Unsettling Trend: HPV Vaccine Myths Put Millions at Risk of Cancer – But Show Need for More Research

Vaccination rates remain static for the two vaccines that protect young girls and boys against infection by several strains of human papillomavirus (HPV), the most common sexually transmitted disease in the United States and Australia. HPV infection is a well-established cause of cervical, anogenital, and oropharyngeal cancers. Current estimates indicate that 527,624 women are diagnosed with cervical cancer annually and 265,653 die from this devastating disease. To date, cervical cancer ranks as the third most frequent cancer among women globally.

Several types of HPV can cause cancer, and two vaccines, Gardasil (Merck) and Cervarix (Glaxo), have been shown conclusively to reduce the incidence dramatically. The HPV vaccine has been shown to be most effective when a person completes the three doses of the vaccine before becoming sexually active so that they are protected at the outset. Even though initially the vaccine was designed for the use in girls, in 2009 FDA approved the use of the vaccine for boys as well.

There were many reports in the media claiming the vaccines have a dark side which is not properly communicated. The 2015 Toronto Star exposé on the Gardasil vaccine, which was later pulled from the website, kicked off a wave of criticism from the medical community and internal rebuke. ?When such articles appear, we all lose,? the editorial stated trying to reduce the harm to public trust in vaccination.

Three obstacles in the way of the HPV vaccination are biased research, ignorant approach of the media, and conservative hysteria that HPV jab causes teen promiscuity.

Many publications on the web simply misused and misreported data from the clinical trials that had been published on the subject. Although we might feel a sudden flow of empathy with unfortunate patient stories described all over the internet, we have to start to admit that very often tabloids and anti-vax campaigners have got the science wrong. When I speak with lay people asking for unbiased opinion on the HPV vaccination, I can see their mouth hanging open, expression somewhere between fear, anxiety, sheer confusion, and, well, fear. In the era of internet, people consume a lot of information which at times lacks credibility. As a public health professional, this never-ending battle against vaccination is very unsettling to me. To be clear, all known vaccines are safe. Some vaccines are effective, others may raise doubts, as in case with BCG (which claimed to defend against tuberculosis). I totally agree that all who are offered an HPV vaccination at school or elsewhere have all rights to accurate and up-to-date information in order to make informed decisions. While statistics have shown a notable impact of the HPV vaccine to date, including substantial reductions in rates of anogenital warts, in HPV prevalence, and precancerous cervical abnormalities in young women, we must admit that we do not know enough about the vaccine at this stage to make any definitive claims.

Many of the studies supporting the effectiveness and impact of the HPV vaccine are compromised by conflict of interest. The most recent study of a 9-valent HPV vaccine published in the New England Journal of Medicine was funded by the manufacturer of the vaccine. Nearly all of the research cited by the American College of Obstetricians and Gynecologists in the 2015 committee opinion paper supporting the use of the vaccine was in part or in whole funded by the pharmaceutical companies. In some cases the studies reported in medical literature were written by employees of those companies. Furthermore, it has to be noted that most of the studies focused on the short-term immunologic reactions triggered by the vaccine, not the long-term effectiveness and possible adverse effects after inoculation.

Also, no research has been published comparing reductions in mortality following the HPV vaccination vs. conventional cervical (Pap-test) screening, which will still be needed by all who are vaccinated. And this is another issue no one seems to care about. A reduction in Pap testing has been documented in young women following the three doses of the vaccine. Despite consistent messaging that screening remains important for vaccinated women, statistical data suggest that young women are less likely to attend for screening than young unvaccinated women. There is also evidence that current screening efforts are gradually becoming less efficient in the context of HPV vaccination.

I believe that public health, medical community and the media ought to support each other in spreading the evidence-based knowledge about emerging health interventions. But the lack of credible evidence on long-term safety of the HPV vaccine and the relative effectiveness of the Pap smear testing beg the question of why the vaccines have been so thoroughly endorsed by governments and even professional associations? Wasn't the evidence-based approach considered a pillar for public health associations?

Finally, as we speak of the good that comes with Gardasil, some people continue to associate its with sex, acknowledging their children's potential future sex lives feels too much like ceding control over their children's most intimate decisions. Parents should make peace with the fact that they have limited control over their children's sexual decisions, though the anxiety is understandable.

In the end, the debate behind the HPV vaccine needs to change. Gardasil is neither a tool of government control nor a mandate that should be enforced upon citizens. The vaccine is a smart choice for both men and women to protect against a sexually transmitted infection. It needs to be presented and understood as such. If you can prevent cancer, why wouldn't you?

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