combatting hesitancy / misinformation

I’m pro-vaccine, but that HPV vaccine…

karenlernst33 Comments

Somewhere along the line, it became acceptable for parents who happily vaccinate their children against pertussis and measles and diphtheria and rotavirus to fear the HPV vaccine. Parents who shun the notion that the MMR causes autism or the the Tdap causes SIDS gobble up willingly blog posts about beautiful teenage girls who developed neurological problems or ovarian issues after the vaccine. That the websites they read are connected to the most notorious in the anti-vaccine world doesn’t register with these otherwise pro-vaccine parents. They are certain that this vaccine is not safe and that, while they can trust the CDC on every other vaccine, the HPV vaccine information has been obscured and sullied.

Parents fear vaccines for lots of reasons, and I’ve always held that fear of the HPV vaccine is one gateway into the anti-vaccine world. (Another prominent gateway is our birth culture, but that’s a different post.) Those pretty teenage girls had so much to hope for. And now their dreams are dashed–even if all evidence points away from the HPV vaccine.

I could go on about how safe this vaccine truly is, but I’ve done that before.

Instead, I’m going to insist today that parents who readily fall prey to misinformation about this vaccine do not understand what is at stake. I was fortunate enough to host a conference call last week featuring Dr. Nathan Boonstra on the topic of HPV vaccine uptake. While you should listen to the whole thing, I was most struck by what he said about the burden of HPV disease:

When we talk about the burden of this disease, I think it is underestimated by a lot of people…We are looking at 80 million Americans currently infected with HPV, 14 million new infections a year in the United States. And it’s most common in people in their teens and their early twenties…We are talking about 4,000 deaths from cervical cancer alone every year. We are talking about 12,000 cases of cervical cancer a year. And when we start looking beyond that, we are looking at something on the order of 25-26,000 cases of cancer in the United States from these [HPV] viruses. And then we can go even bigger and talk about the hundreds of thousands of cases of genital warts and hundreds of thousands of cases of precancerous lesions that have to be removed and that have their own set of complications and their own burden by bleeding or infection or even cervical incompetence…When we talk about males and females, a lot of people think we are trying to protect females. But when you really break down the numbers out of all of these 25,000 cases of cancer that are happening in the United States, a good third of them are in males…Most of these are your oropharyngeal cancers, which can be reduced by widespread use of the vaccine.

What Dr. Boonstra pointed out is that the burden of HPV disease actually outpaces some of the other diseases we vaccinate against. If we consider only cervical cancer deaths (even though HPV causes a number of cancers) and compare those to the deaths of other diseases, the harm caused by HPV disease is obvious:

  • 4,000 HPV-related cervical cancer deaths in the U.S. today.
  • 1,904 polio deaths in the U.S. in 1950 (near the height of the epidemic).
  • 450 measles deaths every year in the U.S. before the vaccine.
  • ~500 tetanus deaths each year before widespread use of the vaccine in the U.S.
  • 100 chickenpox deaths every year in the U.S. before the vaccine.

And so on. You’ll notice that with the diseases we most fear for our children, we readily accept vaccinations. Except that HPV-related cancers kill more people every year than polio, measles, tetanus, and chickenpox combined did before we had vaccines for those diseases.

Parents who feel that they can let this vaccine hang or opt out of it because it doesn’t seem important are playing a dangerous game with their children’s health. HPV is a real threat, and preventing cancer when we can is an obligation. I would never say that one vaccine is more important than another, but the HPV vaccine is certainly crucial, even when it has the reputation of being optional.

While the burden of the disease may not hit their children until they are adults, the chance to protect their children happens when they are still children and parents have the obligations to make the choice to protect.

 

33 thoughts on “I’m pro-vaccine, but that HPV vaccine…”

  2. So are the 4,000 and 12,000 cases of cervical cancer all patients who were able to be vaccinated with Gardasil.
    How many of those patients are senior citizens? How many in their 40’s. Please I want statistics of those who could have had the virus, not the entire population.
    Some people don’t hold off because of Lyme Disease stories. Some people hold off because it just hadn’t been around that long.

