This is a mess. It’s also one of the thorniest questions in vaccination medicine to have surfaced in a long time. From the outset, it must be clear that I am neither endorsing, nor dismissing the question of vaccinating boys. Get a cup of coffee, and let’s kick this one around for a bit.
The issues here are many, so let’s start with some straightforward infectious diseases epidemiology.
Human Papilloma Virus (HPV) is the most prevalent of the sexually transmitted pathogens. The Centers for Disease Control and Prevention have an excellent fact sheet which is a must-read. Click here.
From a strict infectious diseases perspective, the goal of public health is to certainly limit the pool of pathogen within a population, and to eradicate it if at all possible. This was done successfully with smallpox through a determined and aggressive campaign of world-wide immunization. From a strictly scientific perspective, the same makes sense with HPV. Why not shoot for eradication?
Of course, smallpox and HPV are very different diseases, both in their lethality and in their mode of transmission. The smallpox virus is spread through saliva droplets and remains alive for anywhere between 6-24 hours on contaminated surfaces. Someone might have sneezed into their hand, touched an object in the office such as a phone receiver, and thus facilitated transmission to others touching that object.
HPV requires sexual contact. It is that dimension of personal behavior, of choice, that leads to disease transmission and the current debate.
Certainly, as Cardinal O’Connor used to say, good morality is good medicine. Virginity followed by fidelity in both parties to a marriage obviates the need in that couple for any immunization against STD’s. For the rest of the world, we have an imperfect reality. Let’s consider the parent who does not want their child immunized (and we’ll get to the vaccine safety issues shortly).
Regina and I will stress virtue in our children, and would hope that they remain virgins until marriage. Assuming all goes well, there is no guarantee that their spouses will be virgins, despite assurances given verbally. Therein lies the danger. With well over half of the population infected, the probabilities of even the most virtuous among us encountering HPV are astronomical.
Given that the vaccine is only effective before one is exposed to the virus, the question of when to vaccinate becomes a real concern for parents. Children from the best and most faith-filled families succumb to peer pressure and have sex. Many identify virginity with vaginal intercourse and settle on oral and anal sex as compromise activities that bring about orgasm while ‘preserving’ their virginity, such as they define it.
The problem is that HPV can be spread from the genitals to the mouth and oropharynx, with 35% of all throat cancers being caused by HPV. HPV can also be spread from the mouth to the genitalia.
It’s a mess.
In the strictest sense, vaccinating our children against this pathogen can save a great many women from cervical cancer, males from penile cancer, and both women and men from throat cancer. That’s simply a fact.
The problem comes in with some 68 reported deaths from Gardasil given to girls, and tens of thousands of reported adverse side-effects. Still, when one considers the following ANNUAL numbers from CDC:
Cervical cancer. Each year, about 12,000 women get cervical cancer in the U.S. Almost all of these cancers are HPV-associated.
Other cancers that can be caused by HPV are less common than cervical cancer. Each year in the U.S., there are about:
1,500 women who get HPV-associated vulvar cancer
500 women who get HPV-associated vaginal cancer
400 men who get HPV-associated penile cancer
2,700 women and 1,500 men who get HPV-associated anal cancer
1,500 women and 5,600 men who get HPV-associated oropharyngeal cancers (cancers of the back of throat including base of tongue and tonsils) [Note: Many of these cancers may also be related to tobacco and alcohol use.]
The question arises: What is an acceptable risk in vaccinating?
No vaccine is 100% safe. Ever. Period.
People get sick and people die from vaccines. It’s a numbers game. It’s a cost-benefit analysis. If all of the reported adverse effects of Gardasil are actually true, they still represent a drop in the bucket compared to the numbers of HPV-associated cancers reported above. In the cold calculus of public health, it seems an acceptable risk.
Enter again the behavioral component of disease transmission, and the clarity of acceptable risk immediately becomes foggy. Were smallpox once again in the population, I wouldn’t hesitate to accept these numbers as an acceptable risk, precisely because one cannot see the disease coming.
However, people contract HPV through willful behavior. They will the behavior that carries the risk of transmission. In that light, here is the dilemma faced by Regina and me:
Do we risk our children’s lives and health today in an attempt to hedge our bets on their behavior years down the line, or of their future spouses’ premarital behaviors?
Even if our children remain virgins, there is no guarantee with their future spouses. Do we risk their lives to attenuate a possible case of HPV in a future mate?
