Yes, You Should Get Your Child the HPV Vaccine

The following is a Facebook response I crafted to a woman who was opposed to the HPV vaccine because she felt that the risks of the vaccine did not outweigh the benefit. Since it was lengthy, I share it on my own profile, and my friends asked that I make it public. Subsequently, I was asked to make it into a blog post. So here we are.

I find this argument interesting, but I wonder how much of it comes from a sense of complacency. It seems a little bit like a skewed risk assessment more than anything, borne out of complacency.

This isn’t an insult. Let me explain. If I don’t vaccinate my child against measles, that child could be exposed to measles tomorrow (hypothetically) and contract measles. The consequences of not vaccinating my child could be immediate, and I would have no control.

If I don’t vaccinate my child against HPV, he’s not coming down with cancer tomorrow. However, it is possible that through his own sexual activity (though not necessarily consensual and not necessarily intercourse), he could be exposed to HPV in the next few years and then, in 20 or so years, the HPV infection could lead to cancer.

So the risk of HPV-caused cancer seem distant, and there are plenty of rumors about the HPV vaccine (which, by the way, are false).

If I don’t vaccinate my child against measles, he could be one of the 60-600 people infected in the U.S. this year. (My own state saw 79 cases this spring/summer–so the threat was real.)

If I don’t vaccinate my child against HPV, he could be one of the 16,500 men (and 39,800 people) who gets cancer in the United States. There is no Pap smear-like test for oropharyngeal cancer, penile cancer, or anal cancer currently, so we wouldn’t know he had cancer until he became symptomatic.

But even with Pap smears, 4,000 women die in the United States right now from cervical cancer alone–almost all of which is caused by HPV. Before the vaccine, 450 children died every year from measles. So in reality, a girl is 10 times more likely to die from HPV-related cervical cancer than her grandparents were from measles. That alone seems to make it worth preventing, and doesn’t mention the damage done to a woman’s body if her cancer is caught early or in the pre-cancerous stage. The risks go beyond death into infertility, pain, suffering, etc.

The data we have, now, is that HPV infections have been reduced by 90% in places like Australia and they are way down, despite our low uptake rate with the HPV vaccine, in the United States. One study of more than a million girls in Scandinavia showed absolutely no serious side effects from this vaccine.

The other issue is how diseases are contracted. Tetanus is also a behavioral illness. Just don’t get a dirty puncture wound, and you will be fine, right? It isn’t infectious–yet every state requires this vaccine for school entry.

Of course we require this vaccine. You can’t really avoid tetanus by just being careful.

And you can’t really avoid HPV by being careful or abstinent before marriage. Unlike HIV, HPV is not passed along via secretions. It lives on the skin. If someone wears a condom, he can still pass on HPV. Deep kissing can pass on HPV. Non-consensual sexual contact can pass on HPV. A virgin can get HPV on her wedding night from a spouse who caught it before marriage. It is much more like contracting tetanus than we think, and for many people, they have absolutely no control over whether or not they contract it.

So I wonder–does it still seem worth the risk to pass on this vaccine?

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

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.

 

Faux Pro-Vax Gambit

Anti-vaxxers do not like to be labeled as anti-vaccine. They see it as an ad hominem attack, though it is rarely meant to be. It is meant to describe what they are: against vaccines. As media attention moves away from legitimizing anti-vaccine sentiment and more toward exposing it as a threat to public health, anti-vaxxers have become more sensitive to being labeled as such.

Some have come up with their own labels. The favorites are “pro-vaccine safety” and “pro-choice.” The second is especially maddening because they want to have a choice over whether or not their children are protected against disease and a choice about whether or not their communities have high enough immunization levels to protect the most vulnerable. It is a choice born of privilege and of ignoring the needs of others.

Some simply dismiss it outright. Lucija Tomljenovic, a biochemist who has published papers promoting anti-vaccine myths, made this comment on a BMJ article:

I am NOT anti vaccine, I am anti bad science.
The reason so many dismiss even the possibility that vaccine can cause
damage is because they believe this to be true. This is religion and not
science.

Of course this is complete nonsense. People who promote the science behind vaccines do so because they have followed the science.

A prime example of the pro-science, pro-vaccine camp looking critically at the science is demonstrated in this article by Tara Haelle discussing a study that dubiously connected the Hib vaccine to leukemia protection:

couldn’t find evidence of this dramatic reduction in government health statistics.

When I turned to outside experts, I discovered my confusion was justified.

I asked Dr. Walter Orenstein, associate director of the Emory Vaccine Center, if he could help or recommend others. He sent me to Dr. Art Reingold, head of epidemiology at the University of California, Berkeley, School of Public Health, and Dr. Martha Arellano, an oncologist specializing in leukemia at the Winship Cancer Institute of Emory University. Arellano also suggested I speak with Dr. Edmund Waller, an immunologist and oncologist also at Emory’s Winship Cancer Institute.

Every one of them conveyed the same message: Nothing in this paper proves that the Hib vaccine reduces leukemia risk, much less helps prevent ALL.

Tomljenovic is not alone in eschewing the anti-vaccine label despite evidence that she is. After all, even Dr. Bob says that he “gives vaccines every day,” even though he has aligned himself with the anti-vaccine forces in California.

But the most maddening are those who come right out and claim that they are pro-vaccine. It’s a gambit meant to disarm the other person in a conversations. It looks like this:

I am a pro-vaccine parent who strongly opposes SB 277.

My child, now 20, received all of her childhood vaccines, with my informed consent.

Her pediatrician and I decided together to delay the hepatitis B vaccine until puberty, because it addresses a disease that is spread via needles and sex, and she was at almost no risk of coming in contact with it.

The above quote demonstrates the crux of the argument. Basically, “I must be pro-vaccine because I vaccinated my children. Except for this one bad vaccine. I didn’t do that because [insert various anti-vaccine myths and follow with lots of conspiracy theories.]”

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Basically, the Faux Pro-Vaccine Gambit is an introduction, a way of distracting you and throwing you off-balance so that when the anti-vaccine myths follow, you might not know what to do. But it’s possibly the worst gambit out there because the person using it has children who are protected against vaccine-preventable diseases to a degree, but wishes to cast fear, uncertainty, and doubt in order to encourage someone else to leave their children fully unprotected.

It’s the ultimate “I care about my children, and I really don’t give a damn about yours.” And it makes me furious.

It is really dangerous, though, when it is coupled with legislation. Advocates should be aware that people are contacting legislators claiming to be pro-vaccine and against legislation that aims to increase vaccination rates. They are liars, and they are muddying the waters.

So what can you do?

If you are online and encounter a faux-pro-vaxxer, ignore the fact that they claim to be pro-vaccine. Engaging in a discussion about immunization means debunking the misinformation, not taking apart the person. Anyone who promotes incorrect information needs to be corrected, especially in public, so that others are not misled by falsehoods.

If you are contacting a legislator, know that others are claiming to be pro-vaccine. If you are working closely with legislators on the matter, you might prepare them for this gambit. Be aware, however, that letting a legislators know that you are pro-vaccine probably does not mean much to them. Be prepared to use other labels for the anti-vaxxers with legislators such as “opponents to the bill” or “opponents to raising immunization rates.” Then, whether or not they vaccinated their children is an entirely moot point.

And know that whatever people claim, if they follow it up with anti-vaccine misinformation, they are not for vaccines. They are against them. In other words, they are simply anti-vaccine.