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    • I do understand that this vaccine has the reputation of being a “newer” vaccine, but it has been in use in the United States since 2008 and hundreds of millions of people have received it, giving us a great deal of data on the vaccine. If you listen to the podcast linked in this post, Dr. Boonstra notes that this is an extremely safe vaccine, and his words echo many, many doctors I have heard say that it is, in fact, one of our safest vaccines.

      Your comment on Lyme disease leads me to believe you read my other post, which was a direct rebuttal in some ways to a story circulating at the time about HPV vaccines leading to Lyme disease.

      Cervical cancer is most common in mid-life. It is far rarer in older women. Here is some more information on who gets cervical cancer in the United States: http://www.cancer.org/cancer/cervicalcancer/detailedguide/cervical-cancer-key-statistics

      Liked by 1 person

  3. There are always plenty of more inflammatory beliefs/accusations that get the most attention, but the issue I have with the HPV vaccine is with the nature of the disease itself – namely that it’s a virus that’s not accidentally transmitted, and therefore no ‘innocent’ victims. Living a public life with HPV does not pose the risk to the innocent public that measles etc. does, so no matter how slight the risk, how can you justify things like school mandates that students take said risk? Each person must weigh the risk vs. the benefits, as well as their other options for avoiding HPV much like they would avoid getting herpes.
    We place no societal restrictions on people with other STDs. Everyone who has grown up since the ’80s has known not to stigmatize those who are HIV positive, and we all are taught how to avoid contracting it.
    So I ask – if there were an HIV vaccine developed tomorrow that carries a very slight risk of death, would you take it? Would you demand others take it? It may be a bit glib, but the point remains the same: How to you mandate vaccines for diseases that are not so easily transmitted, and what do you do to make whole those rare few that might be harmed? The biggest step towards getting people to accept vaccines might be to make sure that they (or their kids) will be taken care of should something bad actually happen. But for now, the risk, however small, lies with the individual.

    Liked by 1 person

    • I feel like you are responding to things I did not write, which seems odd to me. I did not discuss mandates in this post. The post is about parents making a choice to protect their children and how the burden of disease is not slight when it comes to HPV. How did you read mandates into that?

      I also bristle that there are no innocent victims of HPV. Cervical cancer is not about guilt or innocence. Even if it were, HPV can be transmitted through non-consensual means. It can also be transmitted through deep kissing.

      Furthermore, 79 million people in the United States are currently infected with HPV. Most adults get at least one strain of HPV in their life time. It is extremely common, and my point was that it is worth preventing. Parents should not fool themselves into thinking their parenting can prevent HPV. It is a virus, not a lifestyle choice.

      Your comments about HIV miss the idea of epidemiology of disease. HIV is far less common than HPV. But since there is a vaccine in development, it is still worth preventing. However, because the virus is less common, a vaccine against it would not be added to the routine childhood schedule. It is also well worth noting that a slight risk of death is not at all a side effect of the HPV vaccine. So this apples to oranges analogy does not hold up.

      To reiterate: I’m not talking mandates. The burden of HPV disease is severe. It is worth preventing.

      Liked by 2 people

  4. This has to be one of the most ridiculous articles I have ever read. As a mother to a registered vaccine injured child the ‘science’ you so faithfully push is laughable. The risk for a preteen to develop this disease is practically zero. When the science is eventually proven wrong I hope you are ashamed of yourself. Hopefully, though, you are enjoying your big paycheck from Big Pharma.

    Liked by 1 person

    • This comment has everything. Vague claims of harm from vaccines. A discussion of risk that ignores all the information presented above. An attempt to shame the author. And then the Pharma Shill gambit. Nothing more to say.

