Sexual politics and the HPV vaccine

It says a lot about our society that the development of a vaccine for Human Papillomavirus has been greeted with controversy rather than appreciation. It is absurd that a treatment that has been shown to be effective in the prevention of cervical cancer is being interfered with out of misguided concerns that it will increase the incidence of teenage sex. It seems unlikely that many young woman make their decision about whether or not to engage in sexual activity with the possibility of HPV-induced cervical cancer as a major consideration. (If they do, there are plenty of other STIs to give them pause.) Even if it could be documented that a vaccination program would increase teenage sexual activity to some appreciable degree, a very strong argument can be made that preventing the pain and death associated with cervical cancer is an outcome of sufficient importance to justify the choice to vaccinate. Furthermore, the overall response smacks of sexual double standards. If this were a vaccine that had a strong preventative capacity for both men and women, it seems unlikely that there would be so much furore about its administration.

The tactic of trying to alter the decision-making of teenagers through the reduced availability of life-saving medicines is hardly a behaviour that should be promoted or tolerated. The Globe and Mail gets it essentially right in a recent article, arguing that the purpose of a public health system is: “seizing opportunities to avoid needless death, to improve quality of life when we can and to extend it wherever and whenever we can.” Hopefully, the political opposition surrounding HPV vaccination will be overcome, and the procedure will become as routine as vaccination against Measles or Hepatitis B (itself largely transmitted through unprotected sex).

Author: Milan

In the spring of 2005, I graduated from the University of British Columbia with a degree in International Relations and a general focus in the area of environmental politics. In the fall of 2005, I began reading for an M.Phil in IR at Wadham College, Oxford. Outside school, I am very interested in photography, writing, and the outdoors. I am writing this blog to keep in touch with friends and family around the world, provide a more personal view of graduate student life in Oxford, and pass on some lessons I've learned here.

33 thoughts on “Sexual politics and the HPV vaccine”

  1. Dan Savage explained it best: (his language is colourful, as always)

    *Scroll down to: “STRAIGHT RIGHTS UPDATE”

    “A new vaccine that protects against cervical cancer has set up a clash between health advocates [and] social conservatives who say immunizing teenagers could encourage sexual activity,” the Washington Post reported last week. Doctors want teenage girls to receive the vaccine as a matter of routine, something the religious right opposes. “Because the vaccine protects against a sexually transmitted virus, many conservatives oppose making it mandatory, citing fears that it could send a subtle message condoning sexual activity before marriage… ‘I’ve talked to some who have said, “This is going to sabotage our abstinence message,”‘ said Gene Rudd, associate executive director of the Christian Medical and Dental Associations.” (To his credit, Rudd said he would want his daughters vaccinated.)

    The right’s abstinence message has bigger problems than this vaccine. Studies have shown that young people are still having premarital sex… despite the billions of dollars the Bush administration has poured into abstinence education. A study conducted at Texas A&M University found that kids subjected to abstinence-only sex education have more sex than kids who aren’t. So what the right is saying is this: We’re willing to kill American women in order to avoid “sabotaging” our ineffectual abstinence-only message. Nice.

    Who ultimately gets to determine the government’s position on the HPV vaccine? Thanks to George W. Bush, the Christian fundies do. From the Washington Post: “The jockeying [around the HPV vaccine] reflects the growing influence social conservatives, who had long felt overlooked by Washington, have gained on a broad spectrum of policy issues under the Bush administration. In this case, a former member of the conservative group Focus on the Family serves on the federal panel that is playing a pivotal role in deciding how the vaccine is used.” W stands for women—that’s what he told us when he ran for president. But, hey, it wasn’t a lie. George W. Bush never said anything about standing for live women.

  2. Ontario’s Medical Officers of Health Strongly Support Ontario’s HPV Vaccine Program

    TORONTO, Sept. 14 /CNW/ – The Council of Ontario Medical Officers of Health, a Section of the Association of Local Public Health Agencies (alPHa), remains strongly supportive of Ontario’s publicly-funded program to immunize Grade 8 girls against the human papillomavirus (HPV).

