I’m Joseph Nimeh, MD, Assistant Professor of Pediatrics at SUNY Upstate Medical. I’m a pediatrician, but I have absolutely no affiliation with any drug company and certainly not with one that is marketing this vaccine. Nor do I have any other financial or other relationship to those marketing, producing, and profiting from HPV vaccines.
Let’s state some well-known facts for clarity.
- Cervical cancer typically kills more than 4,000 women every year in the United States. The number is significantly higher if you consider worldwide deaths.
- Women virtually never get cervical cancer unless they have an HPV infection. The virus is the one link that has been shown to cause cervical cancer. The HPV virus also causes many other types of cancer, including cancer of the head/neck, penis, anus, and tonsils, as well as genital warts. HPV impacts both women and men.
- HPV infection generally goes unnoticed. It is asymptomatic. It is extremely common in the general population. Although it is true that most people who get HPV do not go on to develop cervical cancer, it is also true that those who have HPV infection will not know unless they are specifically tested for it. Anyone who is sexually active is at risk for HPV infection, and therefore, may be at risk for the associated cancers, which they may never know until it’s too late.
- There are some case reports related to adverse effects of the HPV vaccine. However, the vast majority of these have not been proven to be causal. In other words, it is not clear that the vaccine caused the reported effects. The most common side effects of the HPV vaccine are those typical of any other vaccine:
- pain at the injection site
- a “large local reaction,” which is a red spot around the vaccine site and is thought to be due to an immune response in the body and is self-limited
- the chance of introducing an infection at the site of the injection, which can happen any time we break the skin and is, with very rare exception, prevented by cleaning the skin with alcohol prior to injection
- self-limited fever
- an allergic reaction, which is also always possible anytime we introduce a foreign substance (antibiotics, probiotics, additives in foods, pesticides you put on your lawn but inadvertently breathe in, etc.) into our bodies
These known potential adverse reactions are nearly always self-limited and inconsequential. While it may be true that there are isolated cases of people who have experienced more serious complications after having this vaccine, those are extraordinarily rare, and they are tracked by a national reporting system called the Vaccine Adverse Event Reporting System (VAERS). This system exists so that very uncommon reactions can be tracked and analyzed to determine whether they were caused by vaccines or by something else. These events are certainly far rarer than the number of women who die of cervical cancer every year.
- It is true that condoms are an effective way to reduce the risk of acquiring sexually transmitted diseases. Their use is highly recommended for this reason. However, condoms are not always effective for preventing the transmission of HPV because the virus can be passed through skin-to-skin contact. And, of course, condoms only work when you are using them. So, although I highly recommend condoms with every sexual encounter to all of my patients, I don’t believe that it obviates the need for the HPV vaccine.
- The original HPV vaccines protected against four strains of the HPV virus, while the new vaccine protects against nine. These nine strains encompass the vast majority of strains known to cause cervical cancer. So although there are many strains that are not covered, the vaccine provides a high degree of risk reduction against HPV infection and therefore reduces the risk of cervical and other HPV-related cancers.
- I am one of the most skeptical people on the planet when it comes to the motivations of pharmaceutical corporations to make profits. In some instances, it is a corrupt industry that profits at the expense of people taking the drugs that they manufacture. However, we are fortunate to live in a society in which vaccine administration has many checks and balances before the vaccines are marketed to the general public. There are years of clinical trials that look for rare adverse events. On the whole, the system works well to protect the public.
- This vaccine has intentionally been recommended to be given to children before they become sexually active as a two-dose series beginning at age 11. Once you have the virus, the vaccine is ineffective against that strain. This is true for nearly every vaccine-preventable disease. One fact that people may not realize is that this vaccine was originally marketed as a three-dose vaccine series. However, follow-up studies showed that the vaccine was equally effective if given in two doses (if started before age 15), and that is now the recommended schedule. This reduction in the number of total shots certainly doesn’t benefit the pharmaceutical companies.
- Vaccines are imperfect. For example, the rotavirus vaccine is given to infants to prevent severe diarrheal disease in infancy. The original formulation of the vaccine, however, was shown to cause intussusception, a serious and potentially lethal intestinal problem. When this was discovered by post-marketing analysis, the vaccine was immediately removed from public use. It has since been reformulated, retested, and redistributed to the general public with great success. This is an example of how the VAERS works effectively.
- It’s easy to forget that over the last 50 years or so, millions and millions of people who would otherwise be dead are still alive because they were vaccinated. Just a few short decades ago, it was not at all uncommon for children to die of meningitis, epiglottitis (prevented by Hib vaccination), tetanus, polio, smallpox, and many others. These diseases are now nearly unheard of. You can look up Google images of people standing in line for many city blocks waiting to get the polio vaccine because they saw the effects of that disease with their own eyes on a daily basis. It (not surprisingly) scared the hell out of them because they knew it could affect them and their loved ones. We have proven that those vaccines worked and prevented those diseases. My strongest instincts tell me that exactly the same thing will be true for the HPV vaccine. Indeed, data are already emerging showing a significant reduction in cervical cancer rates after the implementation of the HPV vaccine. When can you think of another time when getting a shot could claim to prevent cancer? If you knew that a vaccine could protect you against lung cancer or colon cancer or breast cancer or prostate cancer and that it was nearly always safe, would you not ask for it?
Medicine and its capabilities have always been about risk-benefit analysis. In this particular instance, in my opinion, there is absolutely no question as to which side of the analysis this issue falls. My daughter is three and my son is five. There is absolutely no question in my mind that they will be at the doctor’s office to receive their HPV vaccines when they turn 11.