the support to make for a more productive and easier conversation about HPV vaccination with families; and ensures vaccine access to under- and uninsured patients through third-party payors, including Medicaid and the Vaccine for Children Program.”
Nancy Turett, president and global director, Edelman Health: “Science has shown us the tragic consequences of cervical cancer—and now science brings us hope for its virtual eradication. After years of development and study, there now exists a vaccine that, with universal use, will all but wipe out cervical cancer. To encourage widest possible vaccination, we must turn to science again. Recent studies published in Pediatrics and the New England Journal of Medicine have shown sex education and early intervention do not increase adolescent sexual activity. One study in the Journal of Adolescent Health proved that adolescents taught abstinence only are as likely as others to contract sexually transmitted infections, because they are unprepared to protect themselves when they do have sex.
“In light of this evidence, it is illogical and immoral to withhold the cervical cancer vaccine in the hope of delaying sexual activity. To realize the vaccine’s full potential, we must heed the advice of Dr. Allan Rosenfield, Dean of the Mailman School of Public Health of Columbia University: ‘Abstinence campaigns: Use in moderation only.’ We now have the opportunity to end cervical cancer in future generations. One of the most loving, moral gifts parents can give their daughters is proven protection from this deadly disease.”