Debating the Use of the HPV Vaccine Several states are debating whether to make HPV vaccinations mandatory for girls to protect against strains of human papillomavirus. Critics say parents should be able to choose whether their daughters receive the shots. Proponents say vaccinations could reduce the 10,000 cases of cervical cancer diagnosed each year.
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Debating the Use of the HPV Vaccine

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Debating the Use of the HPV Vaccine

Debating the Use of the HPV Vaccine

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You're listening to TALK OF THE NATION: SCIENCE FRIDAY. I'm Ira Flatow. Several states, including Texas, Virginia, California, are debating whether to make it mandatory for girls to be vaccinated with Gardasil, that's the vaccine that protects against some strains of human papillomavirus HPV. HPV is a sexually transmitted disease. Some strains of HPV are known to cause cervical cancer. So who should be getting the shot? Those in favor of making it mandatory for all girls say it's a boon to public health and it would surely cut down on the cervical cancer rate.

Others opposed to the mandatory - to the mandate - say parents should decide whether their daughters get a vaccine against a sexually transmitted disease. That's a family issue that we should deal with. And still others are worried about the safety of any vaccine that has not been tested for many years, hasn't been tested on a very wide scale. Are these kids actually being guinea pigs? What do you think? Give us a call. Our number, 1-800-989-8255, 1-800-989-TALK.

Joining me now to talk more about it are my guests: Arthur Allen is author of "Vaccine: The Controversial Story of Medicine's Greatest Lifesaver." He's a former foreign correspondent to the Associated Press and a contributor to "Slate Magazine." And he joins us from WPCN in Cleveland. Thanks for talking with us Mr. Allen.

Mr. ARTHUR ALLEN (Author, "Vaccine: The Controversial Story of Medicine's Greatest Lifesaver"): Thanks for having me Ira.

FLATOW: Welcome to the show. James Colgrove is the author of "State of Immunity: The Politics of Vaccination in Twentieth-Century America." He is assistant professor of sociomedical sciences at the Mailman School of Public Health at Columbia. He joins me here in our New York studio. Thanks for being with us here, Dr. Colgrove.

Dr. JAMES COLGROVE (Assistant Professor of Sociomedical Sciences at the Mailman School of Public Health at Columbia): It's a pleasure to be with you.

FLATOW: Let me ask you, Dr. Colgrove. Let's talk about the vaccine first. Give us a little thumbnail sketch of what it does and doesn't do.

Dr. COLGROVE: Well, there are about 100 strains of HPV, and most of them are actually not high-risk strains and don't go on to cause cancer. About 20 of the strains are high risk and can lead to very harmful consequences. Gardasil protects against four strains, including two that are responsible for about 70 percent of all the cervical cancer cases. So the vaccine really does have the potential to have a major public health benefit. Basically 100 percent of cervical cancer is caused by HPV. So if you can really prevent people from becoming infected with these two high-risk strains you're really going to have a major impact on the problem.

FLATOW: And how is the vaccine made?

Dr. COLGROVE: It's killed vaccine. It's given in three doses over the course of about six months.

FLATOW: Arthur Allen, made in an interested way, is it not?

Mr. ALLEN: Yeah, it's grown in a - it's cloned into a bacula(ph) virus, a virus that grows in caterpillars - the kind of caterpillar that live in, I think, cabbage and things like that. Anyway, they grow it in a subculture(ph) of these caterpillars, and the idea behind it was that previously a lot of viral vaccines have been grown in tissue cultures of humans or apes where there might be other viruses that could infect people. And so there's nothing that infects caterpillars apparently. There aren't any viruses that attack caterpillars that also attack us. So it's a handy little solution.

FLATOW: You know, it seems like we were just reporting that Merck had success with its clinical trials and boom, now the vaccine is already on the market. How does it move that fast, Arthur?

Mr. ALLEN: Yeah, I think it moved a little too fast. This is really unprecedented for a vaccine to be touted as being worthy of being mandated this early in its career, and it was licensed only about six months ago. And while it was kind of an astounding-looking vaccine coming out of these trials - that it was 100 percent effective against the strains of the virus that it was aimed at. Still it was - the trial involved 25,000 women, which is a good-sized trial. Of them, I think something like 1,500 were girls of the age who were being recommended for the vaccine.

