Should we be rethinking the HPV vaccination strategy?

By Siouxsie Wiles 22/06/2011 48


A study just published in the Lancet suggests that Australia’s cervical cancer vaccination programme is already showing signs of success, with a decrease in the number of high-grade cervical abnormalities in vaccinated girls under 18.

To quickly recap, the human papilloma virus (HPV) is a sexually transmitted infection which causes cervical cancer in women. A number of countries, including NZ, now vaccinate girls from the age of 12 against the most common HPV types. There are currently two vaccines on the market: Gardasil and Cervarix.

Débora Miranda recently wrote about the plight of women with cervical cancer in Africa. Apparently more than 1 in 5 cases of cervical cancer are in women in developing countries, which lack the screening programmes we have access to. The Global Alliance for Vaccines and Immunisation (Gavi) recently announced that Merck offered a 67% reduction in the current public price of their Gardasil vaccine, to $5. Merck also support the Gardasil access programme having pledged to donate 3 million doses of Gardasil to low income countries.

But why are only girls vaccinated? HPV can also cause a variety of cancers in men, including anal cancer and a subset of penile and oral cancers. In fact, in the developed world, the number of HPV-related cancers in men is similar to that of cervical cancer in women.

I was recently chatting with Daniel Keogh, aka Professor Funk, who paid to get himself vaccinated and produced a fantastic video encouraging young men to do the same.

Daniel raised two important points:
1. Why should girls be made responsible for sexual health? After all, its the boys who will be infecting them.
2. What about those boys who are bi or gay?

Indeed, what of the boys? Last year, Joel Palefsky wrote an article published in the Journal of Adolescent Health outlining the case for vaccinating boys as well as girls from a young age. It certainly makes sense. Presumably, the decision to only vaccinate girls is based on some cost-benefit analysis and the boys lost out. But maybe we should be turning this on its head and vaccinating the boys instead. That way they won’t spread HPV to girls, protecting them against cervical cancer, while also protecting bisexual and gay boys.

On an almost unrelated note, I’ve just finished reading The immortal life of Henrietta Lacks by Rebecca Skloot. An amazing story and one which every scientist should read. Cells from Henrietta Lacks’ cervical cancer tumour turned into the first immortalised cell line. And that tumour arose because Henrietta Lacks was infected with multiple copies of the most virulent HPV strain known. So HPV also gave us HeLa cells, the most commonly used cell line instrumental in many of the scientific advances made in the last 60 years.


48 Responses to “Should we be rethinking the HPV vaccination strategy?”

  • “In fact, in the developed world, the number of HPV-related cancers in men is similar to that of cervical cancer in women.”

    Is this true? I’m astounded. The fact that this type of data is not publicised is precisely why men’s health consists of a quick grope of the balls in the shower once on a while.

  • I think that’s happening now. Merck and GSK have run male trials at this point, but the data is somewhere in the FDA approval process.

    I believe that the initial decision to run trials with girls first was due to cervical cancer’s extremely high mortality rate. Though males can develop cancers from HPV, it’s just a much more serious infection for women, particularly for women in the developing world.

    Indeed, Cervarix and Gardasil received (somewhat) expedited FDA approval because cervical cancer is such a pressing issue for women’s health, globally. But everybody involved, at least here in the U.S. — FDA, CDC, ACIP, etc. — recognizes that an effective and fully implemented immunization program will include boys. Give it another year or two.

  • hhhmm, apparently “sexual health” brings out the spammers.

    Anyway, I agree with Tor, there are studies looking at this (eg this one) and calls for the vaccine to be put into wider use. I also think you’re right that initial deployment was trying to get the most “bang for bucks” and to get it out there sooner. So a compromise – girls first. Had a conversation with a woman on my blog a couple of years ago about this. She thought it funny that her kids were the intended recipients but she was against the vaccine while I had no problem with it when it wasn’t offered to me.

    What’s with the price difference though? From what you say the vaccine cost about $15 (before discount) but here it’s $128 (per dose). What part of this equation am I missing?

    • Hi Darcy

      The reduced Gardasil price is to GAVI for use in developing companies. I’m guessing Merck can ‘afford’ this by getting the developed companies to subsidise it, hence the price differential!

