American Journal of Law & Medicine

Foreword--will HPV vaccines prevent cervical cancers among poor women of color?: global health policy at the intersection of human rights and intellectual property law.

Cervical cancer is a disease of social inequality. (1) Women with access to effective screening and treatment rarely die from cervical cancer. The burden of cervical cancer mortality falls most heavily among the poorer women of the world. (2) Cervical cancer starkly illustrates global inequality across race, sex and class. Cervical cancer disproportionately kills poor women of color.

The HPV vaccine is a triumph of science. Current formulations may well prevent infection from the HPV subtypes responsible for approximately 70 percent of cervical cancers, and multi-valiant vaccines are under development to expand the scope of coverage. (3) Nobel Prizes are won for such path breaking science.

And yet, the HPV vaccine is the most expensive vaccine in human history, priced at approximately $360 wholesale for the currently recommended regime of three doses. (4) Through an accident of patent litigation, we have two brand name manufacturers (Merck and GlaxoSmithKline), but no apparent competition on price.

More troubling, the vaccine is being initially sold to the very people who need it least: the well-insured daughters of the middle class in the US and other wealthy OECD countries. Even within the US, the vaccine is going to those with social and financial capital to access vaccination programs, the very women most likely to also have access to effective screening and treatment. (5) In other words, the vaccine is prioritized to the women who need it least. The women most likely to die of cervical cancer in the US are poor women of color, and they may be the least vaccinated group. This inequality reflects the social realities on the ground in the U.S.

These inequalities are magnified when we look at cervical cancer globally. In the wealthiest 34 countries of the world, less than 19,000 women died of cervical cancer last year, compared to more than 240,000 in the rest of the world. (6) The primary commercial markets for the vaccine account for only seven percent of the mortality. (7) For the foreseeable future, the lion's share of HPV vaccine production will go to the countries that need it least, and within those countries to the women who need it least. All of this activity is protected by global intellectual property rules under the WTO TRIPS Agreement.

One surprising aspect of HPV is that most of the controversy focuses on claims about the sexual practices of adolescents (8) rather than these glaring global inequalities. A vaccine that prevents cancers that kill poor women of color is now available, but the primary recipients will be wealthy white women. This should be a human rights issue of the first rank.

The Symposium that follows begins these conversations. …

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