Mandatory HPV Vaccination

[morrigirl]

I was talking to my sister Maria a couple of nights ago and the subject of HPV came up. She and her husband have recently taken in their fourteen year old niece who was having problems with her mother. Apparently, the niece just got her first boyfriend so Maria had to give her "the talk." She only mentioned HPV in passing simply because she didn't know much about it. Of course, I promptly gave her a comprehensive overview on the topic, but that's besides the point. A couple days after "the talk" a friend of Maria's asked her if she planned to get her niece the HPV vaccine, Gardasil. As we discussed the possibility, Maria said to me "I don't know. I don't think I'm going to. I think she's a little too young for it." What she really meant was "I think she's a little too young to have sex," implying that by vaccinating her against a potentially fatal STD would encourage her to run out and have lots of sex. This shocked the fuck outta me because that's the sort of argument you hear from fundamentalist Christians, not my hip, liberal older sister.

Gardasil is all over the news today because the makers of the vaccine are lobbying to make HPV vaccinations mandatory. Let me publicly declare my overwhelming support of this. HPV causes cervical cancer. This is a fact. About 3,670 women in the United States will die from cervical cancer this year. It rates as the second most common cancer found in women and the third most fatal. Condoms do not protect against it. It is passed on through skin to skin contact so intercourse isn't even always a prerequisite for infection. It is estimated that anywhere between 75% and 85% of all US citizens will have had HPV at some point in their lives by the time they reach old age. 50% of the sexually active populous is carrying it at any given time and most of them don't know they have it.

So, knowing all this, when I heard Maria say "I think she's too young" it sounded just about as stupid as hearing her say "I think she's too young to catch rubella or diphtheria" would have been. Adults may have their own opinions about when or if it is appropriate for a minor to have sex, but the fact of the matter is they aren't the ones who will ultimately be making the decision. They can hope to instill their children with the same beliefs about sex that they hold, hope that they will follow a prescribed course of action, but hope is all they can do. At the end of the day it's gonna be the fourteen year old who decides she is or isn't ready to hop into bed with her boyfriend, and the adults in her life might not agree with the decision she comes to. Better she be protected then come down with invasive cervical cancer and have to have a part of her cervix removed, or a hysterectomy performed, or God forbid, DIES! All it takes is one sexual dalliance with an infected partner to catch it. Just one. HPV doesn't care if it's her first time or not. You do not have to be promiscuous in order to catch HPV. It can happen to anyone.

I don't see how even those who object to teenage sex or sex out of wedlock on moral grounds can be more concerned with upholding a particular moral framework than with seeing to it that their daughters, sisters, aunts, nieces, and grandchildren don't DIE. A simple vaccination does not have the power to eliminate all moral teachings instilled by family and society at large. A girl who firmly believes that sex before marriage is wrong will still hold that belief after being vaccinated. Not to mention that the vaccine only protects women from roughly four of the over one hundred forms of HPV known to exist. People who worry that vaccination will lead to consequence free sex are deluded. There are plenty of sexually transmitted forms of HPV that the vaccine does not protect against. It only renders girls immune to a few of the strains most closely linked to the development of cervical cancer. Women can be vaccinated and still come down with all manner of low-risk genital wart causing strains. So worry not you damn fundies, even in the presence of Gardasil there is no such thing as 100% safe sex.

The way I see it, the vaccine itself has only one goal - to keep women from dying.

How can anyone object to that?

Comments

[blahchewy.livejournal.com]

I've been thinking about this a lot recently. Considering the transmissability rates and the ridiculously easy vectors, I'm starting to think it's actually a detriment to consider HPV a sexually-transmitted disease. This term carries so much social and moralistic baggage that vital issues of treatment and vaccination become lost in a mire of politics, religion and parenthood.

HPV should really be treated and labelled as a standard infectious disease. The fact that many cases involve infection without any intercourse at all should more or less prove this. We are almost guaranteed to catch influenze or a common cold by sleeping with someone who is infected. This fact should not make these conditions count as STDs.

Weather this disease ultimately effects so-called "naughty bits" or not, this is not something that should be stuck in the useless politics of STD treatment.

