HPV Vaccine
What is HPV
HPV stands for a human papillomavirus. It is the most common sexually transmitted infection with more than 150 related viruses (What is HPV, cdc). Each HPV virus is given a number which is referred to as its HPV type. Roughly “79 million Americans, most in their late teen and early 20s, are infected with HPV” (Human Papillomavirus, cdc). The virus is transmitted through “genital contact (vaginal and anal sex)” (Office of the commissioner). It can be passed from person to person via skin-to-skin contact. Some of the viruses can cause health problems including genital warts and cancer, however, some can disappear on their own. Both men and women could develop mouth/throat and anus/rectum cancer caused by an infection from the virus. Men, specifically, can develop penile cancer while women can develop cervical, vaginal and vulvar cancer due to an infection caused by an HPV virus. Although one can develop cancer from an infection from HPV, the vaccines can prevent both men and women from developing HPV related cancers.
Development of Vaccine/ Dosage
The vaccine was developed by an Australian professor named Ian Frazer. Ian Frazer, who is initially from Scotland, “and his team at the University of Queensland discovered how to make the vaccine particles, which serves as the basis of the HPV vaccine” (Cancer Council Australia, The HPV Vaccine). Ian Frazer developed the vaccine specifically to combat cervical cancer in women (Gavi). More information about Frazer’s hypothesis and reasoning can be found an interview where he discusses the development: https://youtu.be/aAb5Ib9rMWs
There are two types of vaccines, Therapeutic and prophylactic, marketed by Merck and Co., an American pharmaceutical company and one of the largest pharmaceutical companies in the world. The Therapeutic vaccine is administered to people already infected by the HPV virus while the prophylactic vaccine is given to people who have yet to be exposed to the virus to prevent an infection (Grimes). The first ever marketed prophylactic vaccine was Gardasil. Gardasil was administered between 2007 -2017, which protected against only 4 types of HPV viruses, 6, 11, 16 and 18. Since its development, about 270 million doses of Gardasil has been administered worldwide (Cancer Council Australia, The HPV Vaccine). Gardasil 9, which protects against “nine HPV types [6, 11, 16, 18, 31, 33, 45, 52 and 58] – seven of which causes cervical cancer and other cancer with five of the seven not previously covered [by Gardasil]” (National Cancer Institute). Since its development, over “10million doses of Gardasil 9 has been administered in the US alone” (Cancer Council Australia, The HPV Vaccine).
GSK a British pharmaceutical company also market a vaccine for HPV known as Cervarix. Cervarix protects against HPV type 16 and 18, which are known to cause cervical cancer (Grimes). This vaccine is also only administered to women.
Gardasil 9 can be given as 2 or 3 shots. It is usually administered to the arm muscle. For people between the age of 9 through 14, the vaccine can be given in 2 or 3-dose schedule. “For the 2-dose schedule, the second shot should be given 6–12 months after the first shot. If the second shot is given less than 5 months after the first shot, a third shot should be given at least 4 months after the second shot. For the 3-dose schedule, the second shot should be given 2 months after the first shot and the third shot should be given 6 months after the first shot” (Merck Sharp & Dohme Corp). For people between the ages of 15-26, the vaccine is only administered on a 3-dose schedule where “the second shot should be given 2 months after the first shot and the third shot should be given 6 months after the first shot” (Merck Sharp & Dohme Corp).
Side effects
Like all medication and vaccines, The HPV vaccine has side effects including: “pain, redness and swelling at the site of injection (Cancer Council Australia, Facts about HPV). The very “rare but most serious side effect is anaphylactic or an allergic reaction can occur due to ingredients such as yeast” (Cancer Council Australia, Facts about HPV). “People are to be monitored for roughly 15 minutes after receiving the vaccine in case of an allergic reaction” (Cancer Council Australia, Facts about HPV). If a reaction occurs, “it can be treated relatively quickly and successfully”. Every immunization provider is “Trained and equipped to deal with such a reaction” (Cancer Council Australia, Facts about HPV). The vaccine was deemed safe by the “Global Advisory Committee on Vaccine Safety of the World Health Organization has reviewed all published and emerging data about the vaccines in real world use and declared HPV vaccines safe for use seven times so far” (Cancer Council Australia, Facts about HPV).
Insurance/Cost
The HPV vaccine cost “from $130-$170 per shot, for a total of $390-$500” (Fayed). “Many health insurances cover at least one of these vaccines, however, this varies among providers and policies” (Fayed); “There is no current legislation that requires insurance providers to cover the vaccine” (Fayed).