    “Five years of research and extensive clinical trials have demonstrated that this vaccine is safe and effective against a group of viruses that are responsible for 70% of cervical cancer cases and 90% of genital warts” said COMOH Chair Dr. Charles Gardner. “As medical experts, we wish to make it very clear to Ontario’s young women and their parents that this program is good for women’s health, will reduce suffering and save lives. We strongly urge them to take advantage of this opportunity”.

    Some recent reports in various media have presented arguments against the implementation of this program, which are based on biased and inaccurate information, and ignore the evidence from extensive and careful research. Ontario’s Medical Officers of Health are concerned that this misinformation will needlessly damage public confidence in a very important vaccine program.

  4. “The $39 million vaccination program was intended to reach as many as 84,000 Grade 8 girls this year. The voluntary vaccine is administered by public health officials in three doses over six months.

    Health Canada approved Gardasil last summer for use in girls and women aged 9 to 26.

    The free vaccination program is only for Grade 8 girls. Gardasil is available in Ontario for others but OHIP does not cover the $400 per person cost of the vaccine.

    The vaccine protects against infection from four separate strains of HPV, which combined, cause 70 per cent of all cases of cervical cancer.

    Cervical cancer is the second most common cancer for women aged 20 to 44, after breast cancer.

    In Ontario, some 550 women are diagnosed with cervical cancer and 150 die every year.”

  5. Is the teen sex controversy a big issue in Canada? I thought that was mostly in the US.

  7. See also: The birds, the bees and the taboos

    “The attempt to make sex education universal in a country where sex is rarely discussed openly was always going to be tough. The course’s euphemistic title—“Adolescent Education Programme” (AEP)—did not fool teachers, many of whom were horrified by a flipchart with illustrations of naked bodies and detailed drawings of genitalia.

    Some also expressed anger over the inclusion of information on contraception and sexually transmitted diseases—the main point of the initiative.”

  11. Sexually Transmitted Injection
    Why vaccinate girls but not boys against HPV?
    By William Saletan
    Posted Thursday, Oct. 15, 2009, at 10:10 AM ET

    Should boys be vaccinated against the human papillomavirus?

    You’ve probably heard about girls being vaccinated everywhere for HPV. The virus has been implicated in cervical, vulvar, and vaginal cancers. But it can also cause diseases that affect men and boys: oral, anal, and throat cancers, not to mention genital warts and juvenile onset recurrent respiratory papillomatosis, an infant respiratory condition that may result from maternal HPV infection. “Recent data on the use of the HPV vaccine in males suggest high efficacy against vaccine type infections and external genital lesions,” says a study published last week in the British Medical Journal.

    So, should boys be vaccinated?

    No, say the authors. “Our results suggest that if vaccine coverage and efficacy are high among preadolescent girls (12 years), then including boys in an HPV vaccination programme is unlikely to provide good value for resources compared with vaccinating girls only. … [O]ur analysis favours HPV vaccination of preadolescent girls (with continued screening in adulthood) as a valuable intervention for its cost … Including boys in the vaccination programme, however, generally exceeded conventional thresholds of good value for money.”

    Why vaccinate girls but not boys? The authors cite several factors. First, HPV is more likely to harm girls. Second, the vaccine is more effective in girls. Third, the rate of viral transmission depends on the virus’s prevalence “in the opposite sex at any given time.” If girls are routinely vaccinated, there’s nothing for boys to catch or transmit.

  12. It is objectionable that they are assuming that the only sexual activities that occur and could spread HPV take place between men and women.

  13. How Safe is the HPV vaccine?
    October 12, 2009

    I’ve been reading a lot about the HPV (Human Papillomavirus) vaccine and the risk of serious side effects and even death. I thought I would seek out the numbers and put them in context. Especially given headlines claiming the HPV jab is “as deadly as the cancer” it seeks to prevent.

