Author: Jacquelyn Cobb
Cochrane, a non-profit organization whose research helps individuals make informed health decisions, published a review in May 2018 claiming that the HPV vaccine helps prevent cancer and precancerous changes in the cervix with no serious side effects. The review aimed to increase public confidence in the HPV vaccine – both its efficacy in cancer prevention and its long-term safety. This publication has the potential to affect the opinions of many people regarding the HPV vaccine, possibly reassuring some parents and convincing them to choose it
for their children.
Human papillomavirus (HPV) is the most common sexually transmitted infection, affecting 79
million Americans according to the Center for Disease Control (CDC). In fact, the CDC website
states, “HPV is so common that almost every person who is sexually-active will get HPV at some time in their life if they don’t get the HPV vaccine.”
HPV usually goes away on its own, thanks to the body’s immune system. However, if it doesn’t,
the virus can cause abnormal cells to develop in the cervix. In time, these abnormalities can lead to cervical cancer. People that are infected with HPV often don’t show any symptoms but can unknowingly pass it on to others. Symptoms, when they do appear, consist of genital warts and itching.
There are currently three HPV vaccines available: Gardasil, Cervarix, and Gardasil 9. They were
approved for use by the FDA in 2006, 2007, and 2014, respectively. The vaccines, when they
first became available, were intended to be administered in three separate doses. However, in
2016 the CDC changed its official recommendation to two separate doses, rather than the
original three.
Despite the availability of these vaccines and the high risk of infection, many teenagers do not
receive an HPV vaccine. According to the most recent CDC report on the coverage of different
vaccines, only about 60% of teenagers aged 13-17 received even a single dose of the suggested
HPV vaccine, with only about 40% staying up to date on their HPV injections.
This lack of coverage can be attributed to a number of reasons. According to the CDC report that documents the barriers to HPV vaccination, “Parents often said they need more information before vaccinating their children,” and “many parents who got their children vaccinated said they did so because a doctor recommended it.” When health care providers were asked, they cited the cost of the vaccine and the parents’ concerns as reasons for low vaccination rates. Additionally, the CDC report mentioned that the vaccine is administered through more than one dose, but parents may forget or be unaware that more than one dose is required.
Many reasons for infrequent vaccination can be found under the umbrella of “parents’
concerns”. In this current atmosphere of anti-vaccine rhetoric, it is useful to understand this
sentiment that has become so prevalent.
An internationally screened documentary about the HPV vaccine, "Sacrificial Virgins,” written
and directed by Joan Shenton, is popular among members of the movement against the HPV
vaccine. The documentary claims that the HPV vaccine has caused serious neurological
problems and even death in young girls. It puts three main ideas forward to fight against the
vaccine: the claim that there is no evidence that HPV causes cancer and that therefore the
vaccine provides no real benefit; criticism of the experimental design involved in getting the
vaccines approved; and the stories of two girls who showed serious neurological problems soon after receiving their second dose of the HPV vaccine.
Some parents choose against the HPV vaccine while remaining generally pro-vaccination. Kelly
Wolfe Carlotz, a Pennsylvania woman with two daughters, said that she chose not to vaccinate
her children for HPV, but also that she is not an anti-vaccine parent. Carlotz appreciates that
many fatal diseases have been eradicated thanks to the power of vaccines. However, she says
that because the vaccine is fairly new, she is uncomfortable with the fact that there are no
statistics about the long-term effects. She also says that she has heard “horror stories” of young girls having their “health and futures ripped from them – and for what? a vaccine that may or may not prevent HPV anyway.”
For Carlotz, “it’s a little like playing Russian roulette with the good health of my girls,” she says,
“God forbid there was a bad reaction – how would I ever be able to live with myself, and would
they ever be able to forgive me?”
While many parents decide not to give their child the HPV vaccine, many do. Judi Langhan, a
New Jersey mother, gave her daughter the HPV vaccine, crediting the fact that she’s a registered nurse. She says she “really believes that the benefits far outweigh the risks.”
With all of this in mind, the recently published Cochrane review can have the power to affect the opinions of many parents. The publication was unusually comprehensive; it included 26 studies involving a total of 73,428 participants. In addition to the enormous sample size, the reputation of Cochrane as an organization lends credibility to the review.
“We do not accept commercial or conflicted funding,” Cochrane has published on its website,
“This is vital for us to generate authoritative and reliable information, working freely,
unconstrained by commercial and financial interests.”