And again, there's nothing wrong with the trial that Merck conducted. It was a good trial. Looks like a good vaccine. But this is much earlier. You know, having data for that number of women and going straight to a mandate where you're ordering people to get it, especially when it's this controversial, you know, is unprecedented and my sense was that it was an error.

FLATOW: Dr. Colgrove, do you agree it was an error?

Dr. COLGROVE: That's correct. I mean, the safety data on Gardasil look very good, but some vaccine adverse events. All vaccines have adverse events and some occur very rarely. Even a trial - a relatively large trial - of 20,000 people may be too small to detect extremely rare adverse events. If it's something that occurs in, for example, 1 in every 100,000 shots, that's not something that's going to come up during the trial, and that's why the FDA conducts very extensive post-licensure, safety monitoring to track people after the vaccine is on the market.

FLATOW: In fact, the American Academy of Family Physicians issued a statement on their website that says that they believe that - I'll read the whole thing. It says the AAFP feels that it's premature to consider school-entry mandates for human papillomavirus vaccine until such time as the long-term safety with widespread use, stability of supply and economic issues have been clarified. So it seems like there - from both sides, from people who say I don't want the government in my life telling me what to do with my family. And from the other side, people saying this hasn't been tested long enough.

Dr. COLGROVE: I think there are good arguments for and against mandates, and those arguments can be considered on their merits, but I think there is general agreement that the speed with which this has happened is a little disconcerting. Also, of course, because of the publicity surrounding Merck's very aggressive lobbying efforts created, you know, certainly the appearance of a conflict of interest. And I think that kind of muddied the waters a bit.

FLATOW: Arthur?

Mr. ALLEN: Right, I think you could argue that Vioxx wouldn't have gotten Merck in the hot water it did if they had marketed a little less aggressively and if it had only been, you know, targeted at people who had no other solution for pain control. Then the side effects, there was a smaller number of them and they would have been in a smaller, sort of, population. I wonder if they would have had as many lawsuits. And I think in a sense they took the same sort of broad approach in just trying to get this vaccine into as many kids as they could as fast as they could.

They have a competitor of GSK that's coming out with a vaccine sometime later this year. They may have been trying to sort of corner some of the market share. That's speculation. I haven't talked to them about it, but it sure looks that way. And it's just - there's a group called the Association of Immunization Managers, which are state public health people who are actually responsible for making sure that vaccines get into kids when there's a school mandate. And they were very - they issued, sort of, some guidelines in February

Where they say that any mandate has to be done, you know, sparingly, cautiously and only up to the appropriate time - period of time that a vaccine's been started to be used.

FLATOW: We're going to have Moira Gaul join us as part of the - She's director of The Woman's and Reproductive Health and Family Resource Council in Washington. Let's bring her in now. I'll just formally introduce her right now. Moira Gaul is Director of Women's and Reproductive Health at the Family Resource Council in Washington. Thanks for being with us, Ms. Gaul.

Ms. MOIRA GAUL (Director of Women's and Reproductive Health at the Family Resource Council in Washington): Nice to be with you.

FLATOW: Tell us your objections to it.

Ms. GAUL: Well, generally the Family Research Council has been in support of both the development and the widespread availability of the - any HPV vaccines. We feel that there are this great benefits in the development to protect women's health. What we have trouble with is the mandates, and feel that the mandates infringe on the right of parents to make decisions regarding their children's medical care. And since - as has probably been mentioned already on the program, since the (unintelligible) HPV is not spread by casual contact but rather it's a sexually transmitted infection, that there's not sufficient public health justification to require vaccination for school attendance.

And it could also lead parents to believe that the vaccine is the only way to reduce risks of cervical cancer, which is untrue.

FLATOW: I'm sorry, Allen, do you want - Arthur, do you want to reply.

Mr. ALLEN: I mean, I hope - I assume we're going to talk about this.


Mr. ALLEN: I disagree with this kind of particular reason why we shouldn't mandate it. I think it's too soon to mandate it, but I think potentially this could be a vaccine that would be worth mandating, but we'll get into that later, I'm sure.

