The HPV Vaccine Is Safe. Why Do Health Experts Still Have to Remind Us of That Fact?

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This week in health news, two new studies published in the journal Pediatrics confirmed that there are no health risks associated with the human papillomavirus (HPV) vaccine. This might sound like a bit of déjà vu, because the medical community has been saying this since the first HPV vaccine, Gardasil, was FDA-approved in 2006. Not only have 12 years of data proven it safe, experts say, but it significantly reduces a person's risk of developing cervical, throat, mouth, and anal cancers, the majority of which are caused by the HPV virus. The World Health Organization even believes that if enough people are vaccinated against HPV, cervical cancer could be eliminated altogether.

Clearly, there are (and have always been) many reasons to opt in to this vaccine, all of which outweigh its risk of minor side-effects. So why do health experts need to keep convincing us of this fact?

One part of the answer is purely practical. A new version of the Gardasil vaccine, called Gardasil 9, was approved by the FDA in 2014, and experts have continued monitoring it for safety since then. The results of their analysis were published in the Pediatrics studies on November 18.

"The original Gardasil vaccine protected against four types of HPV viruses that cause certain cancers in women and men. Gardasil 9 protects against the first four, plus five additional cancer-causing HPV viruses—nine total," says Tom Shimabukuro, MD, MPH, MBA, deputy director of the CDC’s Immunization Safety Office and an author of one of the studies. Given that this  is a new vaccine formulation, he adds, the CDC and FDA closely analyzed its safety data during the years following its FDA approval to make sure that any rare side effects are sussed out immediately.

One study looked at safety data from nearly 839,000 vaccine doses given from 2015-2017, and it found no evidence of new or unusual safety concerns. The other covered a three-year period and nearly 28 million vaccine doses, out of which just 7,200 people experienced side effects. The majority of these reactions (97 percent) were minor—headaches, dizziness, and fainting, to name a few. "Data obtained during this post-licensure safety monitoring overwhelmingly support the safety of Gardasil 9," says Dr. Shimabukuro. It's just as safe as the routine vaccines for influenza, pneumococcal disease, and hepatitis B, adds H. Hunter Handsfield, MD, professor emeritus of medicine, Center for AIDS and STD, University of Washington. "The HPV vaccine is just about the most effective vaccine ever developed, for any indication," he says. "I am unaware of any others that can legitimately claim virtually 100 percent protection.”

"The HPV vaccine is just about the most effective vaccine ever developed, for any indication. I am unaware of any others that can legitimately claim virtually 100 percent protection.” —H. Hunter Handsfield, MD

However, a stigma still lingers—which is keeping people from getting vaccinated as they should. CDC data shows that only about half of adolescents were up-to-date on the vaccine in 2017 (the most recent year data is available). Among parents of girls who declined the vaccine, 22 percent cited safety as their main concern, while 20 percent believed it's unnecessary.

"There is, in general, an increased resistance to vaccination," says Ana G. Cepin, MD, Assistant Professor of Obstetrics and Gynecology and Medical Director of the Family Planning Clinic Division of Family Planning & Preventive Services, Columbia University Irving Medical Center/NY-Presbyterian Hospital. Indeed, a recent study of CDC data showed that overall childhood vaccination rates dropped in 27 US states between 2009 and 2018, in some cases by over 6 percent. The CDC says that lack of insurance or healthcare access among low-income families is partially to blame, but the anti-vaccination movement likely also plays a role.

This is also a vaccine that prevents a sexually transmitted disease, which makes many parents of pre-teens and teens—the age at which doctors say it's ideal to be vaccinated—wary of choosing it for their kids. "There’s been a misconception that if you vaccinate children against HPV, people think they’re going to start becoming sexually active," says gynecologic oncologist Sharyn Lewin, MD, FACS, FACOG. "But really, the two things don’t have anything to do with each other." Several studies have, in fact, shown that the HPV vaccine is not linked with an increase in sexual risk behaviors, but some experts believe that more research needs to be done before this can be stated as fact.

Even doctors themselves don't consistently recommend the HPV vaccine to all of their patients. A 2017 review showed that clinicians were more likely to suggest the HPV vaccine to parents of girls than boys and to older versus younger adolescents—and that their own knowledge and beliefs about the vaccine often varied widely.

Regardless, many medical providers agree that everyone who's eligible for the HPV vaccine should get it—which for the record, is anyone between the ages of 9 and 45. "We have an opportunity to protect people from developing certain types of cancers and many are not taking advantage of this,” says Dr. Cepin.

"Unfortunately, it’s been one of the slower vaccines to uptake in the country," says Dr. Lewin. "The HPV vaccine may not benefit my patients with cancer and [cervical] dysplasia, but I tell them 'Please, vaccinate your children so they don’t have to go through the same heartache that you’ve had to go through.'" Given that cervical cancer alone is expected to claim the lives of nearly 500,000 people per year by 2040, it's easy to see why docs want you to think twice before writing the vaccine off.

Did you know the HPV vaccine is now approved for those up to age 45? If you're dealing with HPV right now (like 80 percent of the population will at some point), here's how to ensure your partners stay protected

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