Healthy Skepticism Library item: 5921

Warning: This library includes all items relevant to health product marketing that we are aware of regardless of quality. Often we do not agree with all or part of the contents.

Publication type: news

Whalen J.
Armed With New Vaccines, Drug Makers Target Teenagers
The Wall Street Journal 2006 Aug 23
http://online.wsj.com/article_email/SB115629605880042909-lMyQjAxMDE2NTI2MzIyOTM2Wj.html

Full text:

Armed With New Vaccines,
Drug Makers Target Teenagers
By JEANNE WHALEN
August 23, 2006; Page B1

For decades, immunization has been a rite of childhood and old age. Now, the vaccine industry is targeting teenagers, too.

Drug companies are rolling out new immunizations against diseases that teens are at risk of catching, such as bacterial meningitis, whooping cough and human papillomavirus, or HPV, a sexually transmitted virus that can cause cervical cancer.

New technology and a better understanding of genetics and immunology are permitting vaccination against a broader range of illnesses. Some of these diseases have also been spreading more rapidly among teens in recent years, increasing the need for vaccines. “The adolescent area is…an area of tremendous growth opportunity and tremendous need,” says Wayne Pisano, senior vice president of Sanofi-Pasteur, the vaccines division of Sanofi-Aventis SA.

Drug makers predict global vaccine sales will double by 2010 to $19 billion. If some of the new teen-targeted vaccines sell as well as analysts predict, the teen segment could make up at least 15% of the vaccine market by then.

Teenagers, though, are a tough target. They are difficult to get to the doctor’s office, pediatricians say. Many turn up only when they have broken a bone or fallen seriously ill. They often see a general practitioner or a gynecologist, most of whom aren’t as accustomed as pediatricians to giving vaccinations.

Also, “they’re old enough to say, ‘No, I don’t want it,’ “ says Carol Baker, a professor of pediatrics at Baylor College of Medicine in Houston.

So drug companies are trying to get doctors and parents on their side. When Sanofi-Aventis last year introduced Menactra — a vaccine against several forms of bacterial meningitis, a potentially lethal infection in the membranes surrounding the brain and spinal cord — it compiled a list of college-bound high-school students and sent Menactra brochures to their parents. Adolescents are especially susceptible because the bacteria spreads easily through dormitories, military barracks and other close quarters.

This year, Sanofi is marketing to parents in doctors’ offices. Printed posters and fliers explain how to distinguish flu symptoms from bacterial meningitis; a stiff neck, numbness in the hands or feet and sensitivity to light are common signs of the latter. The materials also direct parents to a Web site — www.fightmeningitis.com — where Sanofi offers more advice and information relating to the disease.

Kaitlyn Keelean, a 16-year-old from Chandler, Okla., got vaccinated against meningitis earlier this year after her older sister unexpectedly died from the disease. “You don’t think it’s going to happen to you, and then something like that happens,” she says.

The current push to vaccinate teens marks a sharp turnaround for the industry. For many years, making vaccines was seen as a business high in hassles and low in profits. Vaccine shots were expensive and difficult to make, and health-care providers weren’t willing to pay much for them. As a result, many drug companies got out of the business in the 1990s.

But the recent shortages of seasonal flu shots, along with fears of a bird-flu pandemic, have helped renew interest in vaccines.

Government, on the federal and state level, plays a big role in the vaccine business in the U.S. A Centers for Disease Control and Prevention advisory panel can recommend new vaccines, and most physicians follow its advice. Also, because vaccines are often required for school and are considered a public-health tool in fighting disease, government programs cover the cost of vaccines for many children.
[Vaccine]

Insurers usually cover childhood vaccines, but some of the new shots targeting preteens and teens are costlier than typical vaccines. Menactra costs $82 a dose, compared with about $20 for a flu shot. Many insurers cover Menactra. It is licensed in the U.S. and Canada and had sales of $215 million last year, its first year on the market.

Sanofi believes the product could eventually reach sales of more than $1 billion a year if it is licensed world-wide and once the company is able to expand its currently limited production capacity. Sanofi’s output constraints, along with high demand for Menactra, are causing shortages of the vaccine in some parts of the U.S.

Sanofi and other vaccine makers are spending a lot of time promoting their products to the CDC and professional associations that influence physician behavior, such as the American Academy of Pediatrics, or AAP, says David Williams, chief executive of Sanofi-Pasteur. “One of the biggest things we do is work with the policy-making community,” Mr. Williams said in an interview at the company’s facility in Swiftwater, Pa. “Knowing who the influential people are is part of our marketing.”

Both the CDC and AAP have thrown their support behind adolescent vaccination in recent years. The AAP recommends establishing a routine vaccination visit for all 11- and 12-year-olds to inoculate them with shots they missed as infants, to provide booster shots, and to give them new adolescent vaccines such as Menactra. A CDC advisory panel recommended Menactra for 11- and 12-year-olds, for adolescents entering high school, and for college freshmen living in dormitories.

Public-health officials are keen to focus most adolescent vaccines on young teens. “They are still under the sway of mom and dad. You can still grab them by the collar,” says William Schaffner, an infectious-disease expert and professor of medicine at Vanderbilt University in Nashville, Tenn.

Another way to force teens to receive a vaccine is to make it mandatory for entering school. State laws requiring younger schoolchildren to be vaccinated for measles, mumps, rubella and other diseases have been in effect for years, helping all but wipe out those illnesses.

Some state legislators and health departments are considering whether to make Gardasil, the new HPV vaccine, mandatory for schoolgirls. Merck & Co., the vaccine’s maker, believes that could be a “successful approach” and has been meeting with state officials, says Mark Feinberg, vice president of medical affairs and health policy at Merck. Gardasil poses particular challenges because it needs to be administered in three shots, over six months.

Making vaccines mandatory for school is a highly political matter, though. Some parent and consumer groups oppose vaccines on safety grounds, citing research that has suggested a link between certain vaccines and autism. Many physicians and drug companies dispute this theory, and the National Institutes of Health says there is “no conclusive evidence” that any vaccine can cause autism.

This debate has made it difficult for states to pass new immunization requirements for school entry, says Diane Peterson, associate director of immunization projects at the Immunization Action Coalition, a nonprofit group in St. Paul, Minn. Some conservative Christian groups particularly oppose making Gardasil mandatory, believing that the vaccine will encourage girls to become sexually active.

Gardasil prevents infection with types of HPV that can cause cervical cancer. The FDA approved it in June for females ages 9 to 26. The CDC advisory panel recommended the vaccine for girls ages 11 and 12.

In March, before Gardasil was approved by the FDA, Merck started running a television and print advertising campaign dubbed “Tell Someone” to raise awareness about cervical cancer.

The ads don’t mention Gardasil. It is a common marketing strategy for drug companies to advertise a disease before specifically advertising their medicine to fight it. Merck is considering whether to run ads specifically mentioning the vaccine, company officials say.

Write to Jeanne Whalen at jeanne.whalen@wsj.com