By Stephanie Ivanick
The most common, most detrimental, and most highly undetected STD is the human papillomavirus (HPV), which infects 6.2 million women per year and may culminate in hysterectomy, chemotherapy, cervical cancer, infertility, and death (Cox 1). In order to eradicate HPV and decrease the number of cases per year, Merck Pharmaceutical Corp. has developed Gardasil, a vaccine that prevents four of the most common strains of HPV. Individuals in the medical and governmental realms applaud Merck for taking the first step in eliminating one of the most devastating STDs and establishing the first preventative measure against cancer. Because Gardasil is fairly new to the pharmaceutical market, many consumers are skeptical about following recommendations from the Center for Disease Control and Preventative Advisory Committee on Immunizations to allow their eleven to twelve year old daughters receive the vaccination. However, health experts, researchers, and survivors unanimously agree that it is not worth taking the gamble of contracting HPV with the availability of Gardasil. Although Gardasil remains the most expensive vaccine on the market, with a price tag of three hundred and sixty dollars, lawmakers are trying to work with health insurances, government agencies, and Merck to make Gardasil affordable for all. While lawmakers and parents debate over who decides to allow young girls to receive the Gardasil vaccine, one thing remains indisputable: the benefits of Gardasil heavily outweigh the risks.
The human papillomavirus (HPV) is a viral infection that attacks the outermost layer of cells of the cervix. Many times the body is able to naturally fight off the virus, but unfortunately not every woman is that lucky. The women who cannot naturally fight off the virus will eventually develop advance stages of HPV such as cervical cancer or genital warts. Such stages consist of the virus cells multiplying and dividing the healthy outermost cervical cells, thus creating lesions. The deciphering factor between high and low-grade cases is the amount of abnormal cells versus normal cells. High-risk cases consist of a high volume of abnormal cells which breakthrough the outermost layer of the cervix. Many times the high-risk cases will result in cervical cancer (Cox 3). Low-grade cases contain fewer abnormal cells, which only infect the outermost layer of the cervix. Many times these lesions will form genital warts. While women of all ages remain at risk, younger women have a higher risk of contracting HPV at both a low or high-risk stage. During puberty, the chemical and hormonal composition in young women changes significantly, causing the cervix to become more vulnerable to infection. With a weakened immune system, the normal cells are less able to fight off the abnormal replicating HPV cells. Thus, it is not surprising that when researchers compiled test results from various universities across the United States, they discovered that 90% of college-aged girls tested positive for HPV in 2005 (Cox 3).
Youthfulness is not the key factor in contracting HPV, but rather the strength of an individual’s immune system. A healthy immune system can easily fight off HPV, but a weak immune system struggles to win the battle. Certain things can further strengthen or weaken the immune system, such as increased sex partners. Each new sex partner brings along an increased risk of contracting something new that may attack one’s immune system. An uncircumcised male has a higher likelihood of passing an STD because the foreskin is a breeding place for germs, bacteria, and infection (Cox 2). Contact with or having HIV or previous encounters with herpes, chlamydia, or genital warts increases your chance of developing a high or low-risk state of HPV because these viruses weaken your immune system and also leave your cervix vulnerable (Cox 2). Other factors that have been associated with contracting HPV are smoking and oral contraceptives (Cox 2).
An insufficient immune system may be the primary cause for contracting HPV, but the lack of sufficient testing and harsh treatments are essentially what makes HPV a dreaded virus and silent killer. Many women are under the false assumption that Pap smears are able to detect every STD including HPV, but the reality is that the Pap test will detect [HPV] 50 percent to 80 percent of the time (Pollack 2). Many cases go undetected for long periods of time because it can take up to ten years for the cells to form lesions that the Pap smear can detect (Pollack 2). Usually when these lesions form the virus has already reached a high-risk stage and cervical cancer is present. A recent study by Dr. George Sawaya, University of San Francisco’s associate professor of obstetrics, gynecology and reproductive sciences, found that 2,500 to 3,000 cervical cancer cases in the United States each year are in women with normal Pap tests (Pollack 3). Additionally, the National Cancer Institute states, 32 percent [of cervical cancer patients] had one or more normal Pap tests in the past three years before their diagnosis (Pollack 2). These numbers are shocking, and it is unfortunate that some women continue to believe that the Pap test is 100% accurate. Often times it takes some sort of first hand experience to believe what some may think is unbelievable.
