The HPV Vaccine Dilemma

To vaccinate or not to vaccinate? That is the question. Following a period of much hype and speculation, in June 2006 The Food and Drug Administration approved Merck's human papillomavirus or HPV vaccine, otherwise known as Gardisil for girls and women between the ages of 9 and 26. A myriad of health professional groups including the U.S. Centers for Disease Control and Prevention officially recommended the vaccine which also helps prevent cervical cancer. However, despite all efforts statistics show that only two out of every 10 women in the approved age groups have gotten the vaccine and now a new debate is popping up around the country regarding whether school systems should require girls and young women to get the HPV vaccine.

But let's start at the beginning. HPV or human papillomavirus is one of the most common sexually transmitted infections on the planet- as many as 80 percent of women will be exposed to HPV at some point in time in their lives. According to Newsweek the virus usually causes no symptoms, is harmless and goes away on its own. However, certain varieties of HPV (there are about 100 altogether) are particularly aggressive. Two varieties- HPV 16 and 18- cause 70 percent of all cervical cancers. Caught early, the disease can be treated with surgery and chemotherapy. If untreated, it can be painful and fairly gruesome. Until the Pap smear was introduced in the 1940's, cervical cancer was the No. 1 cancer killer among women. Since then routine screenings have made enormous strides in radically decreasing the number of cases in the United States. But the disease is far from eradicated. It's still the second most common cancer in women and according to the 2003 World Cancer Report every year, half a million women are diagnosed with the cancer and close to 250,000 die from it.

The vaccination referred to as Gardasil, manufactured by Merck, protects against the two aggressive strains of HPV- strains 16 and 18- that lead to cervical cancer. In clinical trials involving about 21,000 women, the vaccine showed notable results- nearly 100 percent protection from HPV 16 and 18, which cause 70 percent of all cervical cancers. Gardisil also protects against 90 percent of genital warts in men and women which are caused by another HPV strain. It also appears to prevent lesions that could lead to vaginal and vulvar cancers.

To be most effective it must be administered to girls before they are sexually active and it's not beneficial for women that already have HPV. It's been approved for those as young as 9 years old. And it is now up to individual states to determine if immunization should be required in school. But many religious and conservative groups that advocate abstinence oppose mandatory HPV vaccinations. Other reasons that may explain the low number of people being immunized also include the high cost and inconvenience- it typically costs $360 for three shots taken over six months, a lack of awareness regarding HPV and cervical cancer, the low number of regular physician visits among the age group (females age 9-26), and parent's unease over immunizing their kids against a disease contracted through sexual activity.

It's essential that vaccinations among tweens increase so that they are immunized before they may be exposed to the virus. Currently, health officials are trying to target tweens with the concept of an "adolescent platform" of vaccinations that includes Gardasil. Preferably, preteens would get immunizations including the meningococcal conjugate vaccine (or MCV4), the tetanus, diphtheria, pertussis vaccine (or Tdap) and the HPV vaccine.

At this juncture it's still too early to tell if or when immunity may wane and whether women will need to get booster shots later in life. But according to Newsweek, levels of the antibody to HPV appear to stay high for at least five years. Even if another dose is needed later in life, health officials are confident that multiple doses of the HPV vaccine are safe. Dr. Amanda Dempsey of the University of Michigan explains, “It's not biologically possible to get HPV from the vaccine, which contains no live or killed virus and no virus like particles.” The most common side effect has been pain at the injection site.