Rise of the Vaccine Nation


In the last decade, the U.S. pharmaceutical industry has spent billions of dollars to develop an arsenal of state-of-the-art, DNA-based vaccines, which are targeted at all manner of childhood, adult, and sexually transmitted diseases. Clearly, the rise of the Vaccine Nation represents a boon for public health, but it also offers untold opportunities for profit. In 1997, vaccine sales brought in about $1 billion for Merck, the leading vaccine manufacturer, and the industry now has about 42 new vaccines in the pipeline.

Last year, the twin goals of public health and profiteering converged in the form of the Vaccine Initiative, a PR campaign launched by several medical societies to promote universal immunization. Last week, the group adopted a new name, the National Immunization Information Network (NIIN), after attracting new partners and replacing its startup grants from vaccine manufacturers with funding from the Robert Wood Johnson Foundation, the philanthropic arm of Johnson & Johnson.

And the pro-vaccine message seems to be getting heard. Last week, The Wall Street Journal and The Washington Post ran articles urging all Americans to line up for their annual flu shot, while an expert quoted in The New York Times faulted New York State for not supporting the whooping cough vaccine.

The New Yorker has also signed on to the campaign, judging by a “Comment” in the October 11 issue, titled “Shots in the Dark.” Penned by staff writer Michael Specter, the editorial argues that some risks associated with vaccines are overstated (as in the rare case when the old polio vaccine caused polio), while others are unfounded (as in the charge that vaccines can cause autism). He calls mandatory vaccines for schoolchildren the very definition of “scientific progress.”

Specter praises the NIIN and belittles those parents who claim their children have suffered adverse reactions to vaccines. What he doesn’t say is that the parents are lobbying Congress for more oversight of the vaccine industry, a tangled web that involves the manufacturers, the Centers for Disease Control, and the states that get financial rewards from the government and the Robert Wood Johnson Foundation when they set up mandatory vaccine programs.

The pro-vaccine theme was also sounded by New Yorker contributing writer Jerome Groopman in a September 13 feature, titled “Contagion.” The piece describes the human papilloma virus (HPV), a “lethal new epidemic” that cannot always be stopped by condoms or caught by the Pap smear, a standard procedure for detecting the onset of cervical cancer. Groopman denounces the Pap smear as “crude and inexact,” touts the claim that “there is no treatment” for HPV, and tells the horror story of a high-school teacher who died of cervical cancer despite getting regular Pap smears. He concludes, “The most effective way to protect against [the virus] would of course, be a vaccine.”

Interestingly, The New Yorker‘s pro-vaccine pieces both ran adjacent to health-related ad sections, each of which contained ads placed by the Pharmaceutical Research and Manufacturers Association (PhRMA, pronounced “pharma,” the industry’s leading trade association). In 1998, when PhRMA launched its current ad campaign, a spokesman said, “We will try to position the ads adjacent to, or in issues with, health-related editorial.” Attentive readers will recognize PhRMA’s ubiquitous tag line: “America’s Pharmaceutical Companies: Leading the way in the search for cures.”

New Yorker publisher David Carey denies any collusion between advertising and editorial regarding the PhRMA ads. For each of the last two years, he says, PhRMA has bought eight single ad pages in the magazine, adding that PhRMA likes The New Yorker because “we’re widely read in the medical community.” Because ad pages close two weeks before editorial and the edit lineup can change at the last minute, he says, “There’s no practical way we can time advertising to editorial.” He says the placement was a “coincidence.”

Even so, there are some uncanny parallels. For example, the September 13 advertorial, on the subject of pharmaceutical research, leads with a quote from Jan Leschly, chairman of the PhRMA Foundation. Perhaps it’s just serendipity that Leschly is also the CEO of SmithKline Beecham, a company that has invested heavily in developing a vaccine for HPV. And it’s just a fluke that this ad ran between the pages of an article that hypes the incurability of HPV.

Another coincidence: the arguments set forth by Michael Specter in favor of mandatory vaccination exactly mirror the points spelled out in a PhRMA press release issued August 3. Both assert that vaccines have proved to be safe and effective, that adverse reactions are rare, and that the benefits far outweigh the risks. Both recall the scourge of polio and measles, and both imply that anti-vaccine advocates are capable of irresponsibly triggering a new outbreak of disease. (This is a little like the argument that anti-police stories can increase crime.)

Even removed from the context of the ads,
the vaccine stories struck some as conspicuously
slanted. Dr. Diane Solomon, a senior investigator at the National Cancer Institutes, said she found the Groopman piece to be alarmist, sensational, and overstated. “It’s not what I consider balanced educational information for women.”

Solomon called Groopman “irresponsible” for questioning the value of the Pap smear, which he deemed “notoriously inaccurate” because the test may miss up to 40 percent of HPV infections. She said it’s not a test for the virus, but rather a screening test that detects precancerous cell changes. What’s more, a regular Pap test enables doctors to find and treat more than 90 percent of such lesions, thereby preventing cervical cancer from ever developing. “It can be improved,” she said, “but the fact remains that most of the 70 percent decline in cervical cancer mortality over the past 40 years is due to this test.”

Similarly, Specter’s editorial employed the “alarmist” rhetoric of vaccine advocates, according to Dr. Jane Orient, executive director of the Association of American Physicians and Surgeons. “It has this underlying assumption that if the government doesn’t force everybody to have these vaccines, regardless of one’s personal beliefs, then we’re going to have people dropping dead of diphtheria.” Orient opposes universal administration of the hepatitis B vaccine, for example, because few children actually fall into high-risk groups and because she believes no treatment should be given without the patient’s informed consent.

New Yorker editor David Remnick declined to comment on the editorial content, while Carey conceded that the two pieces “seem to be pro-pharmaceutical.” The good news is that The New Yorker has had its best third quarter since 1990. Ad pages are up 15 percentage points over the same period last year, and renewal rates are at an all-time high. Carey said this reflects advertisers’ confidence in Remnick.

Research assistance: Suzanne Latshaw