FLATOW: You can get into it now, sure.

Mr. ALLEN: Well let's get into it now. Yeah, I mean, my feeling is that there's a huge overlap. I mean, of course it's true that there are other ways of preventing cervical cancer and that's what we do now and that's actually one of the most successful preventive strategies we have, you know, for an infectious disease - or cancer in this case - which is pap smears. And obviously, I think the number of women who get cervical cancer, which is I think 14,000 a year, the studies show that almost all of these women haven't been getting regular pap smears. And if they had, in all likelihood the cancer could have been stopped.

But I believe that there's a huge - there's very likely a big overlap between women who don't get regular cervical exams and daughters of people who don't get their kids vaccinated unless they have to. Now, I don't have data to support that, but I have a strong feeling that, you know, the plus side of mandatory vaccination programs in that they generally get people - the people who are brought in and vaccinated are not people who are opposed to the vaccine. They're people who don't know about it, who can't afford it, or who just can't be bothered because they haven't read up enough about the disease.

And so mandatory vaccination programs can be really positive in getting a vaccine to people who need it. And this has proved true, you know, in the past historically with measles campaigns, with rubella, with whooping cough, all kinds of diseases in the past, where making it mandatory did not mean that you grab people by the hair and drag them in kicking and screaming if they don't want to get their kids vaccinated, because there is almost always a way you can opt out.

It means getting people who can't be bothered or who can't afford it. Because another problem with making this vaccine mandatory right away was that the state public health agencies were in no position to pay for it, most of them, with some exceptions. And so you're mandating a vaccine without being able to pay for it for people who don't have it. And I think that there's sort of a morally untenable issue there. Are you going to tell someone they can't go to school because they can't afford a vaccine? I don't think so.

FLATOW: Because it's like $400 for the series.

Mr. ALLEN: And this is an expensive vaccine.

FLATOW: Moira, how do you react to that?

Ms. GAUL: Well, certainly we've supported the Vaccine for Children program, a federal program to help fund vaccine for children who are underserved and who would not be able to afford it. But I just want to go back to an element of prevention which has been missed out of the discussion, and that is early on by pediatricians and health care providers. They can provide another form of primary prevention in the form of risk avoidance, clinical counseling towards sexually transmitted diseases, which they provide for tobacco use, drug use, violence prevention…

FLATOW: Would that be abstinence?

Ms. GAUL: Exactly. And that would be the best form of a preventative. It's a form of primary prevention, as are vaccines, to affect behavior and prevent disease.

FLATOW: What about girls who have been molested or raped or things like that and have no choice?

Ms. GAUL: Well, in that sense, the vaccine again would be beneficial. But I'm speaking to the message that's delivered with the vaccine, which is medically accurate in terms of your best way to prevent receiving the infection, especially with those strains of HPV which are not covered by the Gardasil.

FLATOW: James? Do you want to jump in?

Dr. COLGROVE: I just have a couple of comments on some of the things that have been said. First of all, I think we should clarify the meaning of terms compulsory and mandatory that get thrown around. Almost every state has opt-out provisions that allow parents who have a variety of objections to vaccination to exempt their children. So you could argue, really, that a policy with a opt-out provision isn't really compulsory in the strictest sense.

The other issue I wanted to touch on was the fact that mandates always achieve higher levels of protection than non-mandated vaccines. And as Art said, you're not really forcing - for most people, you are not forcing them to do something that they don't want to do. You're getting people who either haven't heard about it or just never got around to it. And this is particularly an issue for adolescents.

Adolescents are the age bracket least likely to have any kind of contact with a health care provider. It's very difficult to get adolescents immunized or to get them any other kind of regular health care. And of all the studies on this - really mandates for vaccines prior to entry to middle school is really the only effective way to achieve very high levels of coverage for adolescent immunization.

FLATOW: We're talking about HPV vaccine this hour on TALK OF THE NATION: SCIENCE FRIDAY from NPR News.

Arthur, do you want to jump in there?

Mr. ALLEN: Yeah. I mean, I would agree with what James says there. And I - one other point I wanted to make about this sort of sexually transmitted nature of this virus. You know, I think that sex - I mean, one thing is important to point out about this virus is that it's presence in, I think, 80 percent of women who've ever had sexual intercourse.

