Islanders request HPV vaccine
November 24, 2008 · Updated 4:22 PM
At Mercer Island Pediatric Associates, business is brisk when it comes to Gardasil, the new vaccine that protects against cervical cancer.
“Parents have been very receptive,” said pediatrician Dr. Danette Glassy. While the vaccine is available for girls ages 9 to 26, Glassy and her colleagues are routinely offering the immunization to girls 12 and older. “The older the child, the more commonplace it is to get the vaccine,” said Glassy. “Sometimes if she’s only 12, the parent will say, ‘Can we talk about this next time?’” But many parents are initiating the contact, calling in and setting up the appointment without being nudged by the pediatricians, said Glassy. The doctors are also seeing a lot of college students coming in when they’re home on vacation, she said.
Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States. There are over 6 million new cases a year, and 74 percent of those are among people 15-24 years old. In 2005, 20 million people in the United States had HPV.
The HPV vaccine, manufactured by the pharmaceutical company Merck under the name Gardasil, protects against four types of HPV virus. Types16 and 18 cause 70 percent of cervical cancer cases, and types 6 and 11 cause 90 percent of genital warts cases. Two out of three people who have sexual contact with someone infected with genital warts will get them; intercourse isn’t necessary. HPV often has no signs or symptoms, and is easily passed on.
According to a summary posted on the website of the Centers for Disease Control and Prevention’s (CDC), 80 percent of sexually active women have been exposed to HPV, and the magnitude of the risk association between HPV and cervical cancer is greater than that for smoking and lung cancer.
According to the Food and Drug Association (FDA), cervical cancer is the second-most common cancer in women, worldwide, with 470,000 new cases and 233,000 deaths each year. In the United States, there are an average of 9,710 new cases and 3,700 deaths annually.
The HPV vaccine was put on the fast track review process at FDA, gaining approval in only six months. Priority review is given to products with potential to provide significant health benefits. According to the FDA, Gardasil was nearly 100 percent effective during vaccine trials; side effects, such as tenderness at the site of the injection, were minimal.
The HPV vaccine, which became available in June, 2006 is comprised of three injections given over six months. At Mercer Island Pediatric Associates, each shot costs $150. “Last summer, when the vaccine was new, a lot of the insurance companies didn’t cover it. Now, almost all do,” said Glassy. And she’s hopeful that the money Gov. Christine Gregoire has put aside in her new 2007-2009 biennial budget to cover the new vaccine- approximately $22 million - will soon allow doctors to give the vaccine free to all children under 19 years old, as is the case with all other vaccines in Washington state. “I have a very positive view of our state. We have a well-oiled public health sector,” said Glassy.
Rep. Judy Clibborn (D - Mercer Island), is one of the sponsors of HB1802, which would provide education about the HPV vaccine to families of children in grades 6 and up. “It’s a brand new cancer-fighting vaccine, and I felt that putting my name on the bill gave it some credibility,” said Clibborn, a former nurse and Mercer Island City Councilwoman who has worked on health care issues in the state legislature for the last three years. “It’s a signal to other legislators that it’s a good, broad-based bill,” she said.
The bill proposes having information prepared by the state’s Department of Health distributed to parents and guardians of students in grades 6 and above in all private and public schools in the state. The information would include the disease’s causes and symptoms; where to get more information; where to get the vaccine; and recommendations regarding the vaccine.
The bill is not a mandate, and does not require schools or the health department to require the vaccine. “I’m not big on mandating things,” said Clibborn. “People respond better to being educated than mandated to.”
“Truly, the way you give a vaccine true access is to offer it for nothing,” said Glassy. “That way, no mandate is necessary.” But she acknowledges that Washington is one of only 13 states to have a system in place to provide such benefits.
In Texas, Gov. Rick Perry bypassed his state’s legislature by giving an executive order on Feb. 2 mandating the vaccine for all girls entering the 6th grade, beginning in 2008. The order has created a backlash from a variety of conservative and religious groups worried that the vaccine will encourage sexual activity in young girls.
Merck initially provided funding to Women in Government, a national association of state legislators, to push legislation for mandatory inoculation against cervical cancer. But on Feb. 20 the company suspended the lobbying effort in response to opposition from various groups, including parents’ rights groups, anti-vaccine activists, and groups suspicious of the drug company’s motives. (According to The New York Times, analysts have predicted a $5 billion a year market for HPV vaccines.) To date, only Virginia has passed legislation tying the vaccine to school attendance. About 20 other states are considering such legislation. Nationally, there are about 2 million girls who enter the 6th grade each year.
Islander Jennifer Morsello is the mother of two daughters, aged 10 and 13. “I’m totally opposed to having the government tell you what to do,” she said. Yet she feels that the controversy in Texas has been good publicity for the vaccine. When it comes to her own girls, Morsello said she wouldn’t consider having her 10-year-old vaccinated yet, but plans to talk to her pediatrician about her 13-year-old soon. “It’s a difficult question, because you want to trust that nothing will happen because it’s your kids. But you’d feel terrible if they got it and you hadn’t done anything, because the vaccine is available,” she said. Morsello said the vaccination is a big topic of discussion among her and her friends with similarly aged children, and that most of them ultimately reach the same conclusion: “Why not be safe?”
The safety provided by the vaccine isn’t the end of the story, however. The CDC recommends regular cervical cancer screening (Pap tests) for all women within three years of becoming sexually active, or at age 21, whichever comes first. All women who receive the HPV vaccine should continue to get regular Pap tests. The vaccine is not a substitute for Pap tests, and is not a treatment for cervical cancer. It is only effective when given prior to an infection. Proponents of the vaccine hope that its widespread use will eliminate socioeconomic disparities in cervical cancer, a disease most common in low-income populations who don’t tend to get regular Pap tests.
Researchers are looking into whether the vaccine could be used in boys and men as protection against anal cancer and to prevent the spreading of the HPV virus to women. The vaccine has been approved by regulators in Australia and the European Union for boys ages 9 to 15, but has not yet been approved by the FDA for that demographic in the United States, according to a recent article in The New York Times.