In 2006, the FDA approved a vaccine called Gardasil, which encompassed four HPV types and was recommended to be administered to girls ages 9-26 to prevent HPV related cancers, especially cervical cancer. It was recommended to be received at an early age, since HPV was believed to have been associated as an early sexual behavioral disease, even though that had been proven to be untrue (Zimet, G.D., Rosberger, Z., Fisher, W.A., Perez, S., Stupiansky, N.W., 2013). I received the three series Gardasil vaccine at 18 years old in 2007. However, in 2014, a new variation of Gardasil, Gardasil-9 was introduced and approved to encompass males as well as females, and increased the age of recommended vaccination from 9 to 45 years old. (FDA, 2018). Gardasil-9 not only included the four HPV types, but also five more HPV types that the regular Gardasil dosage did not include. This is important on an immunological level, because in 2006 when Gardasil was only geared towards girls, Merck & Co was only recommending the vaccine for females of a small age range. However, where were girls obtaining HPV from? Mostly from sexual contact from male partners (Giuliano, et.al., 2015), who were not at the time recommended to receive the vaccine. By associating HPV as a gender based disease, males, who are just as likely to develop HPV related cancers were overlooked (Daley, et at., 2017).
More research indicated that males were also prevalent to HPV cancers, specifically anal and penile cancers, which then sparked the recommended usage of Gardasil-9 (Daley,et. al., 2017). Because there is not a normalization of the vaccine, many people, males especially, are not receiving it and do not necessarily know and understand the weighted benefits from receiving this vaccine. Though normalizing HPV as a school required vaccine is in the works, the initial stigmatization that this was a vaccine for sexually active young females had caused a misunderstanding in the populations that HPV affects, which is everyone who has sexual contact, whether hetero or homosexual. In an age where the discussion of sexual activity within our youth has been somewhat pushed under the rug, healthcare providers, parents, young adults, health centers/associations, pharmaceutical companies and schools need to get on board with understanding that though HPV is sexually transmitted, there are ways that it can be prevented, and safe measures to take regarding it's transmission.
The increase in age for Gardasil-9 has increased to 45 years old. This is instrumental in reaching not only adults who were deemed "too old" for the vaccine the first round it was administered, but it provides some potential added relief that those who seek it out in older age are protected, especially from prior sexual contact. Not only that, but older individuals are more likely to take charge of their sexuality and ways in which to protect themselves regarding sexual activity. Sex columnist Dan Savage even promotes the vaccine to his listeners on a daily basis. Though there are more health campaigns out now promoting the vaccine for all, is that enough to get the population on board in receiving this vaccine, especially since earlier campaigns cloud judgment with pushing a feminized agenda (Daley, et al., 2017)? Had healthcare providers looked at the scope of HPV related diseases instead of solely focusing on cervical cancer, the possibility to bring justice to everyone who may come into contact with HPV could have been reduced, instead of attempting just non-malfeasance within the female population.
I myself have questions regarding my original vaccine; should I get a booster given the new Gardasil-9 covers five more HPV strains from the one I received? Are primary healthcare providers up to date on the benefits of Gardasil-9 and it's implementation in the majority of the population? What are primary care providers doing in order to emphasize the importance of this vaccine? Given that discussing sexual activity is very daunting and often times embarrassing, how can healthcare providers reach their patients in a manner that the patients retain their autonomy while also being treated for the prevention of HPV? The vaccine is there - the key is now making it known to everyone 45 years old and younger that it is an aid in helping prevent the onset of HPV related diseases due to sexual contact (Lee & Garland, 2017).
Referecenes
Daley, E.M., Vamos, C.A., Thompson, E.L., Zimet, G.D., Rosberger, Z., Merrell, L., Kline, N.S. (2017). The feminization of HPV: How science, politics, economics and gender norms shaped U.S. HPV vaccine implementation. Elsevier: Papillomavirus Research. 3, 142-148. doi: https://doi.org/10.1016/j.pvr.2017.04.004
Giuliano, A., Nyitray, A.G., Kreimer, A.R., Pierce Campbell, C.M., Goodman, M.T., Sudenga, S. L., Monsonego, J., Franceschi, S. (2015). EUROGIN 2014 roadmap: Differences in human papillomavirus infection natural history, transmission and human papillomavirus-related cancer incidence by gender and anatomic site of infection. International Journal of Cancer. 136, 2752-2760. Retrieved from: https://onlinelibrary.wiley.com/doi/pdf/10.1002/ijc.29082
Lee, L-Y., Garland, S.M. (2017). Human papillomavirus vaccination: the population impact. F1000 Research. 6, 866. doi: https://doi.org/10.12688/f1000research.10691.1
U.S. Food and Drug Administration. (2018). FDA approves expanded use of Gardasil-9 to include individuals 27 through 45 years old. Silver Spring, MD. https://www.fda.gov/about-fda/contact-fda
U.S. Food and Drug Administration. (2019). Gardasil 9 FDA. Silver Spring, MD. https://www.fda.gov/vaccines-blood-biologics/vaccines/gardasil-9
Zimet, G.D., Rosberger, Z., Fisher, W.A., Perez, S., Stupiansky, N.W. (2013). Beliefs, behaviors and HPV vaccine: Correcting the myths and the misinformation. Elsevier: Preventative Medicine. 57, 414-418. https://doi.org/10.1016/j.ypmed.2013.05.013
I echo in support for the importance of vaccinating all people (regardless of their sex) against diseases for which medicine-based treatment is available. I want to make 3 points to this topic: the importance of education, a comment on primary care providers (PCP), and The Information Age.
ReplyDeleteAlthough the act is relatively straightforward, receiving an injection that would prevent against deadly diseases, the social (or religious) aspect(s) remain(s) controversial. This is why education is such an important asset for all... that an informed (or largely informed) society, with the exclusion of any outliers, would be less likely to fear/stigmatize away from life-saving treatment. Understanding that diseases can be prevented by immunizing both males and females (between certain ages) and that the benefits outweigh the risks.
Education does not necessarily have to come from school, as you mentioned it is also the responsibility of PCPs to educate patients. I have no doubt that the overwhelming majority of PCPs do provide the necessary education for their patients. Unfortunately, there is a big problem with overbooking appointments which leads to some important conversations to slip through the cracks (LaGanga & Lawrence, 2007). The time for our healthcare system is long overdue and in need of a drastic structural change; insofar as to provide more time to clinicians for more effective consultations (Tuli et al., 2010).
From an optimistic point of view, our generation and any future generations henceforth are/will be equipped with more information that ever imagined. The benefit to this is that individuals will have more access to quick searches to find answers to questions (rather than going to a library, embark on a search & find mission for a book, and find the pages of interest). Such searches may include: what is HPV?, what is Garsasil 9?, Side effects of Garsasil 9, cervical cancer causes, etc.
To conclude, I agree with you in that spreading awareness is much needed with regard to vaccinations and I am optimistic that as we immerse into The Information Age, information will be more accessible.
References:
LaGanga LR, & Lawrence SR. (2007). Clinic overbooking to improve patient access and increase provider productivity. Decision Sci, 38(2): 251-276.
Tuli SY, Thompson LA, Ryan KA, Srinivas GL, Fillipps DJ, Young CM, & Tuli SS. (2010). Improving quality and patient satisfaction in a pediatric resident continuity clinic through advanced access scheduling. J Grad Med, 2(2): 215-221.