If one does not have insurance, the vaccine including office visit fees must be covered by the individual. For those uninsured, there are programs ranging from “Vaccine for Children program, to patient assistance programs offered by the drug companies, to [a] local health department” (Fayed). More information concerning public financing of the HPV vaccine can be found at https://www.kff.org/womens-health-policy/fact-sheet/the-hpv-vaccine-access-and-use-in/ under PUBLIC FINANCING.
For individuals on Medicaid, the HPV vaccine is cover for those under the age of 20, however, there are about “37 states [who cover] the vaccine for individuals ages 21-27” (Fayed).
Racial and gender disparities
Although the vaccine is available for those insured and individuals without insurance, there are large disparities among genders and races in the United States. In a study conducted by Saint Louis University consisting of 6,862 respondents aged 18 years and older, it was determined that only “66% of respondents had heard of HPV and HPV vaccine (57% of men vs. 75% of women)” (Adjei Boakye). When the two genders were compared in a multivariable analysis, women were “were 225% more likely to have heard of HPV, and 281% more likely to have heard of the HPV vaccine” (Adjei Boakye).
Boys ages 9-26 experience the largest disparity with respect to the HPV vaccine. After the US Food and Drug Administration advisory panel approved Gardasil for males, physicians were torn between administering the vaccine to males due to the lack of severity of HPV infections in males. This view is due to the fact that “there is no infrastructure for regular screening of such cancers the way that regular pap smears have helped prevent cervical cancer in women” (Chitale). For more information on the debate among doctors concerning administering the HPV vaccine to males visit: http://abcnews.go.com/Health/MensHealthNews/gardasil-boys/story?id=8541892
In the same study by Saint Louis University, researchers also conducted a multivariable analysis on racial group, specifically non-Hispanic black, non-Hispanic white and Hispanics. It was determined that “non-Hispanic Blacks were 33% and 44% less likely than non-Hispanic Whites to have heard of HPV and the HPV vaccine, respectively. Hispanics were 27% and 53% less likely than non-Hispanic Whites to have heard of HPV and the HPV vaccine, respectively” (Adjei Boakye).
This figure demonstrates the race disparities of the HPV vaccine. The vaccine prevents cervical cancer, thus, the lack of knowledge by specific racial groups increases the mortality rate of the racial group from cervical cancer. For example, black experience more incidents 8.7 than whites 7.4, however, the mortality rates of black are also higher at 3.8 to 2.1 in white per every 100,000 persons (The HPV Vaccine: Access and Use in the U.S)
Global Access
Globally speaking only 64 countries nationally and 4 countries subnationally have implemented HPV vaccines. In these countries, disparities exist especially among women, who are the targeted population. A study conducted by Scientist from the Catalan Institute of Oncology discovered that “From June, 2006, to October, 2014 [. . .] An estimated 118 million women had been targeted through these programs, but only 1% were from low-income or lower-middle-income countries. 47 million women received the full course of vaccine, representing a total population coverage of 1.4% and 59 million women (48–71 million) had received at least one dose, representing a total population coverage of 1.7%. In more developed regions, 33·6% of females aged 10–20 years received the full course of vaccine, compared with only 2.7% of females in less developed regions” (Bruni, Leia, et al). More information about the study can be found at http://www.thelancet.com/journals/langlo/article/PIIS2214-109X(16)30099-7/fulltext
This graph can be found on the World Health Organization page: http://www.who.int/immunization/diseases/hpv/decision_implementation/en/ It depicts the country where the HPV vaccine has been introduced. One can see that undeveloped countries in Africa have yet to be introduced to the vaccine while developed countries in North America and Europe have initiated the administration of the vaccine to its population. Additional information can be found at http://www.who.int/immunization/monitoring_surveillance/data/en/ which provides data and statistics concerning the global disparities of the HPV vaccine.
Opposition
Individuals who oppose the HPV vaccine do so on two reasons, moral concerns and safety fears. Moral concerns stem from parents who are “unable to accept the idea that their children will at some point have sexual urges” (STDAware). This point of view is deeply rooted on the individual’s religious beliefs. These individuals believe that young people should not be engaging in sexual acts therefore the implementation of the vaccine as prevention only “encourage immoral behavior in young people” (STDAware).
Safety fears of the public is rooted in the media. Despite the vaccine’s prevention of HPV infection and certain types of cancer in million of Americans, the media tend to broadcast specific cases out of the millions where minor complication such as “fainting post injection and irritation at the site” as taken place (STDAware).
Politics of Health
The debate surrounding the HPV vaccine is split. There are government officials who believe that vaccinations should be mandatory in order to protect the community as a whole while other believe that it should be left to the individual. The individuals who want the vaccine to be mandatory are attempting/ is exercising biopower. The concept of biopower is when the government or any type of authority exercises power over the body of the citizens. In certain parts of the country, governmental figures have made receiving the HPV vaccine mandatory as to protect the entire community by sacrificing individual rights.
