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Estranged Bedfellows

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The recent political controversy concerning Gardasil, Merck’s human papillomavirus vaccine, contains important lessons for progressives about the dangers of strange bedfellows. The interests of progressives and pharmaceutical giant Merck briefly coincided, but their different motivations ultimately weakened efforts to create widespread acceptance for the anti-cancer vaccine.

The initial cooperation between progressives and Merck to support Gardasil, which prevents strains of HPV responsible for 70 percent of cases of cervical cancer in women, was due not only to enthusiasm over a medical breakthrough that could save thousands of lives, but in large part to a common enemy. When the vaccine was announced, social conservatives immediately attacked it, claiming it would undermine parental authority and encourage teenage promiscuity.

While progressives rallied the public against these spurious claims, Merck quietly lobbied conservative groups to rein in their opposition. These combined efforts were in many ways successful, and Gardasil was approved by the FDA, recommended by the CDC, and federally subsidized for low-income children.

After the vaccine was approved, however, Merck immediately began pushing for state legislatures to mandate it, contrary to the regular—and successful—practice of waiting a few years before mandating vaccines.

Some progressives believed that this was the appropriate path—the best way to quickly achieve herd immunity, to address racial, ethnic, and economic disparities, and to overcome public financing issues. Others were concerned about the high cost and potential public backlash, and took issue with quickly mandating the vaccine. But as a whole, progressives were not prepared to respond, as they were more focused on the common enemy than on developing an agenda to ensure safe and equitable access.

Moreover, after quietly supporting Merck throughout the approval process, we progressives found ourselves in a bind when the company began pushing for mandatory vaccination. Few of us wanted to speak out against our one-time ally, and we certainly did not want to give aid and comfort to our enemies—the conservative right—who were attacking mandatory vaccination.

Merck clearly had its own agenda—and very deep pockets—to push for mandatory vaccination. But it was a mistake not to present a coordinated progressive response. With GlaxoSmithKline filing for FDA approval of a rival vaccine and Roche entering Phase III trials of its own vaccine, there was at least the appearance that Merck was more concerned about maximizing profits before competition drove down prices than about protecting people’s health.

Merck’s aggressive tactics led to a backlash, not just from opponents of the vaccine, but also from health officials and the general public. Politicians responded by rejecting mandatory vaccination laws in Texas and New Mexico, and many other states are expressing misgivings about similar pending bills. Amidst these controversies, public use of the vaccine in some states appears lower than expected.

These problems might have been avoidable if progressives had taken the lead and helped states adhere to common vaccine practices, such as improving public education and trust in the vaccine before mandating it. States like Utah, New Hampshire, South Dakota, and Washington have done just that, providing voluntary free vaccines and/or educational materials on HPV and Gardasil—and with great success. These policies may not be as profitable for Merck, but will almost certainly increase public acceptance—and ultimately use—of the vaccine.

So what should we learn from this experience? When a promising medical breakthrough is announced, we must be clear on if, why, and for whom we want to promote it, rather than simply playing along with others whose interests momentarily coincide with ours. Our stance should be evidence-based, mindful of costs, sensitive to social and economic disparities, responsive to the cultural concerns of different communities, cognizant of trade-offs within a system of scarcity, and designed to utilize public education to create widespread support for our position. Most importantly, we must anticipate how and when our interests may diverge from our unlikely ally of the moment.

The lessons of the HPV vaccine debate will be useful not only for discussions about vaccines, but also for those about burgeoning biotechnologies. Right now, the interests of progressives, medical researchers, and biotechnology and pharmaceutical companies tend to align around support for further research. As the research progresses, however, there will be instances where these interests diverge, whether around intellectual property and patenting, the conditions and diseases new biotechnologies target, the risks and advantages they pose to particular populations, or the costs and benefits of regulation.

Progressives will need to develop our own agenda for biotechnologies to ensure they are developed and used effectively and ethically. At the very least, our agenda must guard against hyping of the science, respect and help inform the ethical boundaries and sensibilities of the public, address funding limitations, and improve public understanding of sometimes complicated scientific issues.

Building broad, bipartisan coalitions is a necessary part of creating political will, and businesses can play an especially important role. But we should not forget that different partners have different goals. Strange bedfellows may be common in politics, but progressives should be sure we won’t have any regrets when we wake up in the morning.

Sam Berger is a Researcher with the Progressive Bioethics Initiative at the Center for American Progress.

Shira Saperstein is a Senior Fellow at the Center for American Progress and the Deputy Director and Program Director for Women’s Rights and Reproductive Health at the Moriah Fund.

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