If Gardasil is good enough for girls, then it’s good enough for boys.
The question is whether it’s good enough?
I honestly don’t know.
You said “HPV associated” regarding cervical cancer. That’s the problem. Many women will have HPV, never know it, it will clear up and they’ll never get cancer. Many women with cervical cancer will also have HPV. Does that mean HPV is CAUSING cervical cancer? Seems unlikely since many more women get the infection and have no health problems.
I’ve also read information on this vaccine that says it only protects against one or two strains of HPV. And as awful as cervical cancer is, let’s not pretend it’s a lethal monster. Regular pap tests are the best defense, and it is a more easily treatable cancer. It would be great if cervical cancer could be eliminated, but I think we need to keep this in perspective. Women are far more threatened by heart disease or breast cancer than by cervical cancer.
Bottom line for me is there’s no way this side of heaven my daughters will be getting this vaccine. The political agenda behind this vaccine stinks to high heaven, and I don’t like the way it’s being shoved down our throats and mandated against our wills. 72 deaths are nothing to sweep under the rug. The severe reactions had by many, many other girls is not “no big deal.” I don’t think the manufacturer or the CDC are being honest about Gardisil. I simply don’t trust them or the vaccine.
Catholicmoxie,
The vaccine protects against the major cancer-causing strains of the virus.
Regarding HPV causing cervical cancer, we now know that almost all cervical cancers are caused by the virus, as we can identify the viral DNA in the cancer cells. This is indisputable.
As for other health risks to women, this is irrelevant. In 2007, over 4,000 women died from cervical cancer, the bulk of which was caused by HPV. I’m not recommending what to do, but I do owe people the scientific truth for their decision making.
Thank you for kicking this around. I feel better knowing that someone who I respect and who has a Ph.D and training in all the “right” categories is also saying, “It’s a mess.”
Your children can decide whether to take the vaccine when they get older and are of marrying age. They can also have potential spouses tested to avoid their having to take a vaccine unnecessarily. For now, explaining to them the serious risks of the vaccine and of immoral behavior, not to mention teaching good values, should be sufficient protection from HPV (something that is very unpleasant and can cause but is not guaranteed to cause cancer many years down the road). The risks of the vaccines are far greater than we are told. Most vaccine reactions are not reported. I’d also wager that many are not recognized as they are not themselves immediate, but are akin to the slow-growing cancers that HPV itself causes.
It’s not irrelevant to keep cervical cancer in perspective, as I said earlier. I’m not minimizing 4,000 deaths; I’m simply saying the folks pushing this vaccine are doing so with such veracity and urgency as to make it seem that cervical cancer is a threat to women equal with other cancers and serious diseases. It’s not. Again, regular Pap tests are the best course of action, along with good judgment and common sense.
This vaccine is just another component of the sex-on-demand-without-consequences agenda. Again, I do not believe Merck is being honest. I don’t trust them; I don’t trust the safety of this vaccine for a second. If Viagra had the same deadly track record as Gardisil, it would be ancient history by now. But no, the girls are fair game. In fact, they need to be promiscuous in order to keep the abortion culture alive and profitable. So anything to give them a false sense of security and make their parents think they’re being “protective” and responsible.
This whole thing is not just a mess; it’s a stinky, rotten mess.
“If Viagra had the same deadly track record as Gardisil, it would be ancient history by now. But no, the girls are fair game.”
The point of this article was to address the recent calls for giving the vaccine to boys as well. Beyond that, I do think there is a legitimate concern on the part of parents. Sure, I’m all for abstinence, and that is what we are teaching. But I’m also aware that my daughters may pick up this disease from their future husbands. It’s a cold comfort to suggest regular pap smears as a lifetime consequence. Also, pap smears only detect cervical cancer and its early warning signs, and not the others listed.
It’s a real dilemma for parents, and I agree that it’s a stinking rotten mess. My purpose here is to shed some light on the issue and not to judge good parents with good morals who might want to go the extra mile for their children. By the same token, watchful waiting of one’s infected cervix, anus, or penis until the day one dies is a cold, cold comfort for not having risked vaccination with a vaccine that is under question.
“But I’m also aware that my daughters may pick up this disease from their future husbands. It’s a cold comfort to suggest regular pap smears as a lifetime consequence.”
Can’t a bridegroom have a physical before the wedding and make sure he’s disease/infection free? I did before my wedding, even though I’d had no sexual partners. So did my intended. Just seemed like a good idea.
