Don’t let vaccination controversy impede progress, expert says

Earlier this year, following a debate among candidates seeking the Republican nomination for president of the United States, Rep. Michele Bachmann, R- Minn., blurted out on national television that she thought the vaccine used to ward off cancer-causing human papillomavirus posed a physical threat to the pre-teen girls for whom it is intended.

Her comments then, and since then, have drawn widespread criticism from the medical community, which sees the vaccine, GARDASIL®, as a paradigm-changer in occurrences of cervical, anal, penile and oropharyngeal cancers.

Anna Giuliano, PhD, an international authority on HPV, has come up against this sort of  misinformation before, and the result usually is not good. “In general, whenever there is media attention (about the vaccine), it is negative. It often is false reporting about an adverse event that has very little validity. Afterward, we actually see a decline in vaccine rates,” she said.

But this time, Giuliano thinks the backlash against Bachmann’s comments may be helpful. “In this setting, (Bachmann’s comments) are so stupid and so bizarre, it may have a positive effect” in raising awareness about the HPV epidemic, she said.

Giuliano is chairwoman of the Department of Cancer Epidemiology at Moffitt Cancer Center in Tampa. In that capacity she has secured tens of millions of dollars in grants,

including $10-million from the National Institutes of Health to study males’ roles in the spread of HPV. It is the largest sum ever granted to a cancer control and prevention researcher at Moffitt.

Giuliano would like to see the debate about HPV shift from political rhetoric to public education. Just as former U.S. Surgeon General C. Everett Koop “brought it home to Americans that we needed to stop smoking, we need to solidify in Americans’ minds that there is a vaccine available to prevent multiple cancers,” Giuliano said.

Such an educational campaign would need to be launched within the “context of vaccines in general,” she said. “Americans are so far removed from infections that cause disease that we think we are no longer susceptible. In fact, our overall rate of complete vaccinations for childhood immunizations is lower than many other countries. ... We get a push-back from Americans (who say) ‘I won’t get that because I live in America,” said Giuliano. “We cannot let down our guard. We live in a global society, which is all the more reason to be vigilant about vaccinations, in general.”

And physicians should be at the head of the class for that education, Giuliano said. “Most physicians don’t even know that HPV causes cancer in men, too. (Physicians) are the starting point of an education campaign,” she said.

The inclusion of boys in the Centers for Disease Control’s recommendation for the HPV vaccine is a huge step forward in dispelling the myths about the spread of HPV, Giuliano said. Most people thought “men were the evildoers, that they carry the infection and transmit it, but never develop the disease. That is just rubbish,” she said, adding that her 12-year-old son has been vaccinated.

Five years ago, “most women didn’t understand that HPV causes cervical cancer,” Giuliano said. Merck, the pharmaceutical maker of GARDASIL®, launched its “I’m going to be one less” advertising campaign, “and it did pretty well with cervical cancer education,” she said. “But when people started saying it causes cancer in men, the problem was so tied to female cancer that the very thought it could cause cancer in men was beyond anyone’s belief.”

Giuliano said “Our first hurdle is that HPV is asymptomatic in both sexes and, as the most common sexually transmitted infection, it is equal opportunity. It’s not gonorrhea or syphilis, where you have a core sexual group” with which you can identify it. There are more than 100 types of the HPV virus, Giuliano said. “It is an infection where everyone, at some point, is exposed and most are infected. In the course of their lives, 80 percent of people will have been infected with one or more types of HPV,” she said.

Marnique Jones, MD, an OB/GYN surgeon at Women’s Care in Orlando, is on the front lines of women’s healthcare, and she wholly endorses vaccination against HPV. “When you consider that 75-80 percent of the population has this virus, and we know that the majority of cervical cancer comes from it, if we can get rid of the virus we should be able to get rid of the majority of cervical cancer,” said Jones.

“We have been vaccinating for hepatitis for years, and it is a sexually transmitted disease, so this is no different,” she said. Unfortunately, Jones said, when people hear about HPV, “they think sex ... and they forget we are trying to prevent or eradicate cervical cancer, the same way we did polio and other diseases. They sort of lose the big picture. ... We have a great chance at knocking out a cancer,” especially if boys are vaccinated, Jones said.

Should politics or religion have any role in defining health policy? Giuliano stops short of making HPV vaccination mandatory. “That’s the whole hoopla with Rick Perry,” the governor of Texas who was Bachmann’s primary target in this controversy, because he supported it as a school-entry requirement for eligible girls. “In terms of politics he made a mistake. The American public was not ready to have a brand new vaccine legislated to them. It was really bad timing. But the policy itself is very sound in terms of the mechanism we need to ensure broad dissemination of the vaccine,” said Giuliano.

“I have a philosophy that I don’t want to make people do something they don’t want to do. ... If I could do anything it would be to change the way people think about vaccines in general, and specifically about the HPV vaccine. If we can accomplish that, I think many of the health policy issues we face will be easier to face implement. ... We need the public to support it without shoving it down their throats.”

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