I have great respect for Governor Hogan. I appreciate and admire his empathetic desire to reduce and prevent cancers that cause terrible suffering and death for Maryland residents and others. A secretive campaign to market human papillomavirus (HPV) vaccinations in Maryland state schools is not a proper public health policy strategy to accomplish those goals.
I learned about this ”under the radar” campaign after my op-ed No Ironclad Case for HPV Vaccine Yet was published January 13, 2018 in The Annapolis Capital Gazette (annotation 15 below). A career registered nurse in Montgomery County schools gave me two letters attached above (“HPV1” and “HPV2”). She told me that she felt she was being “forced” to market the vaccine to students, that she objected to the policy, and that she was scared to speak out for fear of losing her job.
The letters detail a surreptitious campaign to market the HPV vaccine in State schools. There was no public discussion, approval process, or any effort to inform parents. The ethical violation is obvious. Dr. Tai’s directive is strongly coercive state action interfering with free and informed consent – using words like “imperative” to give the vaccine, pressing it through schools, and blurring the line between mandated “school-entry” required vaccines and an ACIP-recommended vaccine. The fact that HPV is a sexually transmitted disease is simply not disclosed.
The first letter (HPV1) was authorized by Dr. Ken Lin Tai , Director, Maryland Department of Health Center for Cancer Prevention and Control. Her office originated, wrote, and approved the letter. Dr. Jinlene Chan MD, MPH, and Dr. Dennis Schrader signed off on it. Per my conversation with Dr. Chan Thursday Feb 16 2018 at 10:07am, it was sent to every school superintendent in the state of Maryland.
The second letter (HPV2) is from Montgomery County Assistant Superintendent Dr. Johnathan T. Brice, instructing all the principals in his district to comply with the DOH directive.
In addition to the ethical concerns, the letters contain fraudulent information and thus potentially might be considered part of a conspiracy to defraud consumers and children in particular. The following inaccurate statements in the Tai/Chan letter are in quotes, with my rebuttal following:
• “the critical public health crisis of under-vaccination Maryland adolescents against HPV”- low uptake rates of HPV vaccine does not constitute a “critical public health crisis.” The uptake rate in Japan is now less than 1%, country wide.
• HPV “pos[es] a significant public health risk” – not true. More than 98% of HPV infections clear naturally (WHO info).
• The vaccine can protect “before exposure” – Evidence strongly suggests that a significant proportion of preteens have HPV infections at the time of vaccination that they acquired other than by sexual contact. Children who are HPV positive at the time of vaccination (PCR or serology) are likely at increased risk of HPV infection based on clinical trial data (“negative efficacy” for those positive for HPV at time of vaccination).
•“It’s imperative” that providers give this. – this is a recommended vaccine, not mandated vaccine, therefore it is not “imperative.”
•“A preventive measure exists to protect against HPV-related cancers.” – No, the vaccine’s efficacy against cancer has never been proven. So far, there is evidence that cervical lesions from the vaccine-targeted HPV types are less common among those who’ve gotten HPV vaccines, but there is yet no evidence that any HPV-related cancer prevalence has diminished due to the vaccine. Clinical trials used cervical lesions as “surrogate endpoints,” not cancer; there is as yet NO proof that HPV vaccination has reduced the overall burden of cervical or other types of HPV-related cancers. On the contrary, there is some evidence that cervical cancer rates have increased in places where the HPV vaccine uptake rate has been high because young women wrongly assume that cervical screening is no longer necessary.
To be clear, the intent of the campaign revealed by these two letters has absolutely nothing to do with reducing the spread of HPVs among our children. The MD DOH had a highly successful campaign to do just that, resulting in a measureable decline in cervical cancer incidence and mortality between 2000 and 2012- starting well before the vaccine was even available. If Dr. Tai’s objective is reduction in HPVs her letter would have included references to the only public health strategies that are actually proven to be effective. She would have emphasized education about known HPV cancer risk factors, such as: promiscuity; smoking; and intravenous drug use. In addition, she would have discussed the importance of regular pap smears.
I request that Dr. Tai’s conduct in this matter be investigated for possible ethical and legal violations of Maryland DOH and School Board Policies. She should immediately step down as director of the MD DOH CCPC until her role in this unfortunate matter is better understood. Further, we need to understand the financial relationship between Merck and Maryland DOH Cancer Prevention and Control. The “HPV Vaccination” section of their website reads like a paid advertisement for the Merck product, as do the letters attached above.
Based on egregious ethical and probable legal issues with the above attached letters, and the underlying clandestine activity demanded by the letters, Governor Hogan should immediately instruct all divisions of state and local governments to rescind recommendations and support for the vaccine (as the government of Japan did in 2013), pending a thorough and independent safety, efficacy, and necessity review. Dr. Peter Doshi, PhD, assistant professor of pharmaceutical health services research at the University of Maryland School of Pharmacy and associate editor at The BMJ, would be an excellent candidate to lead such an investigation, or supervise the creation of a qualified, independent review board. It is instructive to note the government Japan to this day has not resumed its recommendation for the shot.
I implore you to contact the Governor’s office immediately and politely request that this matter be thoroughly investigated, and to ask him to denounce in the strongest possible terms this concerning breach of the public trust. No parent should have to worry that their child is being secretly targeted for sale of an HPV vaccine, or any other product, while they are in their Maryland schools.
I enjoy my cordial and constructive relationship with the Anne Arundel County public school system, where our three children have all received excellent education, socialization, and are generally surrounded by caring and compassionate teachers, administrators, and staff. However, I wish to make my position absolutely clear: if this stealth marketing campaign is not immediately denounced at the highest levels of our state government, and if action is not taken to investigate the potentially fraudulent claims about the vaccine contained in Dr. Chan’s letter, I will examine legal options to force this issue.