I’m not entirely disagreeing with you, really. I know there may be good reasons to have this vaccine, but as another commenter astutely pointed out, why does it have to be forced on 9 year-olds? If you want to receive the vaccine when you’re 18 or older, then you can make the educated decision. But 9 and 10 year-olds? Really? Seems to be in Merck’s best interest; in Planned Parenthood’s best interest; but not our kids’. The deaths and severe reactions to Gardisil are being ignored by the CDC, Merck and the media in general. The risk is being poo-pooed in order to advance the “agenda” behind the vaccine.
And for the record, disease or not, regular Pap smears are a cold (dis)comfort, literally!
And I still believe that if Viagra had the same deadly track record as Gardisil, it would be ancient history.
Gerard, can you comment about the deaths related to Gardasil? I have read that few if any of these can be definitively linked to the vaccine itself, but rather are from “all cause mortality”. For the record, I am a Catholic NFP-only family doctor and I recommend this vaccine for all of my kids ages 11 or older. My own kids will get it when they are of age.
In other words, if a vaccine recipient goes out and steps in front of a truck within a certain time period after getting it, this is still reported to the CDC and included in VAERS data, but is clearly not due the vaccine.
When Gardisil first came out, I made the decision this was not for my family due to numerous serious safety issues (including too many deaths of healthy young pre-adolescents and adolescents).
Here is a link to a report that was published in 2008 by Judicial Watch, that includes a great deal of factual information from the official Adverse Events Reports that the FDA has received concerning this immunization.
http://www.judicialwatch.org/documents/2008/JWReportFDAhpvVaccineRecords.pdf
Here is one example of an adverse event: My daughter began to have facial (flat) warts on her face and chest after the 2nd dose of Gardasil. There are many warts on her face and chest at least 20 or more. She has never had this problem before receiving the vaccine. She was treated for warts by her Doctor and now has been referred to Dermatology. She has not recovered yet.
VAERS ID: 288998-116
Here is another example: Pt [Patient] admitted to hospital with chief complaint of ascending weakness bilaterally, upper and lower extremities . . . Severe form of Guillain-Barre syndrome after HPV vaccine . . . Respiratory failure with prolonged mechanical ventilation and tracheostomy tube Placement . . . vital capacity deteriorated on day 3 . . . able to move only jaw and eyes. VAERS ID: 268143-1 (S)
Due to tech problems will have to follow up further at a different time, sorry. Martha Shuping MD
Below is a quote from the Judicial Watch Report I referenced above, quoting from Merck, the manufacturer of Gardisil:
‘In a report to the FDA on testing protocol, Merck wrote that “Gardasil has not been evaluated for the potential to cause carcinogenicity or genotoxicity.” One would think that any cancer vaccine that has been approved by the FDA ought to at least not cause cancer. Given that Gardasil works by causing spontaneous reactions and cell mutation, its potential to cause cancer is certainly a matter that warrants further study.’
The thing that worried me the most was the deaths–in the U.S., healthy 6th graders don’t just die for no reason, but in the first year and a half of the vaccine being used in the U.S, there was about one death per month. However, in addition, there deaths of young girls in Europe also. (Again, due to tech issues will have to stop and continue in another post, sorry).
When I was very young, polio was epidemic and moms worried that kids would catch this highly contagious disease and die a very young death–or be paralyzed or disabled if one was lucky enough to catch this disease and still live. So when the polio vaccine came out of course everyone got it–moms had already known of children in grade school who had died of polio and even IF the polio vaccine had some risk (actually it was quite safe) the risks would have been worth it considering the risk of the illness. But HPV is a different story in many ways. Healthy kids playing on school playgrounds don’t get cervical cancer and die–the average age of a cervical cancer patient is 48 years old. Women need to have PAP tests to make sure they are not developing pre-cancering cells on their cervix and if they are, there are treatments. In many cases, cervical cancer would be prevented, though if it does become cancer, there are treatments that are more effective if the cancer is diagnosed and treated early. Those at greatest risk of dying of cervical cancer would be those women who fail to get cancer screening tests such as the PAP test for early treatment of pre-cancerous cells or early diagnosis and treatment of cancer–but still, the women at risk are adult women, decades older than the 11 year olds who are being vaccinated. And for those 11 year olds, the risks are now, and very serious. Again healthy 11 year olds are not supposed to die of anything–so when a girl in Austria or England suddenly dies soon after receiving the injection, it’s fine for Merck to say, there is no evidence it was the vaccine, but still–these girls should not have died of anything, and it is very strange when girls receive and injection and then die whether same day or within a few days. And yes, there have been deaths in the U.S. and in a number of other countries.
