Lesion in human cervical epithelium infected with human  papilloma virus (HPV16). Early viral proteins (green) bind to and re-orgainse the ketatin filaments (red) towards the edge of the cell. Via Wellcome Images

Lesion in human cervical epithelium infected with human papilloma virus (HPV16). Early viral proteins (green) bind to and re-orgainse the ketatin filaments (red) towards the edge of the cell. Via Wellcome Images

I remember when Texas Governor Rick Perry decided to make it mandatory for 11 and 12 year old girls to receive the Gardasil HPV vaccine. It caused a huge ruckus throughout the state mainly from the Libertarians and conservative Christians. Needless to say, there are enough Christians in the state to make a pretty big scene and Gov. Perry was under some hot water with this decision.

Gardasil is a quadrivalent vaccine, meaning it can protect against 4 different types of HPV infections (types 6, 11, 16, and 18) which cause somewhere around 70% of all cervical cancers. These strains have also been shown to cause vulvar, vaginal, penile and anal (a big one to worry about in the gay male community) cancers and an estimated 6.2 million people a year are newly infected. The vaccine has proven to be highly effective and the largest clinical trial was halted because it was decided to be ethically wrong to be giving girls the placebo instead of the actual treatment due to such successful results. Currently the WHO lists cervical cancer as the 5th leading cause of death in women around the world.

The religious right has decided that mandatory vaccination will lead to adolescent females having more sex, have more unsafe sex, and it will generally promote a lax view towards sex in the pre-teen and early teen population. I’m not going to address why this belief is ridiculous (maybe we should outlaw condoms as well?) because most views on sex and sexual behavior from the right side of the aisle are very myopic and burn of ideology instead of evidence-based reality. I have recently been considering what a powerful tool the HPV vaccine is in our modern health system and how we as a public health community should approach the public relations of making this a useful tool at eliminating a huge pool of potentially deadly cancers in future generations.

In 1971, President Nixon declared a “War on Cancer” and since then we have spent billions of dollars and countless scientists have dedicated the service of a full career to understanding and stopping the cancers that arise in our population. The goal has always been some “silver bullet”, a cure* for cancer, google returns around 17 million hits for this search. In fact our first cure for cancer came from an unlikely source, a vaccination against a virus, Gardasil. In the US the FDA has approved use of the vaccine in females from 9 to 26 (they have since added older women to the list of safe candidates). It is important to get the series of vaccines before onset of sexual activity because it is ineffective once you have become infected. But even if the light switches on and Americans decide to free the next generation of women from a potential cancer we have only addressed half of the situation. There is still a pool of infected individuals harboring this virus, potentially creating a reservoir where the virus can be hosted until it evolves resistance to the vaccine. This reservoir is the male population (in the US at least, in the UK males have been approved to receive the vaccine).

Currently trials are going on for the effectiveness and safety of the vaccine in males and if approval comes down the chute fast enough there can be a nation-wide mobilization to protect a whole generation of kids from this disease. I doubt many would castigate the merits of controlling measles and mumps, or the fact that we wiped a horrible disease off of the planet in smallpox, but because we are protecting our little girl’s vaginas the public fight for vaccination has been met with some stout resistance. I have no doubt if this was an HIV vaccine there would general agreement to vaccinate as many of our kids and unaffected population as possible, but people do not think in terms of long-term risk (hence the rate of smoking and unhealthy eating despite all of the information linking it to poor long-term health). Here we have in our hands the very first cure for cancer, a proven way to add a huge layer of protection to at risk populations for cancers caused by this virus (females and gay men).

If the vaccine is shown to be effective at preventing transmission in males then I think it will be in the hands of those who have dedicated their lives to stopping cancers to get out in public and make this an issue that is to be heard. Being able to catch these kids before any of them have even have a risk at contracting HPV is like a godsend in the world of cancer, an actual effective means at substantially lowering cervical cancers caused by HPV is in our hands. Hell we wiped out a disease that spreads by coughs and sneezes, we could potentially halt all HPV-caused cervical cancers in the US! I hope that the public health community opens up to speak about this, the religious right is very powerful and will have their say in the court of public opinion but I hate to think of how many little girls with conservative parents are going to die of a preventable disease because of a belief system.

And before you guys decide to email me about how abstinence is 100% effective at stopping HPV transmission I’ll ask you how many had pre-marital sex, or any sex where you didn’t receive an updated STI report before having sex with a partner (not to mention the amount of extra-marital and forced sex that happens in the US). Also, destroying all guns would end all gun violence but I don’t see many people in an uproar to do that.

The big factor right now with Gardasil is the cost, the 3 shots run upwards of $350. The cost could easily be lowered with widespread use of the vaccine and states who have made it mandatory have seen a huge price reduction.

It just baffles me to think that how many people cling to this idea that stopping this disease isn’t worth it because of some ideological system that is in place.

*cure=a means of stopping an infection that leads to 70% of cervical cancers.  It is not a direct means of stopping cancer per se but it is effective at preventing the condition that leads to a majority of these cancers.

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