The huge gap in HPV knowledge among the genders, races, and SES contributes to scientific knowledge production. Since there has been numerous studies on the HPV vaccine and its effectiveness, the fact that most of the population is unaware of the dangers of the infection and the availability of the vaccine signals that there’s a lack of scientific knowledge being spread to these individuals. People of lower social economic status are less likely to have heard of the infection and the vaccine than people of higher SES while people of color are also less likely to have heard of the infection and the vaccine compared to whites in America. Lastly, the lack of education of the public about the dangers of the HPV virus and the effectiveness of the vaccine contributes to the disparities.
Works cited
“Human Papillomavirus (HPV).” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 16 Nov. 2017, www.cdc.gov/std/hpv/stdfact-hpv.htm.
“The HPV Vaccine: Access and Use in the U.S.” The Henry J. Kaiser Family Foundation, 19 Oct. 2017, www.kff.org/womens-health-policy/fact-sheet/the-hpv-vaccine-access-and-use-in/.
“What Is HPV?” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 20 Dec. 2016, www.cdc.gov/hpv/parents/whatishpv.html.
Adjei Boakye, Eric , Betelihem B. Tobo, Rebecca P. Rojek, Kahee A. Mohammed, Christian J. Geneus & Nosayaba Osazuwa-Peters (2017) Approaching a decade since HPV vaccine licensure: Racial and gender disparities in knowledge and awareness of HPV and HPV vaccine, Human Vaccines & Immunotherapeutics,13:11, 2713-2722, DOI: 10.1080/21645515.2017.1363133
Bruni, Leia, et al. “Global Estimates of Human Papillomavirus Vaccination Coverage by Region and Income Level: a Pooled Analysis.” The Lancet Global Health, 1 July 2016, www.thelancet.com/journals/langlo/article/PIIS2214-109X(16)30099-7/fulltext
Cancer Council Australia. “Facts about HPV and the Vaccine.” HPV Vaccine, New Zealand Ministry of Health, www.hpvvaccine.org.au/parents/myths-and-facts-about-hpv-and-the-vaccine.aspx.
Cancer Council Australia. “The HPV Vaccine.” HPV Vaccine, www.hpvvaccine.org.au/the-hpv-vaccine/vaccine-background.aspx.
Chitale, Radha. “Doctors Say ‘Wait And See’ Before Prescribing Gardasil In Boys.” ABC News, ABC News Network, 11 Sept. 2009, abcnews.go.com/Health/MensHealthNews/gardasil-boys/story?id=8541892.
Fayed, Lisa. “Does Insurance Cover HPV Vaccine Costs?” Verywell Health, 27 Apr. 2017, www.verywell.com/how-much-does-the-hpv-vaccine-cost-514124.
Gavi, the Vaccine Alliance. “HPV Vaccine Inventor Ian Frazer Sees His Idea Become Reality.”Gavi, the Vaccine Alliance, Gavi, the Vaccine Alliance, 2 Mar. 2012, www.gavi.org/library/news/gavi-features/2012/hpv-vaccine-inventor-ian-frazer/.
Grimes, Janelle L. “HPV Vaccine Development: A Case Study of Prevention and Politics.”Biochemistry and Molecular Biology Education, Wiley-Blackwell, 3 Nov. 2006, iubmb.onlinelibrary.wiley.com/doi/full/10.1002/bmb.2006.49403402148.
https://iubmb.onlinelibrary.wiley.com/doi/full/10.1002/bmb.2006.49403402148
Merck Sharp & Dohme Corp. “WHO CAN GET GARDASIL 9?” GARDASIL®9 (Human Papillomavirus 9-Valent Vaccine, Recombinant), 22 July 2016, www.gardasil9.com/about-gardasil9/get-gardasil9/.
National Cancer Institute. “Gardasil 9 Protects against Additional HPV Types.” National Cancer Institute, 2 Mar. 2015, www.cancer.gov/types/cervical/research/gardasil9-prevents-more-HPV-types.
Office of the Commissioner. “For Women – HPV (Human Papillomavirus).” U S Food and Drug Administration Home Page, Office of the Commissioner, 24 Jan. 2018, www.fda.gov/ForConsumers/ByAudience/ForWomen/ucm118530.htm.
STDAware, “Controversy over HPV Vaccines.” STDAware Blog, 18 July 2017, www.stdaware.com/blog/controversy-over-hpv-vaccines/.
« Back to Glossary Index