  14. “But the dominant strategy of cancer prevention to which the DES and asbestos scares led—one-by-one alarmist publicizing of man-made carcinogens, regardless of their relative importance—is unlikely to make any serious dent in cancer rates. After all, half of all chemicals are carcinogenic in laboratory tests. A smarter strategy would simply focus on the most preventable exposures causing the most malignancies, without any regard for what’s natural and what’s man-made.

    To begin with, that means paying more attention to common infections. Most women today are infected with human papilloma virus, which is a necessary precondition for about half a million cervical cancers worldwide (not to mention anal, penile, pharynx, and even skin cancers). These numbers dwarf those associated with DES exposure. To prevent HPV infection—and later cancer—people must be vaccinated before their sexual debuts, preferably as pre-adolescents. Yet several state legislatures have withdrawn bills encouraging vaccination, and fewer than half now have school-based requirements for HPV vaccination.“

  15. New Study Says HPV Vaccine Does Not Turn Nice Girls Loose

    A new study has found that inoculating 11-year-old girls against cancer-causing strains of HPV does not inspire them to rip off the nurse’s band-aid and run off to have sex with boys. These findings seem almost too obvious to report, except for the fact that since the HPV vaccine was FDA-approved in 2006, conservatives have been airing concerns that protecting girls from sexually transmitted diseases would constitute a “license for sex,” send “a message essentially encouraging promiscuity,” and encourage pre-teens to “treat sex more loosely.”

    Not true: The study, published this month in Pediatrics, found that American girls who receive the CDC-recommended HPV vaccination at age 11 and 12 aren’t any more likely to turn up pregnant, STD-infected, or on birth control pills three years later. Now that we’ve established that, let’s address the underlying fears behind the absurd claim. Only the most conservative voices will say out loud that preventative sexual healthcare will turn our pre-teen girls “loose,” but the skepticism of the HPV vaccine is not just a fringe view. Though the CDC recommends vaccinating girls before they hit their teen years, only about a third of American teenage girls have received the full three-shot program. Financial and logistical barriers play a part, but some of the resistance stems from the idea that the HPV vaccine is a moral issue, and the government should stay out of it.

  16. Yellowknife Catholic School Board to vote on HPV vaccine

    School board banned vaccine in 2009

    The Yellowknife Catholic School Board will vote Wednesday night on whether to offer the HPV vaccine in their schools.

    Human papillomavirus is a sexually transmitted disease which has been linked to cervical cancer.

    The vaccine has been controversial among Catholic school boards in the South due to religious beliefs around sex.

  17. Vaccinating young boys is key in preventing HPV

    Michael Kennedy

    Improving vaccination rates against the human papillomavirus (HPV) in young boys is key to protecting both men and women, says new research from University of Toronto Professor Peter A. Newman from the Factor-Inwentash Faculty of Social Work.

    HPV has been linked to anal, penile and certain types of throat cancers in men. Since the virus is also responsible for various cancers in women, vaccinating boys will play a crucial role in reducing cancer rates across the sexes.

    “HPV is the single most common sexually transmitted infection,” says Newman, Canada Research Chair in Health and Social Justice. “But now a vaccine is available that can change that and help to prevent the cancers that sometimes result.”

  18. HPV vaccine acceptability among men: a systematic review and meta-analysis

    Results Of 301 identified studies, 29 were included. Across 22 studies (n=8360), weighted mean HPV vaccine acceptability=50.4 (SD 21.5) (100-point scale). Among 16 studies (n=5048) included in meta-analyses, perceived HPV vaccine benefits, anticipatory regret, partner thinks one should get vaccine and healthcare provider recommendation had medium effect sizes, and the following factors had small effect sizes on HPV vaccine acceptability: perceived HPV vaccine effectiveness, need for multiple shots, fear of needles, fear of side effects, supportive/accepting social environment, perceived risk/susceptibility to HPV, perceived HPV severity, number of lifetime sexual partners, having a current sex partner, non-receipt of hepatitis B vaccine, smoking cigarettes, history of sexually transmitted infection, HPV awareness, HPV knowledge, cost, logistical barriers, being employed and non-white ethnicity.

