Dr. Cohen posted an article for this up on the IMMU7630 site, so I'm going to take advantage of the free resource.
It's not news that there's a vaccine for a few strains of human papillary virus (HPV). What is news is that even though it remains controversial in its intended market, and is now being marketed in different ways and becoming even more controversial.
The Gardasil vaccine is intended to prevent HPV type 6, 11, 16 and 18 infections in infection naive patients. These strains have been shown to cause genital warts, and cervical cancer in women. Research has shown that 100% of cervical cancers are attributed to HPV.
Over 120 different strains of HPV have been identified, so it seems like protecting against only four is not going to do much good. Types 31, 33, 35, 39, 45, 51, 52, 56, 58, 59 and 66 have also been implicated in cervical cancers, but the correlation appears to be strongest in 16 and 18 (Which are covered by the vaccine) showing about ~70% attribution to these two strains. Additionally, strains 6 and 11 have been shown to cause about 90% of genital warts.
So here comes the controversy. Gardasil is approved for both women and men. The FDA recommended it be available to men between 9 to 26 years of age. Why do this if it is used to prevent cervical cancer? Well, men spread the disease even though most people think men don't get any cancers caused by the viruses.
That isn't the case. The vaccine covers some anal (90% attribution to HPV), oropharynx (12%) and penile cancers (40%), too. Yes, there is such a thing as penile cancer. The common treatment for it is a fate that most men would consider worse than death.
So, with all of this information, why are parents so hesitant to vaccinate their children? Is it because the viruses that can cause these cancers are sexually transmitted, and they see their children as too innocent to need this type of vaccine?
I don't have a reference for this, but last time I checked, 100% of people who have sexual intercourse were children at one time (And some still are).
http://www.nytimes.com/2010/10/29/us/29vaccine.html?_r=2&partner=rss&emc=rss
http://www.cnn.com/2009/HEALTH/09/09/fda.gardasil.males/index.html?iref=allsearch
http://www.cnn.com/2008/HEALTH/dailydose/11/19/hpv.vaccine.info/index.html?iref=allsearch
http://onlinelibrary.wiley.com/doi/10.1002/ijc.21731/full
This isn't a philosophy or debate blog really but that doesn't mean that public health isn't a pronounced extension of things like this. As with any form of birth control, it is at the discretion of the parents and child to make the decision to get vaccinated and/or supplement with other preventative adjuvants. Personally, I think both sexes should be as diligent for getting vaccinated as the spread of HPV is due to both parties. The concerns of penile cancer in males are of little real value when compared to the epidemiological value of spreading HPV-induced cervical cancer. Also from a fiscal perspective, the cost of vaccination is much more practical than the cost of treating the symptoms and progression of HPV-induced diseases.
ReplyDeleteOne of the major problems with the vaccine is the price. It costs around $350 out of pocket (many insurance plans cover very little of the cost). It also takes three doses, so if a patient happens to get the boosters late, they may have to repeat the series. $350 is miniscule compared to the cost of cancer treatment, but that money could also feed some families for a month. For some people the decision to pay for the vaccine or dinner and a box of condoms may be an obvious choice. Until the price comes down or insurance agrees to cover more of the cost, I think the percentage of children getting the vaccine will continue to be low.
ReplyDeleteWow. I didn't know the vaccine was so expensive.
ReplyDeleteInvoluntary abstinence has proved to be a much cheaper option for me.
I agree with the above comments about the cost of the vaccine being high, but I also think that there is a large group of parents that do not feel they should vaccinate their children as they do not believe they are sexually active. While some children have great relationships with their parents and can openly talk to them about sex, many parents are entirely unaware that their child is sexually active. I really think that both the cost and access to the vaccine need to be improved such that, at some point, a child could receive the vaccine, if they desired to do so without needing parental consent.
ReplyDeleteI went to a lecture of Dr. William Foege's (Senior Fellow of the Global Health Program for the Bill and Melinda Gates Foundation) this past Thursday, and he thoroughly expressed his outrage about the lack of vaccination compliance in this country. One of his proposed solutions was to make parents explicitly liable for the vaccination of their kids, as well as the health of their peers. He suggested that people be made to sign notices stating that they are aware of the implications of not vaccination their children.
ReplyDeleteIt seemed quite extreme, but from his background (Eradicating smallpox and working on eradicating polio), he it quite passionate about vaccination.
This was very informative for me. While I knew the HPV vaccine was growing in popularity, I wasn't sure what the controversy was about. However, I find it hard to believe that men would pay that much money so they don't pass the virus on to someone else. Definitely an interesting Public Health topic.
ReplyDeleteAs a side note, I actually know several woman who have already gotten the vaccine and even one who is attempting to increase awareness in Mexico.
I think cost will eventually play the biggest role in success of the vaccine. With so many types of cancers breathing down our necks, why not prevent the ones we have control over?
Little known fact, most insurance companies cover Gardasil for men, even if your MDs office says it is not covered.
ReplyDeleteIf you call the company yourself, they'll tell you it is covered.
I think the HPV vaccine is one of the most exciting preventive health developments of our generation. To have a vaccine available that can actually prevent cancer is amazing to me and it always suprises me when parents decline the vaccine for their children, expecially when cost is not the concern.
ReplyDeleteAccording to the National Cancern Institure (www.cancer.gov), the estimated new cases and deaths from cervical (uterine cervix) cancer in the United States in 2010 were:
New cases: 12,200
Deaths: 4,210
In my undergrad we had a long debate on the topic and one of the points the opposition made was that the parents would be, by allowing their children to be vaccinated for a sexually transmitted disease, giving their kids a green light to go be sexually active. They even went as far as to say it made them more "susceptible" to other STD's that cannot be vaccinated against by means of thinking they were safer. Personally I think it is the parents role to inform their children and I fully support the vaccine but I thought I would play the devils advocate with arguments I have heard in the past.
ReplyDelete(HOW I GOT CURED FROM GENITAL WARTS HPV VIRUS )
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