If you have teenagers or have raised teens in the last 15 years or so, you’ve undoubtedly had conversations with your provider about the human papillomavirus (HPV) vaccine. Merck’s first-generation Gardasil® shot was approved by the U.S. Food and Drug Administration (FDA) in 2006. It prevented the infection of four strains of HPV (six, 11, 16, and 18) in women. By 2009, it had expanded to include men as well.
In December 2014, the FDA cleared Gardasil® 9 to protect against – as its name suggests – nine strains of HPV, the four strains approved in the original vaccine, plus 31, 33, 45, 52, and 58. It is approved for use in males and females ages 9 to 45. These strains are associated with the majority of cervical, anal, and throat cancer cases, in addition to genital warts.
The vaccine is not without controversy, and, on Monday’s show, Megyn welcomed pediatrician Kristen Walsh, MD, and epidemiologist Allison Krug to discuss the pros and cons of Gardasil® and how Merck’s marketing of the vaccine has changed over time.
Merck Changes Its Tone
In the early days of Merck receiving FDA approval for Gardasil®, the messaging to consumers was simple and upbeat. The 2008 ‘I Choose’ campaign emphasized cancer prevention with young women talking about why they were choosing to get vaccinated:
“I chose to get vaccinated because I’ll do everything I can to help protect myself from cervical cancer.”
“I chose to get vaccinated when my doctor told me HPV can affect women my age and how Gardasil® can help protect me.”
“I chose to get vaccinated after my doctor told me cervical cancer isn’t the only HPV disease Gardasil® helps prevent.”
“I chose to get vaccinated because my dreams don’t include cervical cancer.”
The parting message? “You have the power to choose.”
Megyn, for one, found the ad compelling. “It’s very effective – ‘choose no to cancer,’” she said. “Yes, I agree. I also would like to choose to say no to cancer.”
But times changed for Merck, and the messaging evolved from one aimed at empowering young women to make choices about their health to a blame game targeting parents. A 2016 ad caused a stir for what many considered to be a guilt trip. A female narrator addresses her parents as she says:
“I have cervical cancer from an infection, human papillomavirus. Who knew HPV could lead to certain cancers? Who knew my risk for HPV would increase as I got older? Who knew that there was something that could have helped protect me from HPV when I was 11 or 12 – way before I would even be exposed to it? Did you know, mom? Dad?”
– Merck, 2016
The Rise of ‘Emotional Blackmail’ in Medicine
Calling the ad “absurd,” Megyn said the commercial was trying to “guilt” parents by implying “you gave your kid cancer by not getting them this vaccine.” Dr. Walsh agreed that that the approach was too heavy handed. “I do find the emotional blackmail of parents disturbing,” she said.
As Dr. Walsh explained, this tactic is not unique to Merck or Gardasil®. “I think we’re seeing it in other arenas now… [like] some of the messages parents of kids with gender issues are getting about it’s either aggressive gender confirming therapy or you’re choosing your child’s suicide,” she said. “It also reminds me of a lot of the ways that public health chose to communicate during COVID.”
While Dr. Walsh said that companies are free to market their products how they wish, she said that there has been a trend away from “factual information” and honesty around “what’s known and not known” toward control. “It was more about what can we say to make people behave a certain way,” she shared. “I am really not a fan of that heavy-handed way of trying to make people do what you want them to do.”
The Importance of Risk/Benefit Analyses
Krug shared that she once worked for Merck in the vaccine division, selling to public sector correctional facilities, military bases, and health departments. While she said she appreciated the company’s “approach to training” and held it “in high regard,” she called the 2016 ad campaign “terrible.”
What she believes is missing from most of the conversations about the Gardasil® vaccine is an objective look at the pros and cons. “I think we ought to talk about the risks of disease. We ought to also be able to talk about the risks of vaccines because there are risks anytime you do a medical intervention,” she said. “So, I think it is paramount that we be clear in what they are and that we really do good risk/benefit analyses.”
Through her research, Krug discovered that it does not exist for the HPV shot. “We actually really need to have a third-party, non-biased, not-FDA affiliated open source [approach],” she said. “Maybe recruit citizens and do an open access best modeling effort of what is the real risk/benefit analysis here and bring our best minds to this.” From there, families can make the best decision for themselves. “I really think that we need to talk to parents about the facts,” she concluded, “and make sure that there’s truly informed consent.”
You can check out the full debate between Dr. Walsh and Krug by tuning in to episode 565 on YouTube, Apple Podcasts, or wherever you like to listen. And don’t forget that you can catch The Megyn Kelly Show live on SiriusXM’s Triumph (channel 111) weekdays from 12pm to 2pm ET.