Should Your Daughter Receive the HPV Vaccine?

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Some General Background. On June 8th, 2006, the Food and Drug Administration (FDA), after an expedited approval process, licensed the pharmaceutical company Merck to sell Gardasil. Gardasil was an amazing breakthrough, a vaccine against four types of human papillomavirus (HPV) for use in girls and women between the ages of 9 and 26. It promised 90 percent effectiveness against two types of viruses that cause 70 percent of all cervical cancers as well as protection against two other viruses known to cause genital warts. Gardasil was, in effect, the first anti-cancer vaccine.

The excitement over Gardasil was almost palpable, yet parents had reservations. Despite Merck’s extensive ad campaign, convincing parents to do the “right thing” for their daughters proved harder than expected. Policymakers were baffled. Why were so many people hesitant to give their children this remarkable new vaccine?

In less than 12 months, more than two dozen states considered mandating HPV vaccination. As of September 2008, only Virginia and the District of Columbia require inoculation for school enrollment, but other states are still considering the policy. In addition, 22 states have instituted public health education programs or financial programs to encourage HPV vaccination.

Just last week, the FDA added the prevention of vulvar and vaginal cancers to the list of potential benefits for Gardasil. This conclusion was based on data from 15,000 women who participated in Merck’s earlier cervical cancer studies. Of the women who were vaccinated with Gardasil, none developed precancerous cells in the vagina or vulva, compared to 10 who received a placebo vaccine and did develop precancerous cells.

The Prevalence of HPV and the Threat It Poses. Cervical cancer is the world's second–deadliest cancer for women, but only because women in developing countries don't have easy access to regular Pap tests. Eighty–three percent of the world's new cases and 85 percent of cervical–cancer deaths occur in developing countries.

The Journal of the American Medical Association reports that among U.S. women aged 14 to 24, the combined rate of infection for all 37 types of sexually transmitted HPV is 33.8 percent -- much lower than the 50 percent cited on Merck's website. More importantly, the rate of infection for HPV 16 and 18 -- the two types of cancer-causing HPV against which Gardasil protects -- are astronomically lower: only 1.5 percent and 0.8 percent, respectively. So even if every U.S. woman between 14 and 24 were vaccinated with Gardasil before being exposed to HPV, the vaccine would only protect 2.3 percent of all U.S. women or around 1 percent of the U.S. population.

Most HPV infections, including the carcinogenic ones, resolve themselves without treatment. The American Cancer Society’s HPV guidelines for physicians explain that approximately 75 percent of all types of HPV infections in adults and 90 percent of those in adolescents disappear on their own. (In my early 40s, I had an HPV infection that turned precancerous, but over a two-year period the infection resolved itself without any treatment whatsoever.)