Shaney Osborn, a 32-year-old woman, is an HPV survivor. While going to medical school in Mexico she received regular Pap tests. All of her results came back negative. Upon moving to New York, Shaney found herself with a new gynecologist who asked her if she had ever had an HPV test. What her gynecologist was referring to is the HPV genetic test, which looks for the DNA of thirteen of the cancer-causing strains of HPV (Pollack 3). The DNA test can detect up to 90 percent of precancerous lesions. The high success of the test has caused many doctors and scientists to suggest its use as the primary testing method. Unfortunately, some believe that the HPV genetics test, costing $50 to $100 per test, is not cost efficient in comparison to the $20 Pap test. Also, the precise results do not take into account the body’s natural ability to fight the infected cells, thus producing positive results where no disease is present (Pollack 3). Shaney’s results from the genetic HPV test came back positive. Immediately her gynecologist took a biopsy. Shaney had a very high-risk case of HPV, and was on the brink of cervical cancer. Her cells were weak and the bad were multiplying at a rapid rate. First the gynecologist tried burning cells off her cervix. This very painful procedure was unfortunately not successful. Her end result was the partial removal of her cervix. Shaney says it [was] the most painful thing [she] has every gone through, and if one can they should avoid contracting HPV at all expense. The scariest thought is that if she had not switched to a doctor who regularly administered the HPV genetics test she may never have discovered she had the virus.
Shaney’s experience reflects that the treatments for HPV are brutal. They rip apart one of the most sensitive parts of the female body. A biopsy involves removal of part of the cervix’s tissue for testing purposes. The burning of the cells occurs while a woman is asleep and numb, but upon awaking she is sore, her cervix is inflamed, and painkillers are essential. Partial removal of the cervix or a hysterectomy only occurs in very high-risk situations. These surgeries require the removal of the cervix, uterus, and ovaries, which results in infertility, one of the most devastating things that can happen to women. A hysterectomy is very painful and will leave a woman on bed rest for up to a month. The ultimate upset for most women is when they discover they have cervical cancer. The treatment for cervical cancer is extensive and can involve radiation and chemotherapy. These treatments weaken the immune system, and may cause brittle bones, hair loss, loss of appetite, nausea, and fatigue. In some cases women may undergo chemotherapy, and later have a hysterectomy. Unfortunately, extreme cases of cervical cancer may also lead to death.
HPV is a silent disease that can be lethal. Treatments are intense, and testing is lacking. The direct correlation between increased sexual activity amongst the youth and the rise in the number of HPV cases per year leads one to believe that if individuals are not choosing to abstain from sexual intercourse than another alternative is necessary.
On June 8, 2006, that alternative was made publicly known when the Food and Drug Administration (FDA) approved Merck Pharmaceutical Corp. for Gardasil. Gardasil is a vaccine composed of a series of three injections which, as mentioned earlier, prevents four of the most common strains of HPV, strains 16, 18, 6, and 11. Clinical trials display a 100% success rate amongst the sample of women and girls ages 9 to 52 whom were tested, administered the vaccine, and observed (Merck & Co 2). Like most other vaccines, each of the three Gardasil injections contain just enough of the virus for the body’s immune system to build up immunity to the targeted HPV strains. Strains 16 and 18 are responsible for 70% of cervical cancer cases and strains 6 and 11 are responsible for 90% of genital warts (Wilson 859). Eradicating these four strains will significantly decrease the cases of cervical cancer and HPV, eventually making the virus non-existent such as with polio.
The vaccine is a major breakthrough in the fight against cancer and huge leap forward in preventative care, but a cloud of controversy surrounds Gardasil and lawmakers. Gardasil carries the largest price tag of any vaccine on the market at $360 for the series of three shots (Perry 2). Many health insurance companies are not offering coverage due to the high price tag, and individuals are not willing to pay out of pocket. Currently insurance companies spend billions on testing and treatment. According to Thomas Cox in the Journal of Family Practices, health insurance companies spend approximately 2.3 billion dollars per year on Pap tests, 200 million per year on genital wart treatment, and 4.6 billion per year on treatment for abnormal Pap tests (5). Preventative measures would mean that health insurance companies would eliminate the billions of dollars spent in treatment, thus only benefiting themselves. Insurance companies need to shift their ideology from treatable cures such as chemotherapy to preventative measures such as Gardasil. Additionally, the United States government and Merck are aware of the high price of the vaccine and the inability for the poor to afford it. In response Merck is lobbying to have Gardasil added to the Federal Vaccines for Kids program, which provides free shots for an estimated 40 percent of U.S. children and is aimed at children in Medicaid, American Indian, and Alaska Native born children (Arias 2). With the help of Capitol Hill and state governments, the distribution of Gardasil will increase dramatically, and the price will no longer be an issue.