But in addition to the deaths are too many reports of serious adverse effects, such as, paralysis, being on a respirator, and being disabled for a really long time with no improvement in some cases… or just having warts all over the face of a teen or pre-teen… Based on all that I have read, I do not think there was adequate safety testing and there was not adequate follow up information–the Judicial Watch report tells a lot about this, though there is more iinformation now after three years have past. Still, the report is pertinent because it goes through the early adverse events reports, just that there is even more information now.
Merck promoted this vaccine heavily because they knew another, better vaccine was still in the pipeline and if they did make their money now, they would not be able to later when a competing product comes to market.
There is no need to rush to vaccinate our 11 year olds. There is too much risk and too many unanswered questions. The vaccine is not proven to last more than a few short years, so even if our 11 year olds get this vaccine, it will not last till they get married, and may not last even until some of them become sexually active. For those who choose to practice abstinence, there is a likelihood that they will not have to contract this disease–if a man and a woman marry and have always practiced abstinence, they will not have this virus. I realize that there are situations where there can be sexual assault or sexual abuse, and if the vaccine were very safe I would consider use of the vaccine for this reason. But the risk of serious injury or even death from the vaccine is too high for me to find this to be an acceptable risk for a disease whose true risk I believe to be much less of a threat than has been portrayed. Because the risk of catching HPV can be minimized by practicing abstinence, and the risk of actually getting cancer can also be minimized by proper screening.
In any case, there is at least one if not two new vaccines on the way that may cover more strains and I hope will prove themselves to be safeer than Gardisil.
Having read the Judicial Watch Report and also having read a number of other sources, and even attending contining medical education workshops on Gardisil, my own opinion is that it is not at all worth the risk in my family. For others, perhaps the risk is reasonable and acceptable, but certainly parents need to be very well informed, and it is hard to think that parents would choose this for their children if they had read many of the adverse events reports. I also saw news interviews with two physicians who were parents of a girl who became disabled after receiving the vaccine–they were trying to educate other parents… I think the safety risks are unaccpetable.
Martha, I read part of the report you linked, but stopped when I reached the part about how a 17 year old miscarried 2 weeks after getting the vaccine… As if this extremely common occurrence could possibly be proven related to the vaccine. The rest of the report (that I read) is similar- riddled with anecdotal evidence without any meaningful stastical interpretation showing a plausible cause-effect relationshipbetween the vaccines and the VAERS reported adverse consequences.
I have not been able to find data breaking down the demographics of those who died soon after getting Gardasil. You say it’s not normal for healthy 11 year olds to die of anything, which of course is true, but it’s not at all uncommon for 18-26 year olds to die due to risky behavior totally unrelated to Gardasil. To date, something like 10 million people have gotten Gardasil- do those 10 million have a higher death rate than a similar control group?
Finally, as you note above, this report is from 2008, over 3 years ago- ancient history. Do you have anything more recent to support your claim that the vaccine is dangerous?
Just looked at the CDC info re Gardasil again. It’s actually around 40 mill people who have received the vaccine. 70 some odd people out of 40 mil dying after receiving the vaccine sounds similar to the death rate in an unvaccinated cohort of 9-26 year olds. I am happy to hear anybody’s informed opinion to the contrary.
Just a little bit more from the Judicial Watch Report which you can read in full at the link I gave above… Just up through June, 2008 when this was published, there were 8,864 adverse events reports published… Below is from the report, I am not able to put in the quotation marks, but everything else is from the article:
“In total, 8,864 reports have been filed. The VAERS reports document that there have been 38 reports of Guillain-Barre
Syndrome among girls who received the Gardasil vaccine. Guillain-Barre Syndrome is a potentially devastating illness that attacks the nervous system and can result in paralysis.