  • “In fact, in the developed world, the number of HPV-related cancers in men is similar to that of cervical cancer in women.”

    Rather a dodgy statement, I’d have thought–statistics? Although cervical cancer is almost always attributable to persistent HPV infection, that’s not at all true of testicular or anal cancer. On the other hand, cervical cancer is hardly common in the developed world either and it’s very much lifestyle-related.

    If I were going to get the HPV vaccine for my daughters, I’d certainly get it for my sons, too. However, I’ve yet to be convinced that the potential pros outweigh the potential cons. It seems to be the typical Western approach of enabling people to lead careless lives. Why eat right, sleep sufficiently, cut out the ciggies, etc. to strengthen your immune system when you can live recklessly?

    If you don’t have access to regular health care, decent food including vegetables and fruits etc., it’s probably a great choice. For people who live reasonably well, the vaccine has been oversold. I’d never say that it has no value, but I think it merits a lot more rational and informed discussion than it gets.

    • Some stats for HPV-related cancers:

      http://www.ncbi.nlm.nih.gov/pubmed/15734974

      http://www.who.int/bulletin/volumes/85/9/06-038414-table-T1.html

      And Kirstin, thanks for bringing up that old chestnut:

      Why eat right, sleep sufficiently, cut out the ciggies, etc. to strengthen your immune system when you can live recklessly?

      *Bangs head against table*

      There are essentially two types of infectious agents:
      opportunistic pathogens which by their nature take advantage of things like a weakened immune system,
      evil bastards who don’t care whether you eat right and sleep sufficiently as they have all the weapons needed to circumvent a fully functioning immune system.

      And before you ask, evil bastards don’t necessarily require you to partake in ‘risky behaviour’ to be at risk.

      And I fear you have misinterpreted the purpose of vaccination. Its not so people can lead reckless lives but to stop people dying a nasty death. And not just those who were vaccinated but, through herd immunity, those at risk who may be unable to be vaccinated.

  • Kristin,

    “It seems to be the typical Western approach of enabling people to lead careless lives. Why eat right, sleep sufficiently, cut out the ciggies, etc. to strengthen your immune system when you can live recklessly?”

    Are you saying that having a healthy lifestyle provides the same protection from the various HPV related cancers as the vaccine?

  • Why yes, Michael, I am. I remember my great great great greatgrandfather telling me that fresh air, country life and veges did his children no harm at all. After all, it wasn’t the veges that “took” the lives of 5 of his children out of 10 before they were 3. Boy, if it wasn’t for the fresh air I am certain another 3 or 4 would have succumbed. But that was OK. He put it doen to bad luck. The fact that he went through three wives to get those 10 was a small price to pay to finally have a brood of 3 grownup children to produce (after 5 or 6 generations) me. Afterall, childbirth was just a means to produce offspring you know and not too much stock was given to the delivery mechanism.

    Boy, do we have it good now!! I’ve got 3 kids and surprise surprise – the same wife!! Wow. Talk about lucky!

  • Kristin

    “Cervical cancer is hardly common in the developed world either and it’s very much lifestyle-related.”

    Cervical cancer was the subject of the “Unfortunate Experiment” at Auckland Womens Hospital. It’s pretty common. Lifestyle does not appear anywhere on the list of causes.

    You need to back up your statement.

  • It’s great news that the HPV vaccine is achieving its aims. It’s also happened in a relatively short space of time.

    As well as reducing high grade cervical neoplasia, the incidence of cervical warts has been hugely reduced in clients of Sydney sexual health clinics (Goodfellow conference presentation, Auckland 2009). It was also noted that there was a 10% reduction in incidence of penile warts at the same clinics.

    Reduction of male warts is a good example of herd immunity, the incidence of infection falling even in the non-immunised members of the community. It would be great to extend the vaccination to everybody and get true herd immunity to protect those in whom the vaccine doesn’t take.

    HPV DNA has been found in multiple types of cancer. Unfortunately it seems like there are different strains of HPV in different cancers, so the current vaccine doesn’t help as much with other cancers.

