Unpacking Gardasil’s Controversy

In my final piece for my health and science writing course, I discuss the controversy over the HPV vaccine. 

Unpacking Gardasil’s Controversy 

By Julianne Cuba

In a commercial that first aired over eight years ago, young women proudly stated that they were “one less.” By getting vaccinated, they said, you could be one less, too. Those notorious commercials seem to have run their course; but the idea those young women were advocating– Gardasil– is still prevalent, and no less controversial, today.

But not all women were entranced and coerced by the commercials to go out and get vaccinated; many, like 22-year-old Kaitlyn Eng, were turned off by the vaccine’s heavy commercialization.

“My pediatrician recommended it before I started having sex,” Eng said. “I was about 14 years old, and seeing the commercials kind of pushed me away from it. I questioned whether it was really for health reasons, or just a money maker.”

Over the past few years, controversy over the vaccine, Gardasil, has flourished: Is it safe? Will it lead to Multiple Sclerosis, paralysis, other severe adverse reactions, or even death?

Despite consensus from the scientific community that Gardasil is safe and effective, women’s health advocates and consumers still question its necessity.

Gardasil, a drug created by Merck Co., is a vaccine to protect against the Human Papillomavirus (HPV). HPV is the most common sexually transmitted infection, and nearly one in two people, both men and women, will get at least one strain of HPV in their lifetime. The CDC says that by age 50, nearly 80 percent of women will have had an HPV infection.

It is estimated that there are 14 million new cases of HPV in the United States each year, and currently, approximately 79 million people are living with an HPV infection in the United States.

HPV has over 100 different strains of infection; but there are four, which are known to be the most dangerous. Two of the strains—16 and 18— lead to about 70 percent of all cervical cancer cases, and the other two—6 and 11—lead to about 90 percent of all cases of genital warts in males and females.

The likelihood of cervical cancer, however, is far less common— .7 percent of women will be diagnosed with cervical cancer in their lifetime, and .2 percent of those cases will result in death. But, it is impossible to detect which strain of HPV one has.

Because of the confirmed association between HPV and cervical cancer, and the increasingly high numbers of HPV, nearly eight years ago, in 2006, the CDC recommended Gardasil for girls age nine to 26.

Less than five months after the FDA approved Merck’s Gardasil, in early June 2006, television programs began airing those “one less” commercials, with the hopes of getting girls vaccinated.

In the most recent study from 2013 from the National Foundation for Infectious Diseases, only 38 percent of girls will complete the three recommended doses of Gardasil, while only 14 percent of boys will—who also began getting vaccinated in 2011. For a vaccine—and right now, the only vaccine—that was created to prevent cancer, the statistics of those getting vaccinated do little to show its communal acceptance. From where does the dichotomy between doctors and patients originate?

Unlike Eng, 23-year-old Ashley Herrera’s then-pediatrician, urged her, as a child, not to get the vaccine because of its new status. But just two years ago, Herrera made the decision, with the help of her gynecologist, to get Gardasil after a routine Pap smear came back with abnormal test results.

“My doctor recommended that I get it to protect myself,” Herrera said. “You can’t identify which strain an individual has, and you can be infected by more than one strain.”

Though stated on the National Foundation for Infectious Diseases’ website that the Gardasil shot causes no more pain than any other shot, Herrera said her experience was a painful one.

“First it felt like a truck went over my arm,” Herrera said. “I could actually feel the vaccine going into my body. I’ve never felt anything like that before.”

As a Master’s of Public Health candidate at Stony Brook University, Herrera says she sees things from two different perspectives—that of a public health advocate, and as a patient.

“The reason that people are hesitant to get it is because it’s something that involves sexual activity,” Herrera said. “Parents may think that their child doesn’t need it because they’re not sexually active, but you need to be protected before you become sexually active.”

As a public health student, Herrera said that she sees the benefits in requiring vaccination, but as a patient, she said, she still believes in the freedom of choice.

In the argument over whether or not to require the Gardasil vaccine, the state of Virginia has already decided. In Virginia, Gardasil is required for all girls entering the sixth grade. The notion supporting required vaccinations is to make Gardasil a “herd vaccine,” meaning the infection could become completely eliminated if every person were to get vaccinated. Back in the late 19th to early 20th centuries, herd vaccination was used for smallpox, until it was declared eradicated by the World Health Organization (WHO) in 1980.

Dr. Mark Einstein, Gynecologic Oncologist at the Albert Einstein College of Medicine said, “with any sort of vaccine program, something as communicable as HPV, like small pox, if you are able to achieve herd vaccination, like small pox, you can potentially eradicate HPV.”

But smallpox is certainly not like HPV—one is a highly transmittable airborne infection; and the other, is a sexually transmitted infection that can only be transmitted through sexual intercourse. Unlike with smallpox, one’s presence—with an HPV infection—in a room, does not put others at risk.

Nonetheless, herd vaccinations were started in Australia—where Gardasil was first made—and U.S. doctors and scientists are now analyzing their results, contemplating herd vaccination here.

“We’ve seen glimpse of herd vaccination in Australia, where they had a very active vaccine program early on,” Dr. Einstein said. “And we’ve seen a 93% sharp decline in new genital warts in Australian women. We’ve hit a coalmine; warts have a much shorter timeline. In a very well vaccinated population, we’re already seeing results.”

The problem with Australia’s results, and with Dr. Einstein’s confidence in Gardasil’s protection against cervical cancer, is that because genital warts have a much shorter timeline, responses to the vaccine for warts, and warts alone, are clear—but not for cervical cancer. From just the results seen in Australia, it’s not certain that Gardasil will offer the same protection against the two cancer-causing strains of HPV.

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