-- Preacher

[morrigirl.livejournal.com]

You are absolutely right, the very presence of the letters STD in relation to HPV carry detrimental policial and religious connotations that are definitely inhibiting the march toward mantatory vaccination. And you make a great poiint that there are a host of non-lethal, non-sexually acquired illnesses that one can easily catch from sleeping with someone.

But, over the last several months I've heard a lot of HPV infected women express frustration at the way the media is down playing the fact that HPV is an STD. Take the massive "Tell Someone" ad campaign that is all over TV right now. In those commercials the only information conveyed is that cervical cancer is caused by a virus, that virus is called HPV, you can have HPV and not know it, not all HPV infections develop into cancer, Pap Tests are somehow related to HPV but the ad never specifies how. Nowhere in the ad does it even allude to how one actually catches the virus.

I, for one, think it is absolutely crucial for women to be aware that HPV is sexually transmitted because we can only protect ourselves if we know how infection occurs. Yes, there are documented cases of HPV infection where intercourse was not a factor, but by and large these are relatively few in number when compared to the overwhelming majority of people who caught it through some form of sexual contact. Plus, there is frighteningly little scholarship on how genital HPV is passed if not through intercourse. There is ongoing debate over the danger of having oral sex with an HPV infected person. There is confusion as to whether touching HPV infected genitals and then touching your own can result in infection. More research needs to be done on this one, and until there is conrete evidence confirming or denying an exclusive link between HPV and sexual contact everyone should take extra precaution.

Also, since the vaccine only protects against a handful of high risk strains, even vaccinated women can still cotract any one of the dozens of other low-risk strains that causes genital warts. Because of this people need to be aware that HPV is an STD.

Politics, religion, and morality should not get in the way of saving lives. But I believe we put men and women at risk by distancing HPV from the term STD.

[electra310.livejournal.com]

Well, the other purpose is, of course, to make a huge fuckton of money for the makers of the vaccine. Three shots for every woman under 25 in the country, with them the sole producers till the patent runs out... yeah. On the other hand, if it works, then it might be worth it. But from what I've seen, doesn't it only protect against one form of HPV, while HPV is one of several possible causes of cervical cancer? The way Gardasil is being touted as a "vaccine for cancer" does little to assuage my nervousness that people are going to take it for a lot more than it's worth, including, potentially as protection against a lot more than HPV.

I'm still considering whether or not to get the shot myself. I apparently have another six months before I'd have to start the series, and I still have plenty of questions.

[morrigirl.livejournal.com]

Cori, you never let me down! I knew someone was gonna post this comment and I was pretty sure it would be you :-D

I chose my words carefully when I wrote "the vaccine itself has only one goal - to keep women from dying." That, as far as I can tell, is entirely true. The vaccine is physiologically designed for the express purpose of preventing infection by a handful of HPV strains. It can't do anything else.

On the other hand, Merck, the company that manufactures Gardasil, is TOTALLY trying to milk it for all it's worth. That's what big ass pharmaceutical companies specialize in these days. But, if the thing they are pushing can save the lives of thousands of women across the United States each year, I could care less how unsavory their motives for pushing mandatory vaccination are. I'm pretty sure the 3,670 women who are going to die from cervical cancer this year would agree.

As for your questions about the vaccine itself, Gardasil actually protects against four types of HPV: HPV 6, 11, 16, and 18. 6 and 11 are the two most common low risk strains. They typically cause genital warts, nothing more. 16 and 18 are the most common high-risk strains and are found in the majority of women who come down with cervical cancer. Overall there are 13 strains that are considered high risk: HPV 16, 18, 31, 33, 39, 45, 51, 52, 56, 58, 59, 68 and 69 all of which have been shown to cause cancer. But 16 and 18 are the most widespread so it's good the vaccine targets those two.

Current medical knowledge claims that HPV is the sole cause of cervical cancer. There are lots of risk factors that can make a woman more susceptible to developing it; lifestyle related factors like smoking, living in poverty, an already weakened immune system etc. But numerous studies have found high risk HPV to be the sole cause cervical cancer. That's why this vaccine is so important. It has the potential to eliminate the vast majority of deaths related to cervical cancer.