    I look forward to many other strains of HPV being covered by newer vaccines which will be administered to both females and males.

  • @ Ross and Wiles et al: Old chestnut? Cervical cancer isn’t lifestyle related? Y’all need to check your facts. Smoking, for instance, can increase your chance of getting a PERSISTENT (not transient) HPV infection by I think…27 times? Something like that. Not eating veggies increases your chances of getting a persistent infection by more than 50%. The more sexual partners you have, the exponentially higher your chances of a persistent infection. Etc., etc. You bet your booty HPV cancers are lifestyle related and it’s juvenile and doing a real disservice to our kids not to recognize that. Even anecdotally, I know only two women who’ve had almost-cervical cancer–one smokes like a chimney and the other thinks M&Ms are vegetables. Eva Peron and Jade Goody were poster children for the partner statistics.

    I don’t say that strengthening your immune system will provide the same protection–but it provides different protection and it will also guard against cancers and problems coming from non-vaccine strains (which are now causing more cancers judging from a UNM study). Oh, and various other lifestyle-related diseases. Perhaps you’re of the pop-a-statin-with-your-cheeseburger school.

    The vaccine may be a good choice for you (and it’s almost certainly a good choice for women in developing countries) but it’s indicative of poor reasoning powers to say that it’s the ONLY choice and all you need to know. Research intelligently and widely, and then decide.

  • Kristin

    “I don’t say that strengthening your immune system will provide the same protection–but it provides different protection and it will also guard against cancers”

    And what is wrong with using multiple types of protection against cancer? When I ride my bike I like to have good brakes AND wear a helmet – I don’t see it as an either/or choice.

    “Smoking, for instance, can increase your chance of getting a PERSISTENT (not transient) HPV infection by I think…27 times”

    Could you provide a source for this figure? I’d certainly be interested in reading research that has found such a link.

    “Not eating veggies increases your chances of getting a persistent infection by more than 50%”

    Again, could you provide a source for this statement? It seems a bit vague – what sort of veges and what quantity are required to reduce infection by 50%?

    “You bet your booty HPV cancers are lifestyle related and it’s juvenile and doing a real disservice to our kids not to recognize that”
    Do you have a source for this assertion? Having taught high school for a brief period, I would suggest that not providing “our kids” with HPV vaccines would be doing a disservice to them.

    Your comments seem to me to be very judgemental in assuming that everyone has access to healthy food, a smoke free environment, and trustworthy sexual partners, not to mention good genetics.

    “but it’s indicative of poor reasoning powers to say that it’s the ONLY choice and all you need to know.”
    This statement and some others seem to conflict with your assertion that “I don’t say that strengthening your immune system will provide the same protection” I’m not quite sure I understand your point of view.
    You seem to be saying that vaccine provide different protection but that a healthy lifestyle is a viable alternative which seem to me to mean it provides the same level of protection? Could you please clarify which of these is correct?

  • @Michael:

    Smoking and HPV:
    http://cebp.aacrjournals.org/content/15/11/2141.abstract

    Veggies and HPV:
    http://cebp.aacrjournals.org/content/11/9/876.full

    Sex (risks from multiple partners, sex at an early age, uncircumcised male)
    http://www.jaoa.org/cgi/content/full/108/2/65#REF4
    At one point there was a huge fuss about a big statistical study about numbers of sexual partners and increased risk for persistent HPV, but I don’t have time to look for it now. You will be glad to know that the people criticizing the scientific study shared your view that it’s judgmental (God forbid! You can’t say that! You must be anti-sex!!) to mention sexual habits in conjunction with sometimes-preventable disease.

    “Do you have a source for this assertion? Having taught high school for a brief period, I would suggest that not providing “our kids” with HPV vaccines would be doing a disservice to them.”

    I’m often astonished by what passes for teaching and parenting. It seems to consist of assuming that kids are a) stupid, and b) totally incapable of controlling themselves in any aspect of their lives. Teachers and parents first lecture them endlessly and then say indulgently, well, kids will be kids…they make bad decisions. Let’s make it easy for them to be immature–they can avoid one consequence, and don’t mention the other potential consequences.

