Wednesday, February 28, 2007

The HPV vaccine

Warning: Rant Ahead

Okay, so yesterday I noticed a survey on Universal Hub that asked whether or not Massachusetts should require the cervical cancer vaccine. I thought that this was odd; I mean, really, who would opine against something that prevents cancer? I logged my vote and was stunned to see the “no’s” winning. WHAT? (spoken in incredulous, Borat- voice). Seriously, who likes cancer?

As a microbiologist who specializes in infectious disease (yes, I know I’m only a grad student, but I know my stuff when it comes to nasty pathogens.) , I find it highly upsetting that people would be opposed to this vaccination program. HPV (human papilloma virus) is a serious problem in the United States. Here's an article with some good information about the disease, the vaccine, and infections rates, which vary from 1 in 2 to 1 in 5 in the U.S. HPV is the major cause of cervical cancer, which kills 300,000 women a year worldwide. The vaccine prevents HPV infection and therefore blocks the major cause of cervical cancer. Really, that’s all you need to know: Cancer bad. Vaccine block cancer. Vaccine good.

So, why are people against it?

There seem to be two major arguments. The first is of the "it's just a money maker for Merck" vein of skepticism. Or people who are opposed to vaccination in general (but that's a rant for another day). Yes, Merck will make money on the HPV vaccine, but Merck spent millions of dollars in funding research and development in order to create the vaccine. And it works. And it's a lot cheaper (and far more pleasant) to get a vaccine than to undergo treatment for cancer.

The second, and the one that really makes me angry, is the "it will encourage teenage girls to have sex" line of opposition. It's the same ridiculous argument that was used against sex ed programs the late 80s when AIDS came on the scene. Talking about sex, or STDs, does not encourage people to have pre-martial sex. Let's get realistic. Currently, 24.5% of girls ages 14 to 19 in the United States are infected with HPV. Like it or not, many teenagers have sex. Vaccinating them against HPV prevents them from developing a common and deadly form of cancer. Really, what's not to like about this plan? Vaccinate the population, reduce cancer rates. Does the opposition prefer that those sinful girls will get cancer? Wouldn't that teach them a lesson! Would these same people be opposed to an HIV vaccine, if it existed? "Well, they shouldn't be having sex anyways." Grrrr....


Frances said...

Thank you Eileen! I have had the same thoughts and fits of anger over the whole thing. People are living in a dream world and rejecting what IS reality about our teens. Wouldn't it be better to be safe than sorry?

brigita said...

I can't help but think that people would not be nearly as opposed to this if it wasn't so gender-specific. No one would make a peep if it prevented boys from developing some kind of sexually-contracted dick cancer. Sweet jeebus.

I loved what Colbert said about this vaccine, comparing it to when ran right out to play in his neighbor's pile of rusty nails after getting a tetanus shot.

bigglesworth said...

i canʻt think of anything worse than pre-marital sex, not even cancer. well, maybe livinʻ in sin (but only if itʻs accompanied by a Dunne sisters dance to taunt a Dunne mother ...)

The Sagacious Dodger said...

I would argue with this on the basis that a person should be free to govern their own body. Mandating specific vaccination treatments over others crosses that line. Offering the option to all women is a better way to go I think.

However, this situation inches to a level that is far too pervasive. In such a case, I could see supporting mandatory vaccinations to preserve reasonable public health standards. This is assuming that the treatment is safe for the patients and the contracts with the government are not wasteful.

eileen said...

The reason that most vaccinations are mandatory, and not optional, is that a certain percentage of people within a population need to be vaccinated in order to preserve "herd immunity." Basically, unvaccinated people serve as a reservoir for infectious disease and allow it to persist in the population. For example, if you don't want to get vaccinated against whooping cough, you're not just increasing your own risk of contracting the disease, you're increaing EVERYONE'S risk. Public health policies are set to best protect the overall population, and they work. Not everyone felt like taking the polio or the smallpox vaccine, either.

Ryan said...

Was coughing in public just eqauted with sex?

eileen said...

Sex, coughing, playing in a pile of rusty nails....all fun and games until someone gets a disease!

