Public Controversy: HPV Vaccine

The rate of Human Papillomavirus (HPV) infection has grown at an alarming rate over the past decade and continues to increase at a rapid rate. According to the Centers for Disease Control and Prevention, “HPV infects approximately 20 million people in the United States with 6.2 million new cases each year…There are more than 30 strains of HPV that affect at least half of sexually active people in their lifetime” (CDC). The HPV virus is spread through sexual contact. Often people with HPV show no symptoms; consequently a large numbers of infected individuals are unaware that they have it.

There are approximately 30 types of genital HPV. Some HPV types can cause cervical cancer in women and can also cause other kinds of cancer in both men and women. These particular HPV types can cause cell abnormalities. If untreated, areas of abnormal cells, called lesions, can sometimes develop into cancer. According to the Centers for Disease Control, “Each year, about 12,000 women get cervical cancer in the U.S. Almost all of these cancers are HPV-associated” (CDC). Additionally, there are several other types of cancer caused by HPV, though less common than cervical cancer- these cancers affect thousands of Americans each year. Each year in the U.S., there are about:

500 women who get HPV-associated vaginal cancer

400 men who get HPV-associated penile cancer

2,700 women and 1,500 men who get HPV-associated anal cancer

1,500 women and 5,600 men who get HPV-associated oropharyngeal cancers (CDC).

In 2006, the U.S. Food and Drug Administration approved the first preventive HPV vaccine, Merck & Co.’s Gardasil and later GlaxoSmithKline's Cervarix. These two vaccines work by preventing infection by the most common types of cancer-related HPV. Both of these vaccines are given as a 3-dose vaccine, and both vaccines cost about $400 for three doses (Norton). “Since its FDA approval in 2006, the vaccine has proven to be highly effective. In clinical trials, the vaccines have been shown to be 100% effective in preventing infection with HPV strains 16 and 18, which together cause about 70% of cervical cancer cases” (Kaiser). The vaccine also has a "strong safety record." The most common side effects, according to the CDC, are pain at the injection site, fever, dizziness and nausea (Norton).

Yet, despite the scientific evidence supporting the HPV vaccine, it has been surrounded by ongoing debate and public controversy. The question of whether the HPV vaccine should be among the list of required vaccinations for school age girls first gained public attention in Texas in 2007, when Governor Rick Perry attempted to mandate the vaccination. Governor Perry’s failed attempt has become a political hot topic at the 2011 Republican presidential candidates' debates. With HPV infection rates on the rise, it is essential to separate the science from the rhetoric and closely examine the potential health benefits and risks of mandating this vaccine.

So, why is the HPV vaccine so controversial? Strong backers of the vaccine include the American Academy of Pediatrics, the American Academy of Family Physicians and the Centers for Disease Control and Prevention (CDC). According to the CDC website, “Either HPV vaccine is routinely recommended for 11- or 12 year-old girls. The vaccine series can be started beginning at age 9 years. Catch-up vaccination is recommended for 13- through 26 year-old females who have not completed the vaccine series” (CDC). Despite overwhelming support form the medical and scientific communities there has been a strong public backlash against the HPV vaccine. “Behind the political fireworks is a quieter backlash against a public health strategy that has won powerful advocates in the medical and public health community” (Knox).

Opponents of the HPV vaccine argue that the vaccine “sexualizes” children at too early an age will promote promiscuity and unhealthy sexual behavior. They are uncomfortable with vaccinating girls, and possibly boys, against a sexually transmitted disease. But, in order for the vaccine to be effective, it must be administered before a person becomes sexually active. “The vaccine loses effectiveness if it is given after the onset of sexual activity. More than one in five boys and girls have had vaginal sex by the age of 15, surveys show” (Harris). When boys and girls engage in sexual activity they are at risk of being infected with HPV. Pediatrician Rodney Willoughby, a designated spokesman for the American Academy of Pediatrics, says, “There's a very good reason for the big push to get preteen girls vaccinated. The idea is to get it done well before their first sexual encounter…Studies done before widespread HPV vaccination show that by the time they're 15, nearly 10 percent of American girls are infected with HPV. By age 17, that has doubled to nearly 20 percent” (Knox).