      Liked by 2 people

  5. Well as a woman in my mid 30’s that has had HPV and has had early stage cervical cancer, and has had many painful procedures, surgery, hemoraging, and infection from surgery, and now having cervical imcomptence in my third pregnancy(had sugery to remove cancer cells after my second son was born)- I feel I can speak on the matter. I did not know what hpv was until it was already effecting me, it wasnt discussed as being cancer causing when I was a teen and people need to understand the agony it can cause! There is a very real threat, and likelyhood of your children developing it in their early 20’s and without their knowledge! Im so glad they developed a vacine and my 2 boys and new baby girl to be will all receive it! So one day people wont have to go through what I did!

    Liked by 1 person

  7. Hi Karen, I am interested in the subject but as far as my doctors said there are a lot of factors to be taken into consideration in precancerous and cancerous lesions. It is known that HPV is very widespread, but the fact that only a small percentage of women develop L-SIL and even less have H-SIL seems to indicate that there is something else besides HPV. Also, a lot of lesions go away by themselves and only a small number of women develop cancer. So, there is the tendency to wait and see, in some cases. Of course not with H-SIL. But, as my doctor told me, we cannot be sure if a H-SIL will become cancer, because we are not willing to take the risk and we treat it.
    What I am trying to say is that I was absolutely pro HPV vaccine (if I had children) but now I really don’t know. I feel like there is something missing and science needs to find out the real cause of cervical cancer. It would be interesting, for example, to see if people who work in the sex industry are more subject to this cancer than others. Or even porn actresses.
    That would be interesting to read, to me.

    Liked by 1 person

    • It sounds like your doctor has almost gone out of his way to confuse you. Look–it’s simple. This vaccine prevents cancer. If we look only at cervical cancer, right now in this country, HPV kills 4,000 women every year from cervical cancer.

      Most people recover from measles. Most people recover from influenza. Most people recover from polio. We still prevent those diseases. And HPV causes more death and complications than those three diseases did combined before their vaccines were licensed. Does it matter that most HPV clears in light of those statistics?

      Liked by 1 person

  8. My doctors are among a group of doctors who are studying HPV in Europe and abroad. They are pro vaccine, 100%. What they told me is that HPV is necessary to develop cancer but it is not sufficient, given the fact that the majority of peopl have HPV but only a small percentage develop cancer. So there has to be something else.
    I found this: http://jcm.asm.org/content/42/3/1330.full
    Here, prostitutes were positive to HPV, as one could expect, but the majority of them did not have any condition.
    Why?
    The numbers of HPV infection varies in different states: why? Is it because of different habits, like hygiene or like the use of the condom or less promiscuity?
    If I remember correctly there is also a protein involved in the development of cervical cancer.
    So, my conclusion is that it could be that IN THE FUTURE we will find out that HPV is only a part of the problem. And this is different from polio o measles.
    I am not against the vaccine.

    Liked by 2 people

  9. Hi Karen,

    I am not against this vaccine and I am pro-vaccine. But just out of curiosity, could you state your specific allegiance (if any) to the pharma industry? Are you a paid consultant for Merck?

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    • I am not paid to do anything by any pharmaceutical company. I’ve never so much as accepted a cup of coffee from a pharmaceutical rep. I understand that you are not against this vaccine and are pro-vaccine, but it is an insulting question. I’m sure you didn’t mean to insult me, but it does make me bristle to be asked if my opinion is only offered because I am being paid to offer it.

      Liked by 1 person

      • Wow. No, I didn’t mean to insult you, and it’s too bad you felt that way. You are publishing an article on the internet, and with that forum comes comments and questions. It’s part of the territory. I am a former pharma rep (18 years), and I never got insulted if anyone either accepted or refused a cup of coffee from me. I never asked if your opinion was offered because you are getting paid to offer it. I simply asked if you were a paid consultant for Merck and what your allegiance was, if any, to the pharma industry. I have had plenty of physicians that were consultants of a company I worked for that spoke out openly against drugs that said company sold. Consulting can mean a lot of things, not just that you are getting paid to “sell” for the company. So sorry you got “bristled”. It really was intended to be just what I stated: a question for my own personal curiosity.