    I’m well aware that my kids will have sex, probably long before they get married (if they do)–and probably with more than one partner. My job is to make sure they understand the mechanics of life and their responsibilities (physical, mental, spiritual) as well as their rights. I don’t assume that they’re too stupid to understand that they should eat some freaking spinach, stay out of Mickey D’s for the most part, and avoid being the town bike. It’s also my job to teach them to question everything. Anyone who blithely accepts that current ‘science’ (which is an ever-evolving thing) is always right clearly isn’t paying attention in life. (Vioxx? Thalidomide?)

    The thing that irritates me about discussions like this is that you’re assumed to be a flat-earther anti-vaccine wingnut if you question any vaccine. There are pros and cons. Vaccines are NOT100 percent risk-free. I just got Menactra for my older daughter, who’s off to college. Meningitis is rare but it’s incredibly fast and can kill or maim within days, so to me, it’s worth it potential risks. Cervical cancer is usually slow in a healthy person and can be headed off at the pass in almost all cases, so to me it’s NOT worth potential risks. (Read JAMA for a scientific view on those.)

    And isn’t it in your part of the world that screening rates are dropping in vaccinated women? Talk about unintended consequences.

    “Your comments seem to me to be very judgemental in assuming that everyone has access to healthy food, a smoke free environment, and trustworthy sexual partners, not to mention good genetics.”

    Apparently you didn’t read my comments all the way through. I don’t assume that at all. On the contrary, I said (or implied) that the vaccine is right for some people, particularly vulnerable individuals. It’s simply not a one-size-fits-all vaccine (like, I would venture to say, the polio vaccine for the most part). I would say that you’re being judgmental in assuming that people, particularly teens, have no control over their behavior.

  • @ Siouxsie: Thanks for the stats. As I thought, figures for HPV-related cancers in men aren’t anywhere near cervical cancer numbers.

    I will say that HPV-related oral cancers appear to be on the rise and, in the UK at least, rates of CIN 3 abnormalities are rising in younger women. (Probably because of worsening diets in the UK and increased numbers of partners at a younger age.) So it’s important to discuss Gardasil, HPV, and behavioral risks with kids.

  • Kristin,
    Getting infected with HPV may be a function not of a woman’s lifestyle but of her partner’s lifestyle, or his former lifestyle (i.e. slept around a lot as a young man but settled down later). So a woman cannot assume that she is protected from HPV and cervical cancer by living a ‘healthy lifestyle’ and by having very few sex partners, or only one sex partner.
    Furthermore, as far as I am aware, the HPV virus is infective to people with a normal, healthy immune system, so a ‘healthy lifestyle’ will not prevent infection. If I’m wrong about that, and it requires an immunosuppressed state, please provide references to that effect. I would be surprised if that were the case because viruses that infect only the immunosuppressed tend to be rare. It’s not a good survival characteristic for a virus to have.

  • @ Rosalind:

    Absolutely true–you can be pure as the driven snow and get HPV from some pig who’d bonked his way through the world before marrying you like a good boy. I think something like 80 percent of women will get HPV in their lifetime. Where a healthy immune system comes in is in shrugging it off, usually within a year. It’s only if an HPV infection becomes persistent that you could get cancer, and only rarely then.

    JAMA questioned, in fact, whether Gardasil could eventually prove to be harmful if girls don’t get infected, clear the infection, and become immune to that strain. If you get Gardasil at 14 but it’s worn off by 30 or 40 and you then get infected with HPV, will your weary, older immune system be able to handle the infection or will it become persistent?

    That’s sort of a variation on the Clean Hypothesis. Little challenges build up healthy systems. By eliminating little challenges, are we setting ourselves up for worse conditions (autoimmune disease etc,) later? Science is very young.

    That’s one of the reasons I found the case for Gardasil to be less than compelling.

  • *less than compelling for OUR family.

    BTW, I made a ridiculously lengthy comment containing sources for my crazy claims which shows as awaiting moderation. If it was too long to go through (or maybe it already did) I’m happy to break out the sources.

    Amazing how yappy I can be while procrastinating about work.