Parents and the public in general are understandably uncomfortable when confronted with the idea of young children engaging in sexual activity. But, the moral questions and implications surrounding that are completely separate issues that need to be addressed outside of the HPV vaccination debate. HPV causes cancer and vaccinating children before they become sexually active is key to reducing rates. “Against this backdrop, it is vital that public debates on vaccination stick to the facts — and that politicians who make science-supported decisions be applauded” (Nature).

Unfortunately, it was Michele Bachmann who received the applause at the September 2011 Republican presidential debate. The Minnesota congresswoman attacked rival candidate Rick Perry for his failed attempt in 2007, as Texas governor, to mandate vaccination against HPV for 11- and 12-year-old girls, as recommended by the US Centers for Disease Control and Prevention (CDC) in Atlanta, Georgia. In addition Congresswoman Bachman called the vaccines safety into question. She went so far as to refer to the vaccine as a “potentially dangerous drug” and later suggested that it is linked to “mental retardation” (Nature). Congresswoman Bachman’s statements were immediately and strongly refuted by the Centers for Disease Control and Prevention and by American Academy of Pediatrics. Bachman’s inflammatory statements showed to have no basis in scientific fact, and only served to further confuse and misinform parents who are being faced with the question of whether or not to vaccinate their children against HPV. “Unfounded fears about vaccines are already reaching worrisome proportions. No public figure should stoke them — as US presidential hopeful Michele Bachmann has done” (Nature).

If you are the parent of a young girl, you may be hesitant to have your daughter vaccinated against HPV given all of the misinformation that is out there, and it is easy to understand why. Many parents, as the result of false information, have unsubstantiated fears are choosing to not have their daughters vaccinated. According to an October 2011 New York Times article, “Fewer than half of girls between the ages of 13 and 17 have received at least one dose of the HPV vaccine, and fewer than a third have received all three doses” (Harris). But, parents must remember that the American Academy of Pediatrics, the American Academy of Family Physicians and the Centers for Disease Control and Prevention all strongly recommend that girls receive the HPV vaccination. It is critically important that parents take a hard look at all of the scientific evidence in support of the vaccine and talk to their pediatricians about getting their daughters vaccinated. " ‘There are people out there who, because of this kind of misinformation, aren't going to get their daughter immunized,’ said Dr. Kenneth Alexander, a pediatric infectious disease expert at the University of Chicago Medical Center. ‘As a result, there will be more people who die from cervical cancer’ " (Steenhuysen).

Works Cited

Bowers, Evelyn J. “HPV vaccination: Clarifying the use of 'prepubescent.” Nature. Web. 18 Nov. 2011. <http://www.nature.com/nature/journal/v479/n7372/full/479179c.html>.

Centers for Disease Control and Prevention. “Vaccines and Preventable Diseases: HPV Vaccination.” Web. 18 Nov. 2011. .

Harris, Gardiner. “Panel Endorses HPV Vaccine for Boys of 11.” New York Times. Web. 18 Nov. 2011. <http://www.nytimes.com/2011/10/26/health/policy/26vaccine.html>.

Kaiser Health News. “Study Examines Cost-Effectiveness of HPV Vaccine.” Kaiser Health News. Web. 18 Nov. 2011. <http://www.kaiserhealthnews.org/daily-reports/2008/august/21/dr00054082.aspx?referrer=search>.

Knox, Richard. “HPV Vaccine: The Science Behind The Controversy.” NPR. Web. 18 Nov. 2011. <http://www.npr.org/2011/09/19/140543977/hpv-vaccine-the-science-behind-the-controversy>.

Nature Editorial. “The wrong message on vaccines.” Nature 477, 369. (22 September 2011). <http://www.nature.com/nature/journal/v477/n7365/full/477369a.html>.

Norton, Amy. “Girls' HPV Vaccination Rates Falling Short.” Reuters. Web. 18 Nov. 2011. <http://www.reuters.com/article/2011/10/18/us-girls-hpv-idUSTRE79H5WP20111018>.

Steenhuysen, Julie. “Analysis: Bachmann Vaccine Comments Toxic, Doctors Say.” Reuters. Web. 18 Nov. 2011. .