I think your concern about women getting the wrong idea about Gardasil and thinking it is capable of doing more than it actually does is well founded. That's why, as I said to blahchewy , I think it is incredibly important that doctors, awareness campaigns, and advertisers make it very clear how HPV is contracted and how the vaccine actually works. Catch phrases like "Tell Someone" and "Choose to Know" don't go very far. Women need specifics.

I'm sure you've guessed by now that I am going to urge you to get the vaccine even though you are married and in a monogamous relationship (I think.) One should always be prepared. I'm pissed I wasn't able to get the vaccine. How's this for irony, Gardasil was approved for girls and women between the ages of 9-26...on my 27th birthday. *faints* I can't tell you how angry I was.

[electra310.livejournal.com]

Did a little more research, it looks like the full Gardasil series retails for 360 dollars (which is an odd choice of words for a vaccine, but hey.) That's a healthy chunk of change, especially if you have to go to your doctor three times to get it. Given that I am married and (yes) monogamous, I can't help thinking I might be better served spending that money on fixing my teeth or my car. Especially since the only guarantee they're giving at this point is that the vaccine will work for five years.

In brighter news, research is continuing into the use of Gardasil in older women, and in men as well. Though if I think the pricetag is a bit high, try getting men to shell out that kind of money to vaccinate against a disease that in many cases, they are only carriers of. But it's certainly possible that adult women will eventually be vaccinatable as well.

[starstealingirl.livejournal.com]

While I think that theoretically, universal HPV vaccination is a good thing, and I agree that the conservative sexual value baggage that has attached to the issue is ridiculous, I stop short of agreeing that mandatory universal HPV vaccination is a good thing. The legislation is being backed by the corporation who patented the vaccine, who as the vaccine's sole producers can sell Gardasil at any damned price they want. This has nothing to do with concern for women's health, and everything to do with a pharmaceutical company wanting to extort money from this nation's women, whether they have it or not.

I am one of the lucky ones who has health insurance-- at least until I turn 25, and then I'm shit out of luck-- so I can afford to get vaccinated. (And I have been; had my first shot almost two months ago, and will be getting my second shot in a week or so.) I know several other women who would like to get the vaccine, but can't because the cost is so prohibitively high.

We can make mandatory HPV vaccination law once the generics are released on the market, and low-income women can actually, you know, afford the vaccine. Or better yet, maybe we could just take a page out of the Canadians' book and nationalize health care, so that women never have to make the choice between eating and protecting themselves against disease. Yeah, that'll happen.

[morrigirl.livejournal.com]

There's a lot to consider when looking at the price and potential availibility of Gardasil.

As I understand it, drug patents last for 30 months before they can start being produced generically. Once those 30 months have elapsed without contest, drugs can start being produced generically, and that includes vaccines. So regardless of whether it becomes mandatory tomorrow or ten years from now, those 30 months stay intact and, yes, Merck will fill its pockets charging $360 for the vaccine.

But...

If the vaccine were to become mandatory before generics can legally be produced then the states that require them must make them availible to girls from low-income families. States annually absorb a large chunk of the cost to immunize children from low-income families. Gardasil would become just another, albeit abnormally expensive, vaccination the government is already footing the bill for.

Low-income women of color, particularly in developing countries show the highest number of deaths due to cervical cancer. These are the women who need it most. Merck is reportedly working with several foundations and non-profit organizations to see that Gardasil is made availible to them at very low or no cost. I've also read that they are trying to do the same in the states, but I have yet to see that information confirmed by multiple sources so don't quote me on it.

Also, the London based pharmaceutical company GlaxoSmithKline is working on its own HPV vaccine that could be ready by 2008. It has been theorized that competition could drive down the price.

In all honesty, I don't think HPV vaccinations will ever become mandatory in the US. There are too much political and religious opposition. As is, it'll be availible to those who can afford it. But I still wish it would become mandatory. I think making it mandatory is the only way we can really assure that it will be made affordable to low-income girls before the patent expires. Not to mention it will force those who can afford it but are too forgetful or flat out lazy to make time for it, to actually get it done. I don't see any of that happening if it remains optional. And that makes me sad because...now that I've kind of been forced to care about this issue, all I can think about is all the women who will die die die die die of cervical cancer this year and next year and the year after and how much I do not want to see it happen. But it will. And that...*sigh*...sucks.