It's - you don't have to be promiscuous and therefore, you know, to be infected with HPV, you - and therefore, you're not sending a message that it's okay to be promiscuous when you vaccinate someone with this vaccine. And if someone is promiscuous or is having a lot of unprotected sexual encounters, this vaccine will certainly protect them against a couple of strands of HPV, but there are a lot of other things it wont protect you against.

And certainly I would be the first person - I mean, I think most pediatricians would agree that it's good to caution, you know, young women and men about this, about, you know, the risks of contracting disease from having sex. But I just don't see how sort of withholding this from kids is good public health.

I mean, or really that it's going to really affect the behavior in any significant way.

FLATOW: Let me see if I can I get a phone call in. Sally from Leesburg, Virginia. Hi, welcome to SCIENCE FRIDAY.

SALLIE (Caller): Hi. I'm calling from Virginia. I believe it's one of the states that just passed the law to make this mandatory. They did it rather quickly and I find it rather hypocritical since this is a state that teaches abstinence only in its sex education programs.

But my question is, if this is really such a big deal and we really need to protect our women, why are we not vaccinating the carriers that are the boys?

FLATOW: All right. James, do you want to…

Dr. COLGROVE: The vaccine is not licensed for use in boys. Merck has data on its safety in boys but they don't have data on its efficacy. Once they look at that data, which they are currently doing, they may or may not apply for its use in boys depending on what they find. But it is not currently licensed for boys.

Mr. ALLEN: I think that's a really good point that she makes. I mean, eventually it would make sense to have it licensed for boys as much as for girls.

And I mean, you know, the thing about HPV, I mean, it is an important disease. I mean, 4,000 women die of it every, so it's nothing insignificant. That's about the number of kids who died of measles every year before we started measles vaccination which - so, you know, it does have a serious impact on a population, but it's something that's going to require a lot of buy-in and a lot of money and a lot that you can't demand out of the population until you have really good evidence that it's safe and effective. And that will take a few years.

And that's why, you know, other vaccines have been introduced more slowly and I think that's why this one had, you know…

FLATOW: Hang on, because I have to take a break. We'll come back and we're going to get more of the reaction to that, what you think about boys being vaccinated too. So stay with us. We'll put on our thinking caps and talk about vaccinations with HPV virus. What do you think? Take one of your calls. Should we wait? Is it too soon? Interested in hearing what's on your mind. So stay with us, we'll be right back after this short break.

(Soundbite of music)


You're listening to TALK OF THE NATION: SCIENCE FRIDAY. I'm Ira Flatow.

We're talking about the HPV Vaccine with my guests Arthur Allen, author of "Vaccine: The Controversial Story of Medicine's Greatest Lifesaver," James Colgrove, author of "State of Immunity: The Politics of Vaccination in Twentieth-Century America," Moira Gaul, director of women's and reproductive health at the Family Research Council in Washington. Our number: 1-800-989-8255. Moira, would you object to boys getting the vaccine?

Ms. GAUL: Absolutely not. As was just indicated, as soon as the data on the efficacy in boys becomes available through clinical trials that are being conducted. As long as results look good, it would only make good medical sense for it also to be available to boys.

FLATOW: You need to explain the difference in your thinking between boys and girls on this.

Ms. GAUL: I would not say there's many difference in making it available to boys and girls as long as the - we only have medium term data, again, for girls and young women. But if it reflects that there's an absence of serious adverse events and that the efficacy protecting against the strains, infection with the strains of HPV look good, then again it would only make good medical sense to offer it to the boys. That would reduce the spread to women.

FLATOW: The only reason I asked that is I got the impression that you're against the girls getting it because you believe that abstinence was the way to prevent getting it from the girls. But I'm hearing that they don't agree that's the same with the boys. Or am I not hearing you correctly?

Ms. GAUL: No. I think you're not hearing me correctly.

FLATOW: Okay, good.