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    • I am a pediatrician who has given a fair amount of vaccines. I myself, my clinic, and the clinics of all the pediatricians I know have never received money from a company that makes vaccines when we give out vaccines. In fact, we all have to PAY to buy them. Where did this rumor come from that doctors are pro-vaccine because of receiving money from pharmaceutical companies? Don’t you think that big pharma would rather pay us to stop vaccinating people, since vaccines cause immunity and prevent diseases, and people getting sick from such illnesses would requirement treatments, drugs, and hospitalizations off of which pharma would make a lot more money?

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    • So I have given your comment some more thought and, after consulting a friend, have decided to update my About page to indicate that I have no conflicts of interest to disclose. Thank you for giving me something to think about.

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  10. I am totally pro-vaccine. But why would I get the HPV vaccine for my 14 year old daughter who has totally committed to stay a virgin until marriage? (her decision, not mine)

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    • I think that is a fair question. Here is my answer.

      1. Not all sexual contact is consensual.
      2. You don’t know whether or not her future spouse has committed to remaining a virgin until marriage.
      3. HPV can also be transmitted to virgins through deep kissing, for example.
      4. Because she can still remain a virgin even if she gets this vaccine.

      It sounds like you have a great relationship with your daughter. Hope my thoughts can help the two of you have a productive discussion.

      Liked by 3 people

      • Those are all good responses but you can add that the ACIP recommends administering the HPV vaccine at age 11 due to the more robust immune response in that age group thus providing better coverage.

        Liked by 1 person

    • because she is 14, and even if she didn’t waiver, she could be God-forbid one of the many girls who are raped during high school or college

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    • My daughter had a friend who was a virgin until she married a man who had intercourse with one other person before her. She contracted the virus from him. Get her the vaccine. Then you did all you could to protect her.

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  11. For somebody that gets easily brustled at ad hominem attacks, you don’t seem to mind dishing them out yourself, in the most ironic fashion. I mean, this is a “pro-vaccine” blog, is it not?

    “That the websites they read are connected to the most notorious in the anti-vaccine world doesn’t register with these otherwise pro-vaccine parents.”

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    • I am not certain which comment you think is an ad hominem. I have accused no one of dishing out ad hominem attacks and do not see the statement you quoted as an ad hominem, either.

      Liked by 1 person

  12. Who can trust the FDA, CDC anymore with pink slime, saw dust, and the mercury filled shots?? Need I go on.. the issue is that how do we American’s trust this corrupt system any longer…? We trusted them with our lives, what we give and feed our children. To be constantly disappointed! When it comes down to it they seem to approve anything thing for money and to hell with any and all consequence.

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    • This vaccine, like all our vaccines, are used and studied across the globe. The largest study was done in Scandinavia, and looked at nearly one million girls who received the shot. That study could find no correlation between severe adverse events and the HPV vaccine.

      Liked by 1 person

  13. Australia has mandated the vaccine and they’re already seeing the benefits. While the mandates are only for 12 to 13 year old girls, they’re seeing huge declines.of genital warts in men and women. They’ve also see a “striking decline” in the number of cervical abnormalities which would often lead to cancer. Since cancer takes a long time to develop, it will be years before this cohort can report a similarly huge decline in cervical, anal, penile and head and neck cancers.

    Here’s the NY Times write up about an article in the British Medical Journal. http://well.blogs.nytimes.com/2013/04/18/hpv-vaccine-showing-successes-in-australia/?_r=0

    My point is to reiterate that the vaccine has been tested globally and instead of seeing scary side effects, they’re seeing crazy good health benefits.

    Liked by 1 person

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