Organisations challenge basis for recommending HPV vaccine for boys

BMJ 2011; 343 doi: (Published 07 November 2011) Cite this as: BMJ 2011;343:d7238
  1. Jeanne Lenzer
  1. 1New York

A recommendation that all boys in the United States receive the human papillomavirus (HPV) vaccine (BMJ 2011;343:d7068, doi:10.1136/bmj.d7068) has been challenged by two medical organisations that raise questions about the financial interests of guideline writers, politicians, and organisations promoting the vaccine.

John Brehany, executive director of the Catholic Medical Association, and Maricela Moffitt, its president elect, wrote in the 3 November issue of the National Catholic Register that “Merck has given hundreds of thousands of dollars to medical societies like the American College of Obstetricians and Gynecologists to help persuade key decision-makers to encourage HPV immunization.”

Corporate reports show that Merck, which makes the quadrivalent HPV vaccine Gardasil, contributed $477 000 (£300 000; €350 000) in programme support, publication distribution, and research awards to the American College of Obstetricians and Gynecologists in 2010 and $97 000 for continuing medical education during the first quarter of 2011.

The Association of American Physicians and Surgeons also issued a news release on 3 November stating, “It would be good to know what, if any, financial conflicts of interest might exist for members of ACIP [the Advisory Committee on Immunization Practices of the US Centers for Disease Control and Prevention (CDC)]. A thorough review of the CDC website failed to turn up a financial disclosure page.”

A spokesperson for the CDC in Atlanta told the BMJ, “The financial disclosure forms filed by ACIP members are confidential and cannot be released. In addition, no information from the form can be publicly disclosed. The only financial information that would be releasable would be that information publicly disclosed by the member at the beginning of each ACIP meeting.” The meeting transcript will be available in a few months. In a later email to the BMJ the spokesperson stated that two panel members did have “potential conflicts,” but in a subsequent telephone call the ACIP’s chairman, Larry Pickering, told the BMJ that in neither case did the conflict concern the current manufacturers of the HPV vaccine.

Richard Amerling, author of the news release for the Association of American Physicians and Surgeons and associate professor of clinical medicine at Albert Einstein College of Medicine in New York, told the BMJ that he was disturbed by the failure to release panellists’ financial disclosure forms. He said, “This is a large policy issue that will affect millions of people, and it’s not reasonable to withhold this information.”

The current concerns follow a heated battle that erupted during the 2007-8 US presidential campaign after the candidate Rick Perry, the governor of Texas, signed an executive order to make the vaccine mandatory for all girls in the state (BMJ 2007;334:332, doi:10.1136/bmj.39122.403044.DB). Mr Perry acknowledged receiving funding from Merck, and his campaign came under further scrutiny when his chief of staff, Mike Toomey, left to become Merck’s lobbyist for the vaccine. Mr Toomey recently announced that he plans to raise over $50m for Mr Perry’s campaign.

Politicians in other states who have supported mandatory vaccination have come under similar criticism for taking money from Merck. Merck’s 2010 annual report states that the company gave $1.25m to politicians and political action committees last year.

The recommendation for universal vaccination of pre-teens has come under fire by a leading expert on HPV. Diane Harper, principal investigator for Merck’s pivotal study of Gardasil and a paid consultant for Merck and GlaxoSmithKline, which makes the bivalent HPV vaccine Cervarix, told the Kansas City Star that the vaccine for boys is “pie in the sky,” in part because most HPV infections do not result in cancer or illness. She said, “We’re short of healthcare dollars. Why should we spend it on that?” (


Cite this as: BMJ 2011;343:d7238


  • Feature: Human papillomavirus vaccine: Life saving treatment or giant experiment? (BMJ 2007;334:721, doi:10.1136/bmj.39164.510127.AD); Research: Comparing bivalent and quadrivalent human papillomavirus vaccines: economic evaluation based on transmission model (BMJ 2011;343:d5775, doi:10.1136/bmj.d5775)