  • Kirstin

    A strengthened immune system is called autoimmune disease – it’s when the immune system attacks the body and causes illness. There’s lots of scientists trying to figure out how to stop it happening and improve the lives of people with these devastating diseases. Why would you want to do it to yourself?

    It seems that smoking can provide a degree of immunosuppression, making it harder for the immune system to deal with all sorts of infections. Like Michael, I would like to know where the source for your numbers comes from. All of the data I can find suggests the numbers are much smaller.

    In general, it’s a good idea not to stimulate or suppress the immune system, it tends to work fine by itself.

    Another good idea is to present the immune system with small amounts of foreign antigen under carefully controlled conditions. If we can do this, then the next time the immune system “sees” the antigen it can raise a devastating attack and destroy the organism possessing the antigen before it can infect the body. The process is called vaccination or immunisation.

    If it’s possible to prevent a lethal or disabling illness, with less risk than driving to the supermarket, why not do so? That’s what HPV vaccine can do – provide the ultimate backup to anything else you may think will help prevent HPV.

    Bring on the day when we provide it for the young men in our community as well!

  • (Using a pad, slow response!)

    Kristin

    Anyone who accepts science is not a scientist. Lot’s of what we know now will be wrong. That’s no reason not to use the current state of knowledge.

    HPV appears to stay latent even after the warts have disappeared. HPV DNA can be isolated from cervical cells decades after the infection appears to have resolved. That suggests all HPV infections are persistent.

    Why not take the opportunity to prevent your children getting the infection in the first place?

  • @ StuartG:

    Maybe a strengthened immune system is called autoimmune disease in NZ, mate, but it ain’t called that here in the US. Are you seriously implying that eating and sleeping well, not smoking etc. causes autoimmune disease?

    Autoimmune diseases arise in genetically predisposed individuals but require an environmental trigger. Autoimmune disease make the immune system over-react and attack the body instead of defending it. Eating well etc. keep the system healthy. What is it that you don’t understand about that?

    If I can defend my health without even the risk of driving to the supermarket–at least you admit that there IS some risk to Gardasil–then why wouldn’t I do that? Particularly when a healthy, intelligent lifestyle will prevent all sorts of other diseases as well?

    Since apparently my comment IS still awaiting moderation, here are the appropriate sources:

    “@Michael:

    Smoking and HPV:
    http://cebp.aacrjournals.org/content/15/11/2141.abstract

    Veggies and HPV:
    http://cebp.aacrjournals.org/content/11/9/876.full

    Sex (risks from multiple partners, sex at an early age, uncircumcised male)
    http://www.jaoa.org/cgi/content/full/108/2/65#REF4
    At one point there was a huge fuss about a big statistical study about numbers of sexual partners and increased risk for persistent HPV, but I don’t have time to look for it now. You will be glad to know that the people criticizing the scientific study shared your view that it’s judgmental (God forbid! You can’t say that! You must be anti-sex!!) to mention sexual habits in conjunction with sometimes-preventable disease.”

  • @Stuart; My response to your first comment is awaiting moderation, but in response to your second:

    You’ll have to take up the discussion about persistent infection with the people who write the studies differentiating transient infections and persistent infections. Their view is that infections that are cleared by the body do not appear to cause cancer, and in fact appear to create immunity. Those infections may remain present in the body in some imperceptible form but, to the best of my knowledge, are not called persistent or cancer-causing.

    I choose not to get the vaccine for my kids (and the oldest has researched for herself and chosen not to get it) because the pros do not appear to outweigh the cons. I may be wrong. There is no perfect choice; and where blindly pro-vacciners err, IMO, is in saying that there is. (Also in assuming that the vaccine will protect them 100 percent. 16 and 18 cause a little under 70 percent of cancers and are losing ground to non-vaccine strains.)

  • Kristin,

    “The thing that irritates me about discussions like this is that you’re assumed to be a flat-earther anti-vaccine wingnut if you question any vaccine.”

    I certainly haven’t assumed that. I queried a couple of your statements, which you’ve kindly provided more information for.

    With regards to suggesting you were being judgemental perhaps I misunderstood the tone of your comments which came across to me as “good people” don’t need the vaccine but “bad” or “poor” people do. An oversimplification and misinterpretation on my part, sorry for that.

