Now in my 40s I find myself at an unexpected crossroads of having to consider getting the Human Papillomavirus (HPV) vaccine not just for myself but for my two young daughters as well. Caught between these two stages of life, me being pre-menopausal and never having received this vaccine and the girls approaching the recommended inoculation age, it prompted me to revisit the controversy that surrounded this specific vaccine when it was first approved back in 2006.
I never considered myself a “#pro-vaxxer,” it was more of an understood act of responsibility having been raised by a nurse, but now with growing hesitancy towards vaccines and groups of “#anti-vaxxers,” I wanted understand why people would be opposed to giving their children a vaccine that significantly reduces the chances of cervical cancer – one of the leading cancers found in women! Like most people I started my quest by typing into Google and off I went into a vortex of information and here’s what I quickly learned.
It’s easy to get overwhelmed by the amount of information online so I decided to follow the research. I began on the World Health Organization’s (WHO) site for some high level facts. HPV is the most common viral infection of the reproductive tract and an alarming percentage ( 80%) of sexually active women and men will contract it at some point in their lives, most commonly between the ages of late teens to early 20s. Another critical piece of information (especially for young adults just becoming sexually active) is that HPV is not only transmitted by unprotected penetrative sex but also by skin-to-skin genital contact.
There are several strains of HPV (nearly 100 types!), many of which that do not pose dire problems and will clear up without any intervention within a few months to 2 years of acquiring it; however, according Cleveland Clinic there are 14 types of HPV that can persist and progress into cervical cancer. It is reported by WHO that nearly all cases of cervical cancer are linked to a HPV infection and can also potentially lead to cancers of the anus, vulva, vagina, penis, and oropharynx.
Non-cancerous HPV Infections
Some more severe but non-cancerous types of HPV can lead to highly infectious genital warts and respiratory papillomatosis which causes tumours to grow in the air passageways leading from the nose and mouth into the lungs. While typically not life threatening, these infections can persist overtime and severely impact quality of life.
This virus is sneaky. It can remain dormant for years with an incubation period of 15-20 years in healthy women and 5-10 years in women who have weaker immune systems. Cervical cancer is the fourth most common cancer in women and in 2018 an estimated 570,000 women were diagnosed with it worldwide of which nearly 311,000 died.
Knowing that this cancer doesn’t present itself for several years after infection, The Society of Obstetricians and Gynaecologists of Canada suggest a few key prevention practices to help reduce the chances of transmitting and contracting HPV. Limit the number of sexual partners – the less exposure, the greater the chances are that you won’t contract it. Practice safe sex by using a condom but be mindful that performing oral sex and/or touching your partner’s genitals will not spare you from contracting the virus. Quit smoking as it can increase your chances of being able to fight off an HPV infection. Those best practices aside, the most obvious and effective tools we have as women to protect ourselves are regular pap smears for early detection and vaccination.
The effectiveness of the vaccine is directly associated with the level of sexual activity, which is why vaccination is highly recommended from the ages of 9 through 26. That said, health organizations have increased the recommended age to 45 in women, citing its benefits depending on you and your partners lifestyle and to discuss options with your doctor.
The vaccine is administered in either two or three doses , depending on your age, as studies have proven that younger people between the ages of 9-14 respond positively and develop sufficient antibodies after just 2 doses compared to people 15+ years.
Since the introduction of the HPV vaccine in 2006, cervical cancer rates have dropped significantly, boasting a 90% prevention rate of cancers caused by the virus.
Now with a solid understanding of the HPV vaccine, I dove into its controversy and what seemed to be driving it all was misinformation. When the vaccine first hit the market, there was a lot of noise around the lack of clinical trials and its ineffectiveness – perhaps a fair concern back in 2006; however, a study conducted in 2019 analyzing more than 60 million HPV vaccinated girls across 14 countries concluded strong evidence of its effectiveness significantly decreasing HPV infections, genital warts, and prevalence of precancerous lesions across females ages 15-19 and 20-24 years.
Mild side effects such as pain or swelling at the injection site, slight fever, headache, fatigue, muscle pain, nausea, vomiting, and diarrhea were also contributors to the controversy but all been proven to be rare and not to cause any serious long-term effects.
Given that this vaccine is specific to protecting against a sexually transmitted disease, there was also a lot of concerns surrounding the inoculation age. More conservative mindsets felt that pushing the vaccine on children seemingly nowhere near the age of engaging in sexual intercourse would only promote promiscuity but studies have proven it does not. It was also felt that the early inoculation age infringes on parents’ rights to manage when and how they want to speak to their child about sex. I can appreciate this given I have two young girls, but personally I feel avoidance of the topic and potentially opening them up to a lifelong disease seems like a much scarier gamble than a frank discussion about sex.
While there is great optimism that high-income countries can eradicate cervical cancer by 2040 with early screening measures and vaccination, there are still several competing factors that will contribute to making this a difficult feat – a combination of cost, access, personal and religious beliefs as well as the growing trend of anti-vaxxers.
Poorer countries that account for more than 85% of annual cervical cancer deaths, in combination with remote, underserviced communities in first-world countries, are faced with challenges such as lack of education, access, and cost. It will require a huge global initiative involving education and programs to enable access to the vaccine in such areas for it to be fully eradicated globally; but for now, it’s encouraging to know the research proves it’s effectiveness for those who are privileged enough to receive it.
After considering everything I learned from writing this piece, I am more confident in my decision to move forward with vaccinating my girls. I went into this with an open mind, truly trying to understand the reluctancy about receiving this vaccine, and while I respect peoples concerns and opinions, I fundamentally feel it is all of our responsibilities to vaccinate ourselves and children to ensure they have a future less burdened with disease.