Ms. GAUL: Because we have certainly supported it. For girls whose parents choose - it's a parents' rights issue - if they chose to have their child vaccinated, they would have time to confer with their health care provider, do a risk assessment for their child, and then make an informed decision. And really, again, it's placing the decision back in individual parents' hands. And I think that, you know, going back to mandate a widespread coverage with the vaccine, this would set a bad precedent for mandating a vaccine which is not spread through casual contact like measles and other childhood diseases.

Dr. COLGROVE: Can I jump in? I would actually disagree with that. I don't think that casual transmissibility is the only conceivable justification for mandating a vaccine. And, you know, I would also point out that for about 25 years we've had a vaccine against hepatitis B. Hepatitis B is, as you know, transmitted primarily through sexual contact and through injection drug use.

There are some other relative infection, but those are the primary ones. It's been universally recommended since 1991 and now almost all states require it for admission to elementary school or middle school, or both. And I think that there are other rationales besides casual transmissibility for mandating a vaccine.

Ms. GAUL: True, but again the hep B can be transmitted through blood. There is that other route. So again, this places this vaccine in its own category by clearly one route of transmission.

FLATOW: So you separate this vaccine, Moira, from all the other kinds then in your own mind?

Ms. GAUL: Because it is a sexually transmitted infection.

FLATOW: Yeah. Arthur?

Mr. ALLEN: Yeah. I mean, I just - it's certainly true that there's a percentage of small - and this is part of the justification between giving hepatitis B at birth was that it can be transferred from mother to child, and there are some other transmissions that occur that aren't explained, that occur in young people before they've had sex. But it's really a small percentage of the new infections. So, I mean, this is angels dancing on the head of a pin. I mean, most of this - mostly in our country, not around the world, but in our country, hepatitis B is mainly spread through actions that many people deem sinful.

But it doesn't stop it from being good public policy to do it. I mean to - and it cuts down disease. And we don't see, you know, the reductions in hepatitis B and some of these diseases. They're not dramatic. They don't jump out at you, you know, the way that getting rid of polio did, you know, or smallpox. But it's significant.

I mean, the rate of hepatitis B in kids who've been vaccinated in that age group up to 15 has fallen 98 percent. You know, there's some new data that just came out yesterday. So, I mean, these are kids who - when you're infected at a young age, you're more likely to have become a chronic carrier and could get liver cancer, cirrhosis of the liver.

These are, you know, thousands of infections and thousands of deaths and terrible illnesses that have been prevented through this vaccine. And the same could be true of HPV. That's why it's really unfortunate, in my view, that we're having this whole debate about mandating. Because it'll make it probably harder to mandate this vaccine in four or five years because everyone's going to still feel, like, oh, maybe this isn't soon enough.

But if you - if we hadn't had this misstep initially, I think it would have been easier to sort of deal with this more, you know, sort of - I won't say rationally because I don't want to accuse people of being irrational - but more sort of detachedly.

FLATOW: 1-800-989-8255 is our number. Lavonne(ph) in Madison, Wisconsin. Hi, welcome to SCIENCE FRIDAY.

LAVONNE (Caller): Hi, thank you for taking my call. I have three daughters, and I actually did just take my daughter in to get the first in the series of the shots, and she is 17. One thing I want to mention, it was quite painful. So I don't know how much that'll play into deciding the age. But the other question I had about that was, how long does the protection last, and does it make sense to wait just a little bit longer to try to hit that period of time where, you knot, the bad decisions might happen with the teenagers?

And then I also wanted to know about insurance coverage and if the insurance companies were going to start covering this. I actually - I should have called mine, but I didn't. I just took her in and had it done. And so I guess I'm waiting to see if they're going to cover it.

And then also I wanted to comment that I don't think that counseling abstinence works with all teens, and I just don't think that that's a good idea as a way to protect our teens from things like cervical cancer in their future. Because you know, I agree with abstinence. I think it's the best way, but I just - I don't always trust them. I know I have some trouble with dishonesty in my teen, so…

FLATOW: And if they just make a mistake one night and they have a lapse of judgment, and then they have to pay for it. James, what about some of those issues?

Dr. COLGROVE: Well, the safety duration, the longest follow-up that they have is five years, and the efficacy data at five years look very good. So it appears that it's quite effective for at least that long, and they will continue to study it with various cohorts for many years into the future.