Even though some of these cases had onset dates within days of receiving Gardasil, the
CDC stated that, “After a careful review of the GBS reports received by VAERS, many
appear to have insufficient clinical data. Because GBS occurs at a rate of 1-2/100,000
person years during the second decade of life, it is likely that some cases will occur after
vaccination but will not be due to vaccination.”47 However, even taking into consideration coincidental cases, the VAERS reports show that the average onset date of Guillain-Barre Syndrome in Gardasil-related cases was only 18 days after receiving the vaccine. Twenty-nine of the thirty-eight cases have onset dates of two weeks or less, and ten girls developed Guillain-Barre Syndrome within twenty-four hours. Below are excerpts from the VAERS reports:
“Information has been received . . . concerning a 16-year-old
female who on 16-APR-2007 was vaccinated with a dose
of Gardasil. Since 1 day post-injection, the patient had
progressive bilateral leg numbness and weakness and motor
weakness. VAERS ID: 277814-1″
* * *
Information has been received . . . concerning an approximately 19-year-old female who was vaccinated IM with a first dose of Gardasil. Subsequently, the patient was diagnosed with Guillain-Barre Syndrome and was hospitalized. The patient’s Guillain-Barre Syndrome persisted . . . Guillain-Barre Syndrome was considered to
be disabling and immediately life-threatening.
VAERS ID: 296713-1 (S)
Martha, Mary:
I know that we three share the same dedication to the highest standards of empiric evidence. The problem here is that this issue is so fraught with moral codes of conduct as confounding considerations. I wonder if we three as doctors can’t put all of the moral issues aside and just approach this vaccine by the numbers. If 40 million vaccine administrations have produced less than 100 deaths (and here I am stipulating causality for argument’s sake), then that seems pretty safe to me. We all understand that humans have a range of susceptibilities to a given antigenic challenge, and 70 fatalities out of 40 million is far less than peanut allergies!
Mary is quite right to note that VAERS does not get into causality, but merely notes coincidence. I am unaware of any peer-reviewed systematic study of Gardasil’s adverse effects.
Martha, I’ll stipulate the GBS cases, as 18 days post-vaccination is pretty compelling, however…
Let’s return to the incidence of cervical and other cancers down the road. My question as a microbiologist for you and Mary as physicians is this:
The adverse effects of vaccination represent a 1:30,000 occurrence relative to adulthood HPV-induced cancers if I read the numbers correctly. Does this not represent an acceptable risk relative to disease prevention?
Yes.
“I also saw a news interview of physician parents of a girl who became disabled after receiving the vaccine.”
Well, if she became disabled after getting Gardasil, then it must be the vaccine’s fault, right? Actually, this statement gives no information about what the cause of the disability is, or what the incidence of this extremely vague injury is in the general (unvaccintated) population. It’s like observing that most 5 year olds who fall off their swing set have had a peanut butter and jelly sandwich over the past 3 weeks. So did the sandwich cause the fall? No- it should be obvious to anyone of average intelligence that this is not a causal relationship,and that most 5 year olds, whether they’ve fallen or not, have eaten a PB&J sandwich recently. Yet this is the kind of logical non sequitur that I see too often in the anti-vaccine literature, sometimes even by physicians who should know better (alas) .
Thanks for your thoughts on this, and insights into the actual science behind the vaccine. I’d love to read your thoughts on vaccination in general, particularly wrt the morality of using vaccines allegedly developed using cell lines descended from aborted fetuses. God bless!
“The problem is that HPV can be spread from the genitals to the mouth and oropharynx, with 35% of all throat cancers being caused by HPV. HPV can also be spread from the mouth to the genitalia.”
If HPV can be spread from mouth to genitalia, can it then be spread from mouth to mouth? If that is the case, then virginity is not an assurance of not contracting it because kissing could then transmit this disease. Am I misunderstanding something here?
I don’t think you are, Cecilia. I just don’t know that it can be proven epidemiologically. Good luck finding a large cohort of subjects who have only ever kissed.
Popping in to the discussion from afar – I’m impressed at the quality of discussion on this page, given the contentiousness of the issue.
Dr. Nadal seems to have summed up the quandry precisely, and I look forward to hearing how he comes down on it in the end.
I’ve been trying to figure out the core reasons people have misgivings about hpv vaccination. I suspect it boils down to whether they think their kids are going to abstain from sex until marriage, and/or whether they trust medical science. These core reasons are then amplified by confirmation bias, often via web sites that are biased or/or not backed up by solid facts. That part, too, is a mess.
My notes so far are up at http://kegel.com/hpv/qualms and its parent page,
and I’d love feedback from this group (either here or via email).
Thanks!
(Full disclosure: I’m an engineer with a biology degree, and an atheist Unitarian. I live in California, and make my living writing software for a game company.)