    ” I would say that you’re being judgmental in assuming that people, particularly teens, have no control over their behavior.”

    I’m not assuming that most people don’t have some control over their behaviour, but very few people have control over their lives all the time in every way. As has already been discussed control over a partners fidelity is not possible, and most people have experienced times when under stress or the influence of alcohol they behave out of character. With regards to teens I have come across those with great self control and those with very little.
    I think your view of human, and particularly teenage behaviour is very optimistic but not realistic. One only has to look at NZ’s teenage pregnancy rate and teen suicide rate to realise that teens do not always live in the best circumstance or make the best choices.

  • @ Michael: Thanks for clarifying, and apologies for perhaps being a little snitty in my response. Always the problem with an online exchange–misinterpretation of intent plus flying fingers.

    Actually I DO think poor people need the vaccine more. Perhaps not in Oz, if that’s where you are, but certainly in developing countries where women might not have access to routine health care, and in the US, where the health system is (again IMO) lamentable in its distribution. It’s one of those ethical conundrums. Wealthy people who eat well and have good access to health care need Gardasil less, but are more likely to get it. But if only poor people get it, does that translate as experimenting on them with a relatively untried vaccine? (For clarification, I’m not wealthy but do have health insurance and a strong affinity for farmers’ markets.)

    I truly believe that a lot of kids act like idiots because we treat them like idiots and give them no responsibilities and little purpose in life. Childhood as we know it is a Victorian invention. I find many (certainly not all) kids to be highly sophisticated but shockingly immature. And I know a lot of kids whose family circumstances break my heart.

  • When I was at university I was told by an ernest young man that he didn’t use condoms because he ‘didn’t sleep with that sort of girl’. I laughed so hard I almost fell out of bed.

    You can do your best to convince your daughters not to be ‘town bikes’ and your sons not to be ‘pigs’, but unless you’re going to vet all their partners (and their partners, and their partners), you can’t stop the spread of diseases with that method. If you make it a disease that only ‘sluts’ (town bikes, pigs, whatever pejorative you like) get, women and men who do not think of themselves in those terms are likely to underestimate their risks.

  • Kristin

    I mentioned the “Unfortunate Experiment” as this is a New Zealand based blog and Siouxsie’s comments seemed to be about the NZ vaccination strategy. I assumed that you would have knowledge about that episode. Search for it and Herbert Green. There’s still a lot of controversy about it in NZ.

    I used it as an example to demonstrate that there is a high incidence of cervical cancer in NZ, amongst all sectors of the community. The incidence is reducing because of increased surveillance and treatment options, but it is still worrying. HPV vaccine is seen as a good investment for the future and is offered free to all young women from the age of 12 in NZ.

    Before being given the vaccine, each young woman has to give signed informed consent. I understand the uptake has been much higher than the Ministry of Health predicted.

    I, too, have children, but no daughters. My youngest has also done the research and has questioned why he was not offered the vaccine as well as his female classmates. He even tried to get the vaccine himself but no luck! He usually gets vaccinations free, because of his cancer, but not this time.

    From your own words, the vaccine appears to be reducing 16 and 18 dependent cancers (hence the increase in non-16, non-18 cancers). I haven’t followed this up, but to me this seems to be demonstrating that the vaccine is doing what it was intended to do.

    I would agree with Siouxsie that it should also be offered to the young men of our population.

  • Anyone read the actual paper and accompanying editorial/commentary? If so, does anyone have an opinion as to the significance that there was no decline in low-grade abnormalities?

  • @ Papango: LOL! But in fact, I believe that disease of all kinds will spread when people prefer and are enabled to remain ignorant of basic biology. Remember the outcry from women who’d been unable to have kids because ‘feminists told us we could have it all and we left it too late!’? Putting aside the slur on true feminism, you shouldn’t put your brain on hold at the behest of others. As you get older, fertility decreases and risks increase. Biology, not a plot against feminists.

    Similarly, we shouldn’t let kids put their brains on hold. What does having multiple partners put us at risk for? A LOT of things, including AIDS. You can minimize risk with strategies like Gardasil and condoms, but you’re not going to eliminate it, and you can increase other risks. Biology. So kids shouldn’t be thinking ‘I’m not the town bike,’ they should be understanding what multiple partners means.