    Conclusions Public health campaigns that promote positive HPV vaccine attitudes and awareness about HPV risk in men, and interventions to promote healthcare provider recommendation of HPV vaccination for boys and mitigate obstacles due to cost and logistical barriers may support HPV vaccine acceptability for men. Future investigations employing rigorous designs, including intervention studies, are needed to support effective HPV vaccine promotion among men.

  20. Misconceptions leading to fewer HPV vaccinations for U.S. preteens

    …

    While nearly all doctors surveyed discuss the vaccine with at least some patients that young, more than one-third don’t strongly recommend it for those ages. They were most likely to recommend vaccination and to give the shots to older kids and girls.

    The most common reasons doctors cited for delaying HPV discussions and vaccinations included a belief that patients hadn’t had sex and that parents would object.

    Noting that about one-third of all youth have had sex by age 16, the researchers said some doctors need a clearer understanding of reasons to vaccinate preteens.

  21. HPV Sharply Reduced in Teenage Girls Following Vaccine, Study Says

    A vaccine introduced a decade ago to combat the sexually transmitted virus that causes cervical cancer has already reduced the virus’s prevalence in teenage girls by almost two-thirds, federal researchers said Monday.

    Even for women in their early 20s, a group with lower vaccination rates, the most dangerous strains of human papillomavirus, or HPV, have still been reduced by more than a third.

    “We’re seeing the impact of the vaccine as it marches down the line for age groups, and that’s incredibly exciting,” said Dr. Amy B. Middleman, the chief of adolescent medicine at the University of Oklahoma Health Sciences Center, who was not involved in the study. “A minority of females in this country have been immunized, but we’re seeing a public health impact that is quite expansive.”

    The news is likely to serve as a welcome energizer in the tumultuous struggle to encourage HPV vaccination in the United States. Despite the vaccine’s proven effectiveness, immunization rates remain low — about 40 percent of girls and 20 percent of boys between the ages of 13 and 17. That is partly because of the implicit association of the vaccine with adolescent sexual activity, rather than with its explicit purpose: cancer prevention. Only Virginia, Rhode Island and the District of Columbia require the HPV vaccine.

  22. HPV vaccines

    Your article on vaccines for the human papillomavirus (HPV), a common sexually transmitted infection, contained some minor errors (“The cost of embarrassment”, March 26th). In a fashion virtually identical to Pap smears performed on the uterine cervix, anal Pap smears are now being performed on men at risk for HPV- associated disease. The equivalent data to that derived from decades of Pap smears on women in lowering the incidence of cancer is lacking, but there is every reason to believe this will be an effective screening tool. In addition, some dental practices are now screening patients for tumours of the oral cavity.

    There has been a dramatic increase in HPV-associated oropharyngeal cancers. These cancers are more common in men but also occur in women. They occur because of sexual practices, not the sex of one’s partner. In addition it is worth pointing out that, in America at least, anal cancer is actually slightly more common in women than men, again related to sexual practices.

    ELLIOT WEISENBERG
    Pathologist
    Chicago

  33. The human papillomavirus (hpv) vaccine, first approved by America’s Food and Drug Administration in 2006, makes cervical cancer preventable. It is widely used in the rich world. Australia, where inoculation rates are 80%, may eliminate the disease as a public-health burden by 2035.

    In Japan, however, few women have had the jab. The government approved the vaccine in 2009. In 2013 it included it in its routine immunisation programme, making it free for girls aged 12-16. But just a few months after that, spurious allegations of side-effects such as paralysis and seizures led the government to drop its recommendation. Vaccination rates plummeted from some 70% of the target age-group to less than 1%. A study by Hokkaido University reckons this will cause 5,000 additional deaths among women born between 1994 and 2007. “It’s a public-health tragedy,” says Michael Reich of Harvard University.

    https://www.economist.com/asia/2022/03/17/covid-19-jabs-are-making-other-inoculations-less-contentious

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