Tricia said...

I'm really struggling with this one. I do think that teenage girls should get this vaccine; I don't think it will encourage sex nor do I oppose vaccination.

I don't, however, think that HPV is in the same category as whooping cough or smallpox when it comes to required vaccination. I realize that HPV presents a huge public health risk, and a lot will be saved publicly and privately if people don't contract this virus. I also realize that if the vaccine were to be optional many many people who should take it won't, regardless if it's freely provided.

All that said, I don't think that we should require people to take a vaccine for a sexually transmitted disease. A kid is not going to transmit this disease just by showing up to school, so it shouldn't be required for a kid to get vaccinated to go to school.

It comes down to a balance between sacrificing personal liberties to reduce risk to public safety and where do you draw the line between the two. Right now, I think that the line is somewhere between the MMR and the HPV virus.

(Note: Everyone I've spoken to about this agrees with you, Eileen, so you're in good company; I just wanted to provide a third arguement). :)

eileen said...

Let me clarify, I used the whooping cough example as an argument to those who are against vaccines because they don't think the goverment should tell them what to do, not specifically as an argument to support the HPV vaccine program. Obviously, STDs are not transmitted as easily as airborne infectious pathogens.

However, I feel that it should be mandatory, because many girls who are at high risk for contracting the virus are the same girls whose parents oppose the vaccine for so-called moral reasons. After acquiring HPV, it takes years to decades to develope cervical cancer, so parents make a decision for their teenager are influencing whether or not she may get cervical cancer when she's in her thirties.

I do agree that there is an element of sexism in the opposition, but Brigita put it much more eloquently.

brigita said...

Kinda like the whole "if men could get pregnant, abortions wouldn't be just a right, they'd be a sacrament" argument.

And "dick cancer" is eloquent? use a very light hand with your sarcasm, Mlle. DCoE. ;)

brigita said...

PS: Is there an ideal age range for girls to get the shot? Because all signs point to our next-gen brigita being a girl, and you *know* I'm going to be all over that. At the same time, I'm also going to try to raise her to be a tomboy filled with the realities of sex:

"He won't like you more, it'll just be fodder for the locker room! STDs are nasty and pregnancy is forever! Not to mention the fact that you won't even enjoy it! Just take matters into your *own hands* (wink wink, nudge nudge) and we can have this coversation again when you get to college."

eileen said...

The CDC recommends the vaccine for girls 11 to 12 years of age, so Baby Brigita will have a while to wait.

Here's some more info on the HPV vaccine from the CDC.

J.R. said...

Boy O boy... does this blog ever love to throw around the "Woe is Woman" card.

The HPV vaccine actually protects against four strains of HPV, speficically strains 6, 11, 16 and 18. And while strains 16 and 18 cause %70 of all cervical cancers. strains 6 and 11, cause 90% of all genital warts. Not exactly "dick cancer" but certainly a less than fun disease that afflicts both men and women. So why aren't men being told to line up for the shot, and why aren't we hearing calls from public health officials to vaccinate all boys ages 9-12??

I suppose, in the end, public health authorities have deemed fighting cancer a worthwhile enough cause to consider violating personal autonomy for the sake of the greater good and mandating vaccinations. And on the flip side of that coin, they probably decided that genital warts is not serious enough to warrant the same approach... even though lots of boys would be protected from "dick cancer."

Incidentally, approximately 70% of all public health school graduates are women, so if you're looking to play the sexism card in the administration of public health decisions, most likely the finger is going to end up pointing at a female administrator.

All this being said, I agree with Eileen that this vaccine should be mandatory. Save the Cervix!!

eileen said...

The vaccine isn't approved for males yet, because Merck wanted to get the vaccine on the market ASAP, so the initial clinical trials were done only on women. I think they pushed it as an anti-cancer product instead of an anti-genital warts one for both public health and PR reasons.

Anonymous said...

Have you ever have more comments in any of your posts??
Eileen, I think this is a record, a "sign".

I agree with JR, save the CERVIX and be happy with out the risk of an abnormal PAP.