  • @StuartG: I did a quick check on Herbert Green but I don’t really see how he’s relevant. Are you saying that we’re experimenting on women with Gardasil, or if we don’t give them Gardasil?

    I understand the principle behind Gardasil, but there are so many unknowns–including replacement disease, decreased natural immunity that could prove fatal later in life as well as ‘worn off’ vaccinations and the potential for multiple boosters to unknown effect. Not to mention as yet undetermined issues such as seizures etc.

    If your son wants the shot, nothing stopping him getting it. He should also get circumcised if he isn’t, if he really wants to protect future partners.

    The study I mentioned looked at cervical cancer in NM from 1985-1999, pre-Gardasil. It showed that 66.3 percent had been caused by HPV 16 and 18–and that 16 and 18 had been losing ground to other types. With Prevnar, vaccine strains lost ground to non-vaccine strains and the replacement strains were anti-biotic resistant.

    Informed consent is basically meaningless in the current form. When it comes to Gardasil, it emphasizes the risk of disease and oversells the vaccine, and gives misleading info about HPV. I’d be interested in seeing the NZ version as I’d bet it’s similar to the US version.

  • @ Paul: haven’t read the full paper, just the abstract. I could hazard some guesses as to why there was no reduction in low grade abnormalities but they would be just guesses.

  • @Kristin

    Which study is the NM one? I assume you mean antivirals rather than antibiotics? I’d be interested to know what they were resistant to.

  • @ Siouxsie: Sorry, I didn’t write that clearly. The unlooked-for finding in the NM study was that HPV 16 had been declining as a cause for cervical cancer for the previous (pre-Gardasil) 20 years; something that editors considered a cause for concern given potential post-Gardasil replacement diseases issues.
    http://jnci.oxfordjournals.org/content/early/2009/03/24/jnci.djp044.full

    Prevnar is an anti-pneumococcal vaccine, totally unrelated except that the strains that replaced the vaccine strains were nastier and antibiotic resistant (yes, I did mean antibiotic)–again, good information to ponder.

    http://www.nejm.org/doi/full/10.1056/NEJMoa0800836

    BTW, my pre-med daughter also read ‘The Immortal Life of Henrietta Lacks’ recently. Her takeaway was very different (amazing research; astounding indifference to the human beings involved) but she strongly recommended it,too. I’ll be interested to get to it.

  • I think the reason that males are not vaccinated is political. It has been hard enough to convince parents to vaccinate their daughters. I have talked about the HPV vaccine with my adult college students a number of times and I still get parents against it. Their reasons are not very rational. They divide into two camps: those who think that it increases sexual activity and those who think their “good girls” would never need it. Unfortunately telling parents to vaccinate their sons to protect the girl or in case they are gay just will be outrageous to many conservative parents.

  • @Kristin

    You commented “cervical cancer is hardly common in the developed world either and it’s very much lifestyle-related.”

    I merely used the example of the “Unfortunate Experiment” to demonstrate that there is and historically has been a high incidence of cervical cancer in all areas of the NZ community. I believe NZ is still considered to be part of the developed world. I agree that as an example it’s not directly related to discussing the vaccine.

    Using that example does make me wonder if the attitude of Kiwis to Gardasil and cervical cancer may be a little different from other countries because of it? That’s pure speculation and I don’t know the answer.

    It is difficult to use Gardasil on males in New Zealand. In females it can be used from 9-45 years of age. Males have to be 9-15 years, i.e. probably well before most males would start thinking about pros and cons.

  • @ Michelle: Funny, I’ve met many doctors who say parents won’t get their kids vaccinated because it’s a sexual disease, but I’ve never met a single parent who thinks that (and I’ve met and/or talked to MANY). Most I talk to are concerned with the total vaccine burden on kids and think it’s unnecessary and possibly harmful for the various reasons I’ve given above, as well as being nervous about triggering autoimmune disease for no good reason. Some have mentioned the fear of their daughters feeling protected and then not going for screenings, which is what is happening in Australia. And of course, I know a ton of people who HAVE got their kids the vaccine, including conservative Christians. Even the Catholic Church isn’t against it.