FLATOW: And insurance coverage. Is insurance paying for it now? Arthur, do you know what's going on?

Mr. ALLEN: I've heard that there are some insurers that are covering it. I don't know if everyone is. I don't know if others have heard about this. I know that there isn't enough money to pay for it for people who don't have insurance, but…

FLATOW: Maybe Moira, do you know what's happening with that?

Ms. GAUL: Some private insurers I know are covering it, certainly.

FLATOW: So Lavonne, you have three daughters. You have to pay for this out of your pocket then?

LAVONNE: Well I'm hoping not. I have two insurances. I'm fortunate enough that both my husband and I carry insurance, so I'm hoping that they will. But the other thing I wanted to mention is making it a part of what kids have to do to go to school, wouldn't that pressure the insurance companies to cover it?

Mr. ALLEN: Yes, yes it would.


FLATOW: Did you discuss this with your teenagers before?


FLATOW: How did you approach the subject?

LAVONNE: I did discuss it with my - only one of my daughters is a teenager. The other two are like five years and three years. And I discussed it with her, and she thought it was a good idea. Because I made her aware that it wasn't just because I wasn't trusting her and, you know, I'm glad that she's a virgin and all those kinds of things, it's just that if it prevents cancer, you know, you can't beat that. And I know I wish I would have had the opportunity to have such a vaccination.

And also I had a question about if adult women can be tested to see if they carry the HPV. And then if they choose, they could get the vaccination as well.

FLATOW: That's interesting. Let me as Moira. Moira, do you have any daughters?

Ms. GAUL: I do not, but I was going to say I know that there is a DNA test available that a woman can get to see if she's carrying the virus and different strains of the virus.

FLATOW: Can you get - can teenagers or women at any age?

Dr. COLGROVE: Well, it's approved for use between ages nine and 26. You know, I'd like to comment on the issue the caller raised about insurance coverage. You know, there are many ethical issues that have come forward here, and the ones about parental autonomy and respecting parental decision-making have been the most - kind of gotten the most attention. And that's a very important issue, and I think we need to pay careful attention to it.

But the other issue I think, really, is that, you know, we probably wouldn't be having this conversation about mandates if the U.S. health care system didn't do such an abysmal job of providing preventive to its citizens across the board. We just do a really poor job of this.

This is often not framed as an issue of ethics. It's considered to be an issue of economics or politics, but it really is an ethical issue. I think it raises critical questions about human rights and about justice and equity.

FLATOW: Thank you for calling, Lavonne. Good luck to you.

LAVONNE: Thank you.

FLATOW: Can teenagers get it themselves if their parents - if they're minors and their parents don't approve of it?

Dr. COLGROVE: You know, the laws on what services minors are allowed to consent for varies considerably from state to state, as do many health regulations.

FLATOW: How is this debate different than other vaccines? We never - people were flocking to get a polio vaccine, right? You didn't have to talk anybody into that, you know. What's different about this?

Mr. ALLEN: Well that's - the point I was trying to make is that with polio, I mean, the risk of not getting vaccinated was clear. I mean, the benefit of the vaccine was just shouting at everyone from every street corner. And it isn't as clear when you're dealing with diseases that are somewhat less public.

I mean, it's interesting because polio in particular is a very public disease because of the paralysis that affects the patients and then, you know, just the widespread nature of it.

And with cervical cancer, or for that matter with liver cancer, I mean I think it happens much more in private. It isn't visible. And so I think that's part of their - I mean, people don't' see it. And especially the people who are most vocal opposing or being critical of vaccination policy don't often come across these diseases, perhaps because they're getting better medical care than some of the people who would be protected by the vaccines.

I think that's another reason. And I also think that these vaccine controversies kind of come in waves that aren't entirely predictable, but they…

FLATOW: Do you think that, you know, do you think that people trust the government less these days, and that's why they're questioning more than, you know, people trusted everything in the '50s.

Mr. ALLEN: Yeah. I mean, I think the sort of backlash against vaccines started in the '70s with swine flu vaccine sort of fiasco, which had so much to do with…

FLATOW: President Ford had to show himself getting vaccinated.

Mr. ALLEN: Right, right.

