The human papillomavirus (HPV) vaccine has had some negative press with respect to health concerns in a study conducted by the Centers for Disease Control and Prevention (CDC) between 2015 and 2018 on 39,000 caregivers of teens. The issue seems to be largely precipitated by social media misinformation, when in fact, according to the National Cancer Institute, there has been “15 years of consistent evidence that HPV vaccines are safe and effective”.
Dr Frances Paterson, obstetrician gynaecologist and specialist urogynaecologist says, “The benefit of vaccines is that they may protect one against acquisition of HPV infection and development of subsequent HPV-associated disease.” Much information on social media presents the vaccine as a sexually transmitted infection vaccine rather than a cancer prevention vaccine, which is one of the reasons parents have declined the shot if their children are not sexually active. There is also, of course, the general anti-vaccine rhetoric remaining post-COVID.
Much information on social media presents the vaccine as a sexually transmitted infection vaccine rather than a cancer prevention vaccine.
What is HPV?
Although HPV is transmitted by sexual contact, Dr Paterson says, it isn’t a typical STD like chlamydia: it is ubiquitous and pretty much everyone has HPV (even nuns have HPV). HPV can cause anogenital (vulval/vaginal/cervix/anus/rectal) and oropharyngeal (mouth/throat) disease (including cancer) in males and females.
HPV exists in various types, with some posing a higher risk of causing cancer compared to others. These are referred to as high-risk HPV genotypes. Dr. Paterson clarifies that among these genotypes, types 16 and 18 are responsible for approximately 70 percent of all cervical cancers worldwide, while types 31, 33, 45, 52, and 58 contribute to an additional 20 percent. Types 16 and 18 are also responsible for approximately 90 percent of anal cancers, as well as a significant proportion of oropharyngeal cancer, vulvar and vaginal cancer, and penile cancer. Additionally, HPV types 6 and 11 account for approximately 90 percent of anogenital warts.
Dr. Paterson emphasises that the presence of high-risk HPV types does not guarantee the development of cancer; it simply implies a higher risk. Among a group of individuals with high-risk HPV types, some may develop cancer while others may not, and the precise factors influencing this outcome are not fully understood.
What are the pros of HPV vaccines?
According to Dr. Paterson, the advantages of these vaccines are manifold. They not only provide protection against cervical cancer, vulval warts, and other related conditions at an individual level but also bring about substantial benefits on an economic and healthcare utilisation level in the community.
Additionally, in settings where there has been a significant uptake of the vaccine among females there is also evidence of herd immunity among males of similar age, reflected in a decrease in the incidence of genital warts.
Interestingly, in a trial of more than 18,000 females aged 15 to 25 years, there were no differences in serious adverse events between those who received the vaccine versus those with the placebo. There is also no difference in risk for boys receiving the vaccine versus girls as far as Dr. Paterson is aware.
“The benefit of vaccines is that they may protect one against acquisition of HPV infection and development of subsequent HPV-associated disease.”
What are the cons of HPV vaccines?
The main negative with the vaccine is the small window in which the vaccination is recommended. After this, and in girls/boys who have already had exposure to HPV it may be less effective. Some other cons are the following and depend on the vaccine (Gardasil, Gardasil 9 and Cervarix):
- Mild or moderate injection site reactions (pain, erythema, and swelling).
- A “postvaccination syncopal event”, which is when people faint after the injection and is most likely a response to the stress of having the injection rather than the contents of the vial itself.
- Mild symptoms: headache, nausea, vomiting, fatigue, dizziness, and generalised weakness.
- Some other rare adverse events have been reported.
Australia’s free school vaccination programme, which began in 2007 and has reduced the HPV infection rate by 92%.
Do the pros outweigh the cons especially considering the high rape and teen pregnancy stats in South Africa?
According to Dr. Paterson, notwithstanding the rape/teen pregnancy stats, the most compelling evidence for the HPV vaccine is the following:
- Cervical cancer ranks as the second most frequent cancer among women in South Africa and the first most frequent cancer among women between 15 and 44 years of age.
- Cervical cancer is the LEADING cause of cancer-related deaths in South Africa.
- Cervical cancer is almost completely preventable with appropriate vaccination and screening (we know this because the risk of cervical cancer and death from cervical cancer is markedly reduced in countries with an organised vaccination and appropriate screening programmes).
One example of this is Australia’s free school vaccination programme, which began in 2007 and has reduced the HPV infection rate by 92%. They feel that they are on track to essentially eradicate HPV in the next 20 years. This is, however, implausible given that many countries on the African continent are unlikely to be able to institute this any time soon.
Is the vaccine safe?
Vaccines do not contain live viruses or the actual virus itself; instead, they consist of virus-like particles that imitate certain parts of the virus. These particles do not carry viral genetic material and are manufactured using biologic systems with well-established safety records. Dr. Paterson further explains that HPV vaccines have undergone rigorous testing in large clinical trials and have accumulated extensive post-licensure data, demonstrating their safety.
The World Health Organization (WHO) Global Advisory Committee on Vaccine Safety also states that the benefit-risk profile remains favourable.
It is to be noted, however, that there is always the possibility or risk of side effects with any given medication or vaccination. Plus, if your child has an impaired immune system or other health conditions, please weigh the pros and cons with your trusted healthcare professional. Having a vaccination is an individual choice.
*If you are concerned about adverse events and vaccinations, you can search this database for https://vaers.hhs.gov for more info.
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