    My personal opinion? Those docs start out with the opinion that there’s no rational reason for not getting Gardasil so they don’t actually hear parents’ reasons.

    Frankly, there’s so much misinformation out there–including in this post and comments–that you can’t blame parents who research for wondering if their doctors know what they’re talking about.

    In the US the vaccine is not automatically given to boys because it doesn’t make economic sense, not because it’s political. There is little direct benefit for straight boys, so the thought is that if their partners are protected, then the cost per life saved is outrageous. For gay boys, things are rather different, but they can request coverage or pay out of pocket.

  • @Stuart G: I think the unfortunate experiment was quite some time ago, wasn’t it? Cervical cancer rates have dropped substantially since then. I don’t know what the rates are in NZ, but I think it ranks at around 11th in the cancer stakes here in the US. Interestingly, an insurance company did an analysis and found that a massive proportion of its subscribers with cervical cancer that had been found late had not gone for screenings. No health coverage is a huge problem here, and if we didn’t have coverage I’d get the vaccine like a shot (haha) for my kids.

    Although that doctor seems to have acted very unethically, from what I briefly read, he had a point. Cervical abnormalities are now known to be over treated and many will resolve themselves. However, where he messed up is in not doing the ‘watchful waiting’ thing a whole lot more carefully.

    Can males in NZ not get Gardasil privately? Or, if gay and therefore at higher risk, have it covered?

  • @Kristin

    Unless Pharmac changes the indications for Gardasil, any use outside of those age limits requires massive amounts of bureaucracy for individual patients.

  • Well, according to Dr Diane Harper, the head of the research team at Merck who tested and researched GArdasil who has openly spoken out against the vaccine admitting it wasn’t tested long enough AND saying it wasn’t necessary (the vaccine). Well, many doctors in the US have been saying for a long time that it was just a money spinner for the drug company – they hoped to make billions from GArdasil to pay off the massive lawsuits they owe on Vioxx – yep, another deadly drug rushed thru purely for profit. Add it up yourselves. You’ve got a brain. A computer. You can do your own research (not the crap the drug company wants you to believe… unless you’re a sheep.) And before you go, oh another anti vacciner… no… just anti Gardasil and drugs designed purely for profit and remember, most anti vacciners used to be pro vacciners once – tragedy is what forces you to look beyond your nose and trust me what you find isn’t pretty. Certainly makes you think twice before naively trusting your govt or any drug company again. Why not do the research yourself before mouthing off for a change…

  • Jenna

    Thanks for demonstrating the level of misinformation that is being circulated about Gardasil, emotive insults and conspiracy theories.
    A clear spelling out of Dr Harper’s true feelings on Gardasil including her reservations regarding the MARKETING of it can be found here
    http://www.gardasilhpv.com/2009/10/dr-diane-harper-badly-misquoted-on.html

    Why not do the research yourself before mouthing off for a change…

    Perhaps you should heed your own advice?

    most anti vacciners used to be pro vacciners once
    That is not my experience. Most antivaxxers I have come across indulge in various other pseudoscience beliefs and are quite clear that they never believed vaccines were good.

  • The are many unanswered questions relating to Gardasil. The manufacturer Merck states in the package leaflet that the vaccine has not been tested for carcinogenic properties.

    There is also a worrying issue – that of “replacement”. This is a normal phenomenon in virology. The virus strains which are removed by the vaccine are always replaced by new ones.

    No research experts know the answer as to whether the new strains will be more carcinogenic than the original ones.

    In other words, it is not known whether Gardasil will actually increase the risk of cancer.

  • Mindano Iha

    Why would a vaccine increase the risk of cancer? You make it sound like active virus is present in vaccines and not virus proteins!
    With regards to substances being carcinogenic we know that many substances do have some degree of carcinogenicity but it is dependant on the dose. For example coffee, well cooked foods and toast all contain substances that can be classed as carcinogens.
    Too often the word carcinogen is bandied around as a scare tactic without specifying the dose that would be required for something to be a carcinogen