Cochrane prides itself on being transparent and accessible, with its main goal to help everyone, regardless of financial freedom or education level, make informed health decisions. Mark Wilson, the Chief Executive Officer at Cochrane, said that they are constantly trying to “balance Cochrane's financial viability with our long-term goal of providing immediate free access to Cochrane Reviews for the whole world.” Since 2013, Cochrane has “made all Abstracts and Protocols free to access immediately upon publication.” The abstracts and protocols have information such as the background, review question, main results, and conclusion, which provide more than enough information for the general public to make health decisions, or to at least start an informed conversation with a trusted medical professional.
To help combat the lack of scientific literacy among the general public, Cochrane has “made all
Abstracts and Protocols free to access immediately upon publication, as well as Plain Language
Summaries, which describe the findings from reviews in everyday language.”
In summary, Cochrane has the unique ability to reach the general public through its reputation
for transparency and readability. Not only is the general public able to trust the reviews from
Cochrane, as it does not accept commercial or conflicted funding, but they will actually be able
to understand what the review is saying due to Cochrane’s commitment to readability as seen in their Plain Language summaries. These easily-understood summaries are not available for most scientific research articles.
This latest review allows the general public, who do not necessarily have extensive backgrounds in science, to gain a real, informed understanding of the HPV vaccine and its efficacy and risks, all from a source they can trust.
“In those vaccinated between 15 to 26 years of age, HPV vaccination reduces the risk of
precancer associated with [high-risk HPV] from 341 to 157/10,000,” the Cochrane review states,
“and any precancer from 559 to 391/10,000.”
In terms of safety, the review states, “The risk of serious adverse events is similar in either HPV
and control vaccines (placebo or vaccine against another infection than HPV).” Additionally, the review states, “HPV vaccines did not increase the risk of miscarriage or termination of
pregnancy.”
In addition to these findings supporting the vaccine, the full review addresses the concerns that
are presented by Shenton’s anti-HPV vaccine documentary. Regardless of the mechanisms of
how HPV causes cancer, this study shows with high confidence that the HPV vaccine decreases
the risk of precancer associated with high-risk HPV by more than half. Additionally, the shoddy
experimental design that is referenced in her documentary deals with the highly discussed use of aluminum adjuvants (in order to increase immune response) in vaccines, and how these
adjuvants were in both the placebo and test group of the experiments, so their effects could not be properly understood.
The Cochrane review addresses this by stating, “Occurrence of autoimmune events, possibly
associated with the use of the [aluminum] adjuvants… was assessed in a pooled analysis of
trials.” More than 68,000 records were included, among which 39,160 participants received the
HPV vaccine. The review noted that the total rate of autoimmune events that was 0.5%, and the relative risk of autoimmune events for all aluminum adjuvant vaccines was 0.98, while the
relative risk was 0.92 for the HPV vaccine alone. For reference, a relative risk value of 1 would
mean that the risk of an autoimmune event would be the same for both the placebo and the test group.
Shenton, of “Sacrificial Virgins,” was unfortunately unable to comment on these findings that
were relayed in the Cochrane review, and whether or not her opinion would be swayed.
However, a colleague of Shenton’s, Elizabeth Hart, is “extremely well versed on the Cochrane
situation,” and was referred by Shenton.
Hart, when asked if she trusted Cochrane, gave a resounding no. She has been challenging
Cochrane for the last five years about a particular review that was published regarding
aluminum and vaccine safety. She also takes issue with the fact that Cochrane has accepted
monetary support from the Bill and Melinda Gates Foundation, believing that this disrupts their
quest for unbiased reviews.
Hart believes this subject to be vastly complicated and needing of careful analysis. “I suggest we
are in the midst of an emerging international scandal regarding HPV vaccination,” she said, “I
suggest people who aren't properly educated about the subject tread very carefully and keep an open mind.”
The Cochrane review on the HPV vaccine gives everyone, of all opinions, a chance to reflect on
and to reevaluate their stance. It is an opportunity to take a look at the different evidence and
opinions that are available and make an informed choice. Cultivating an informed decision is
vital.
Sources:
http://sanevax.org/hpv-vaccine-documentary-sacrificial-virgins/
https://www.cdc.gov/std/hpv/stdfact-hpv.htm
http://www.cochrane.org/about-us/our-policies-and-positions
http://www.cochrane.org/CD009069/GYNAECA_hpv-vaccination-prevent-cancer-and-pre-
cancerous-changes-cervix
https://www.cdc.gov/hpv/parents/vaccinesafety.html
https://www.cdc.gov/vaccinesafety/vaccines/hpv-vaccine.html
https://www.cdc.gov/mmwr/volumes/66/wr/mm6633a2.htm#T1_down (National, Regional,
State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13–17 Years —
United States, 2016)