HPV Vaccine Controversy is About Rights and Transparency, Not Sex and Health

Denise J. Hunnell, M.D. | October 19, 2012 | 10:41am EDT
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According to a study published in the journal Pediatrics, all those parents who were afraid that their daughters would run wild once they were protected from Human Papilloma Virus (HPV) can breathe a sigh of relief. The Kaiser Permanente study shows that risks of pregnancy, STD treatment or the need for any counseling that suggested the girls were sexually active among those vaccinated was the same as the unvaccinated girls.

So the popular media is abuzz with news that the vaccine does not lead to increased promiscuity among the girls who receive it. Unfortunately, this study does not address the real root of the HPV vaccination controversy. The issue is not the vaccine itself but rather who gets to make the decision to vaccinate: the government or parents.

The Human Papilloma Virus occurs as more than 100 subtypes, only four of which are associated with cervical cancer. When Merck created the first HPV vaccine, Gardasil, in 2006, the company engaged in an aggressive marketing and lobbying campaign to get governments to mandate vaccination of all girls ages 11 and older. Merck was in a hurry to establish Gardasil’s market dominance because it knew its competitor, GlaxoSmithKline, was not far behind with an HPV vaccine of its own.

Interestingly, this first high-pressure marketing campaign was launched before there was widespread experience with the vaccine to assess safety, and the attempt to ramrod HPV vaccination into the menu of government-mandated vaccines was met with substantial resistance. There were some who objected to labeling all 11-year-old girls as being at risk for a sexually transmitted disease and in need of protection. Some parents did voice concerns that this vaccine would cause their girls to run sexually amok. The most cited concern by parents and health professionals, however, was that HPV did not rise to the public health risk to warrant taking the decision to vaccinate out of the hands of parents and giving it to the state.

Six years after the initial release of Gardasil, it appears that some of the initial concerns were not well founded. Both Gardasil and Cervarix, the GlaxoSmithKline vaccine, appear to be mostly safe. A recent review of nearly 200,000 girls who received the HPV vaccine showed no statistically significant ill effects.

While it is good that young women’s health does not appear to be adversely affected by these vaccines, what has not been addressed is the justification for infringing upon parental rights in health care decisions for their children.

Proponents of mandatory vaccination will point to studies showing HPV to be the most prevalent sexually transmitted disease with nearly 45% of women ages 20 to 24 being infected. However, this includes all of the various subtypes. When looking at the subtypes that are considered high risk for cervical cancer and covered by the HPV vaccine (subtypes 16 and 18), the prevalence rate drops to 2.3%. Importantly, the vast majority of these infections will be cleared by the body’s own immune system with no medical intervention needed.

Adding to the scandal of the promotion of these vaccines is the fact that at least 30% of all cases of cervical cancer are associated with HPV types that are not covered by vaccines. Therefore, getting the vaccine does not lessen the need to get regular pap smears. The Center for Disease Control (CDC) states that getting these regular pap smears alone will prevent most cases of cervical cancer because precancerous changes can be detected and successfully treated before they develop into actual cervical cancer.

What does this series of three shots costing $400 provide? It does not save women any money or time with regards to preventive care because they still need the same cervical cancer surveillance as those who are not vaccinated. And it does not change your ability to fight HPV subtypes not covered by the vaccine. All it does is prevent the need for treatment of precancerous lesions in that small percentage of women who contract subtypes 16 or 18 and do not clear the infection on their own.

So is HPV vaccination a good thing? Contrary to certain huge pharmaceutical companies and their partners in government, the answer is complicated. It appears to be relatively safe. Considering that the risk for HPV infection increases the younger a man or woman becomes sexually active and the more sexual partners he or she has, it is reasonable to recommend vaccination for those who are at high risk for early sexual activity and numerous sexual partners. Of course, it is much more reasonable – and much safer – to recommend that young people stop sleeping around and wait to have sex with the one person with whom they will spend the rest of their lives.

On the other hand, because the odds are high that if one does contract HPV the subtype will not be one of the HPV strains covered by the vaccine, and that even if it is one of the strains covered by the vaccine it will be naturally cleared by the immune system, only a very small segment of the population actually benefits from this vaccine. This means that it is equally reasonable to simply rely on regular pap smears for cancer prevention. Because the vaccine is recommended for young men and women up to the age of 26, if a parent declines to vaccinate a child, the child is still free to seek vaccination once he or she reaches the age of maturity. No permanent harm necessarily results from the delay.

The bottom line is that both the decision to vaccinate and the decision not to vaccinate against HPV are reasonable choices. Parents have the right to weigh the risks and benefits of the HPV vaccine and make a decision based on their own unique situations. The state has offered no convincing argument to justify usurping parental rights and mandating HPV vaccination. To do so attacks the integrity of the family and benefits the corporate interests of Merck and GlaxoSmithKline far more than it benefits the health of American men and women.

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