The Center for Disease and Control (CDC) established a crucial guideline suggesting that all girls ages 11 to 12 receive the Gardasil vaccine (Arias 1). Many individuals are more trusting in the CDC, whose committees are composed of highly esteemed health experts than Merck officials, thus increasing distribution. Merck’s target age for Gardasil is 9 to 26, but the CDC is quick to point out that in order to be effective girls must be vaccinated before they partake in sexual activity. Unfortunately it is not rare to hear of a 12 or 13 year old having sex thus, 11 to 12 is a practical age. James Wagoner, president of Advocates for Youth, supports the CDC’s decision and states the goal should be to get this vaccine to the largest number of people at the most effective time (Arias 1). Now the question remains whether the state or parents shall decide if their daughters ages 11 to 12 should receive the vaccine or not.
Both parents and the state governments hold strong arguments as to why they should make the decision. Some parents believe Gardasil promotes sexual activity and infringes on the moral ideal of abstinence before marriage (Hendricks 2). They tend to believe that the morals they instill in their children will remain with them throughout their lives. Many parents find themselves in denial that there is a chance their child is partaking in sexual activity at an early age, but evaluating the situation in a realistic manner is essential. Pre-teens are just as curious about sex as teenagers are, and therefore proper precautions should be taken.
Unlike parents, state governments believe that mandating girls between the ages of 11 and 12 to receive the shot will allow the best opportunity to control a preventable disease, and will not lead to an increase in sexual activity (Hendricks 2). Sixteen states are currently processing legislation that would require girls age 11 to 12 to receive the Gardasil vaccine. Amongst these sixteen states, Texas Governor Rick Perry was the first to sign an executive order mandating all girls entering sixth grade and between the recommended ages receive the vaccine. Governor Perry stated in a press conference that requiring young girls to get vaccinated before they come into contact with HPV is responsible health and fiscal policy that has the potential to significantly reduce cases of cervical cancer and mitigate future medical costs (Blumenthal 2). Governor Perry also allotted money from the Texas budget to cover the vaccine, directly attacking the steep price tag of the vaccine. If any parent objects to the vaccine for medical, religious or personal reasons then his or her daughter will receive an exemption (Hendricks 1). Texas contains the second largest number of HPV cases in United States, and Perry’s decision can do nothing but help safeguard his state’s citizens from cervical cancer.
Texas paves the way for other states to follow, but many parents have responded to Perry’s law with doubts and angst. While some parents are apprehensive of increased promiscuity, others are concerned with the fact that HPV is not contagious in a conventional sense. Past school mandated vaccinations have occurred because the classroom is considered an incubator for germs and disease. In order to protect children from airborne viruses and germs that lurk in the classroom, a child must receive a vaccine. These vaccines brought comfort to parents knowing that their children would not contract diseases such as polio or the measles. The Gardasil vaccine is different because HPV is not caught due to airborne germs, but rather through sexual intercourse – something that should not occur in the classroom. Parents believe a state mandate for such a vaccine is unjustifiable, and they will continue to challenge the states authority to make the final decision (Hendricks 2-3).
No one wants to see his or her twenty-year-old daughter, friend, or family member dying from cervical cancer, especially when it could have been prevented by a simple vaccination. The predominance of HPV amongst college-aged girls is overwhelming and scary. HPV is a silent killer that should not exist, given the availability and efficacy of preventative measures that Gardasil provides. Given the ability of Gardasil to prevent the enormous negative effects of HPV, trying to shun Gardasil as a catalyst for sexual intercourse is not only naive but actively promoting the future suffering of those at highest risk (is this too over the top?). Regardless of whether parents or state governments make the ultimate decision, every girl age 11 to 12 should receive the Gardasil vaccination. Gardasil is not an option, but a necessity.
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