When the Israeli Health Ministry decided to provide the Human Papillomavirus (HPV) vaccine to 8th grade girls in 2013 and to boys in 2015, the mutterings online about opting-out surprised me. To date, HPV vaccination coverage in Israel hovers around 10% – compared to the United States where 60% of preteens have completed the full course of vaccination. The continued low rate of vaccination despite the availability of a very safe and effective vaccine is deeply troubling, and misconceptions about the two available vaccines – Gardasil and Cervarix – abound.
Human papillomavirus does not refer to one single virus, but rather a group of 150 related viruses each with its own identifying markers. Some types of HPV can cause genital warts, but for the most part infection is asymptomatic. And therein lies the danger – recent Israeli studies place the HPV infection rate for men and women aged 19-59 around 40%. This statistic is similar to the infection rate in the United States and in other developed countries and is the most common STD in the world. HPV is transmitted through sexual contact, be it oral, anal, or vaginal, and although many infections resolve themselves without treatment, some remain latent and undetected due to lack of symptoms.
I remember vividly the day that Gardasil hit the market with final approval from the American Food and Drug Administration. I was visiting my mother at the Montreal headquarters of Merck-Frosst, the developers of the world’s first vaccine against HPV. It was a big day, there were balloons strung up throughout the building and signs everywhere inviting employees to come get their free ice cream (“CURE GENITAL WARTS!! FREE ICE CREAM!!”). The vaccine had passed through years of rigorous clinical trials, had been tested on 30,000 study participants, and continues to be monitored even today. It was a landmark occasion, bringing with it the possibility of vastly lowering the number of people infected with HPV. From 2006, 70 countries have implemented an HPV vaccination program and over 200 million doses of the vaccine have been administered. The reason for the strong push to vaccinate is that HPV causes 70% of all cervical cancers, 12% of all female cancers, and causes a number of other cancers, including certain types of testicular, oral, penile and anal cancers. In Israel, the rate of HPV related cervical cancer is 5 for every 100,000 women, however the mortality for those affected is close to 50%. Cervical cancer is very hard to diagnose, meaning that most women do not know they are sick until the cancer has progressed. From 2003-2010, the US experienced a dramatic drop in rate of HPV infection, from 12% of 14-19 year olds to 5%. This is a feat, and as the vaccination program continues the effects for women will be nothing short of lifesaving.
So why are Israeli families choosing not to vaccinate their children?
The fact that HPV is a sexually transmitted disease has contributed to widespread resistance against Israeli vaccination programs by the country’s religious population. One recent study found that many objectors believe that circumcision protects against STDs, that their children will remain virgins until they are married, and that HPV only affects those who engage in unprotected premarital sex. The belief that one’s children will not engage in unacceptable sexual relations and therefore are not at risk for HPV is a dangerous and mistaken assumption. Apart from the denial that religious teens might possibly have sex, a second and more general misconception is further hindering HPV vaccine adherence. The anti-scientific stance that vaccines are some sort of evil conspiracy designed as a money-making ploy by Big Pharma has been applied to Gardasil and Cervarix, with devastating results.
One patently false claim is that HPV vaccines may impact a girl’s fertility.
Not one single peer-reviewed journal has ever demonstrated the veracity of this claim, nor of the claim that the vaccine has been linked to adverse neurological, autoimmune, or thromboembolic venous (blood clots) events. Of course, no vaccine is without side-effects. The possible ones linked to Gardasil and Cervarix include soreness, itching, and redness at the site of the injection, flu-like symptoms for up to a week, and fainting (the drug manual contains instructions to prevent injury from falls following vaccination). These mild side-effects are the only ones that have been observed from the HPV vaccine, and the wild accusations of anti-vaxxers have been disproved time and again. However, the fear-mongering persists, causing some parents to opt-out of vaccinating their children – possibly with tragic consequences.
I have three daughters, and when the mutterings on social media about refusing the HPV vaccine became louder, I asked my mother about Gardasil and Cervarix, and whether she would recommend I vaccinate her only grandchildren. As a scientist who worked in drug development for years, she unequivocally responded that I should and could not fathom why anyone would not want to protect their child from cancer. Even if every conspiracy theory online said otherwise, and even though I trust my daughters to discuss sex with me and use protection should they become sexually active, the fact that my mother would encourage me to inject her precious granddaughters with this vaccine is sufficient for me to verify its safety. And if that’s not enough, there is always medical journals, the CDC, the FDA, the Israeli Ministry of Health, the WHO… all of whom are invested in offering the HPV vaccine for free to young girls in order to potentially save their lives. So, when the permission slip comes home with my 8th grade daughter, I will enthusiastically tick the ‘yes’ box.