FLATOW: We're talking about - let me just give an ID. We're talking about vaccines this hour on TALK OF THE NATION: SCIENCE FRIDAY from NPR News. I'm sorry, go ahead, Arthur.

Mr. ALLEN: Yeah, so - I mean if you look at - President Bush got himself vaccinated against smallpox in 2002, and the idea was that we were going to vaccinate 10 million people in this country against smallpox. That was the policy decision. Well, 40,000 people were vaccinated. Well why not? Because there was no confidence, there was no trust in the idea.

And so trust is based, you know, on - it has to do with an obviously - I mean, it can have to do with the obvious soundness or unsoundness of a policy, but it also has to do with how much we trust the people who are giving us the advice or who are asking us to do something.

FLATOW: 1-800-989-8255. Let's see if we can David(ph) in Ocean City. Are you there, David? No? I guess we lost the phones again today. Anybody else there?

(Soundbite of laughter)

Let me ask you, James. Do you think trust is the issue here?

Dr. COLGROVE: Absolutely. I guess the point I would make is that public health is a social science as much as it is a medical science or an epidemiological science. And the implementation of a public health measure absolutely depends on the relationships between government, individuals, civil society. And trust is essential, which is why this issue of the haste with which it's being mandated, I think it threatens to undermine what are some otherwise very good rationales for mandating it.

FLATOW: Well, the title of your book is "The Politics of Vaccination," and is this the politics?

Dr. COLGROVE: Absolutely, absolutely.

FLATOW: The haste to get it - is it because corporations are, you know, feeling the pressure for profits, or is it because they see the other vaccine down -the competitor down the road?

Dr. COLGROVE: That's certainly an element, yes.

FLATOW: So when is the other vaccine due? Do you have any idea…?

Dr. COLGROVE: GSK's vaccine, I think they're planning to submit the data later in this year. It might go over into early next year. But, you know, I think there's probably a perception that they've been scooped by Gardasil, and that was clearly Merck's intention in getting as high coverage as they could achieve while theirs was the only vaccine on the market.

FLATOW: Moira Gaul, where do you see the future in this? Do you think that there are going to be states that are going to say we don't want this as a mandatory?

Ms. GAUL: Absolutely. I think my line was just dropped, so I'm just jumping back in the conversation.

FLATOW: That's okay.

Ms. GAUL: You know, I think Texas has sent a very loud message. Parents rose up there very quickly upon Governor Perry's instituting an executive order, and spoke out very loudly from both the right and the left to say that they saw this as a parental rights issue.

And before my line was dropped, there was talk about the cause of distrust perhaps in the government on this issue and related topics. And I think that, again, this mandate would set a bad precedent and only increase distrust, especially by parents, given this issue of vaccine mandates. And again because this is in a unique category, it's going to cause them to intensely scrutinize anything that comes along in the future.

So it has the potential to really erode trust in vaccine mandates, and that's something that the public health community, of which I'm part of, needs to be carefully listening to.

FLATOW: People more vigilant, and they're going watch these trials, any new vaccines. They're going to look at the size of the trial.

Dr. COLGROVE: Well, this is actually not a new phenomenon. People have been looking very closely at vaccine safety for at least 25, 30 years. There's been a real rise of very activist groups and organizations who pay close attention now to vaccines in a way that they really didn't in previous eras.

So there's already…

FLATOW: Certainly with the mercury and the (unintelligible)…

Dr. COLGROVE: Exactly, exactly. So there's already quite an existing kind of background level of scrutiny that is quite intense.

FLATOW: I want to thank you for taking time to be with us. James Colgrove, author of "State of Immunity: The Politics of Vaccination in Twentieth-Century America." He's assistant professor of sociomedical sciences at Mailman School of Public Health at Columbia. Thanks for joining us today.

Dr. COLGROVE: Thank you.

FLATOW: Moira, thank you. Moira Gaul is director of women's and reproductive health at the Family Research Council in Washington. Thank you for talking with us today.

Ms. GAUL: Thank you.

FLATOW: And Arthur Allen is author of "Vaccine: The Controversial Story of Medicine's Greatest Lifesaver." He is a former correspondent for the Associate Press and contributor to Slate magazine.

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