The luxury of anti-vaccinationism

There was some big news last week, that believe it or not, did not involve delusional, myopic, hypocritical bloggers on the internet.

FOR REALZ!

At the International Papillomavirus Conference, at a symposium sponsored by QIAGEN, QIAGEN announced that their super awesome HPV test was approved for use in the Third World:

... the careHPV test makes HPV DNA testing simple, effective and affordable for women in low-resource settings. The careHPV Test can be performed by a healthcare worker in a community facility without mains electricity or running water and offers HPV detection results in a matter of hours - a critical characteristic for women traveling long distances to clinics and for those women who can benefit from treatment during the same visit.

This is AWESOME!

The key to treating cervical cancer is early detection. 288,000 women die of cervical cancer every year, with ~80% of those deaths occurring in the Third World. Now we have a cheap early screening method that will be usable in these exact places! YAY!! ... But the question everyone is asking is, "So you detect it early. Then what?" Sure, weve got great treatment options here in the US for women who get 'abnormal' pap smears, but what, exactly are the options in the third world?

HPV researchers are in the same boat as us HIV-1 researchers. Great! We get a cheap, fast, easy HIV-1 test!... but we dont have enough anti-retrovirals for everyone who needs them after we diagnose them.

The trick to stopping HIV-1 is to stop new infections. Thats why Im trying to make an HIV-1 vaccine.

The trick to stopping cervical cancer is to stop new infections. HPV researchers have a kick ass vaccine. But Gardasil is even expensive here in the US-- About $120 for each of three shots. There is no way in hell an average family in Zambia can afford these shots for their daughter, even if they know these shots could one day save their daughters life.

But here in the US (and other 'rich' parts of the world), you cant spit without hitting someone anti-HPV vaccine. Age of Autism is in on it, for some reason. Here is a sad case of post hoc, ergo propter hoc. Which would be more sad if they werent exporting their views to the third world. And of course, there are all the right-wing groups against HPV vaccines, because their daughters aint no whores.

All of this without a thought for the hundreds of thousands of women around the world, dying of a preventable disease. Without any recognition that because of where they were born, and circumstances of that chance event, they have the luxury of saying 'OH NO HPV VACCINE FOR ME MATER! IM OFF TO PLAY THE GRAND PIANO! PAHDON ME WHILE I FLY MY AERO-PLANE!' No frigging clue how much those three shots mean to someone else. They cannot comprehend the emotions of someone else-- Knowing something exists that could save your or a loved ones life, something you can never have unless some company takes pity on you... while someone else is throwing it away.

Only in America, baby...

More like this

I suppose that mater thought the HPV vaccine was to common, except for on the bleedin' croquet lawn!!!!

(monty python FTW)

It needs to be noted that raising your daugther "right" nor Jesus Christ himself will stop an HPV infection resulting from rape, sex with a cheating husband who managed to get himself infected with HPV, or sex with a good Christian husband who saved himself for marriage but whose mother was a "ho" and transmitted HPV to him at the time of his birth.

The guy doesn't have to cheat. He could have picked it up before the marriage. And I don't know any straight men who have gotten tested for HPV.

Well to be honest... I was contemplating to get vaccinated against HPV. It's kind of recommended here in Germany for any girl age 12+, but it's only paid for by the insurance if you're under 18... which is to my mind kind of assuming that once your older than 18 you're obviously already infected anyway - which, even if it were true would be no real argument against a vaccination. (but insurance companies always try to not pay for the essential things... especially when it comes to vaccination - so you're older than 18? Vaccination against mumps, measels and rubella is something you need to pay yourself for, because it's not essential - like hell, do they know how bad rubella or measels might hit an adult?) So you already have say HPV Type 22 (don't remember the serotypes of the "evil" ones right now, it's just a randomly picked number :D), the vaccination will still help against all the other possibly cancerous HPV types.
My mom was asking me to look into the matter, because although I'm older than 18 (and my younger sister is as well), she said if it helps she doesn't care if it's expensive.
But then I did look into it more closely. And to be honest, I told her that until further notice I didn't want to be vaccinated (although I'm vaccinated against everything else there is :D), because the freaking side effects were a little too risky (there are reported deaths due to the HPV vaccination, I know of one in austria and I think three or so from the US and there migth be more unreported), whereas infection with the "dangerous" kinds of HPV might also be avoided using condoms.
If your partner was infected (which can be easily tested), in case you wanted children you probably had to consider artificial insemmination but apart from that you might be halfway save.
You usually don't get infected with the dangerous types of HPV from swimming in a public pool or something anyway. It's in most cases sexually transmitted (except someone got his weals - I think it's not the right word, but sry, english ain't my mother tongue) on his hands or somewhere else on his body, which is often not the case.

Plus... they always talk about vaccinating ONLY women. Which is, according to my virology prof total bs as the disease is usually spread by MEN. Women will get cervix cancer, but they get ill because the guy had HPV to begin with. So actually both genders - and maybe even primarily men - should be vaccinated.

But that's just my view on this specific matter. I'm generally pro vaccination, but as long as the HPV vaccine is not totally safe... I would be hesitant for me personally. On the other hand if there's such a high number of deaths caused by HPV and only 1 in 10000 vaccinated persons (no clue if this number is anywhere near the truth though, it's just an example) is maybe affected by severe adverse effects, the use/risk assessment is pretty clear to me.

So okay... maybe I should relativise the part about condoms avoiding infections (that was written a bit too definitive). It's not 100%, but it still will reduce the risk.

@i0nz (4): last time I checked up on the scientific literature (and granted, that was the beginning of this year), Gardasil showed no increased risk of adverse effects compared to other vaccines. No vaccine is totally safe, but like every other vaccine, Gardasil is apparently safe enough and the benefits outweighs the risks. You see, part of the problem is that Gardasil is a new vaccine that was in the news a lot! Pretty much every non-attributed death that happened to coincide with the vaccination is lumped together as a potential side effect. This is common practice when new vaccines are released to the public. However, when running over the statistics, as far as I read in the literature some time back, the deaths could not be attributed to the vaccine (except for a few cases of shock, which a really low number of people might get from any vaccine). In other words, (i) correlation does not automatically imply causation; (ii) like any vaccine, risks are present, though minimal, and; (iii) the benefits outweigh the risk (i.e. the chance of and adverse effect is way lower than the chance of you getting ill and/or even dying from the disease the vaccine is trying to prevent). See, if this wasn't the case, the vaccine would've been pulled off the market months ago.

I understand that you are worried. As a fellow human being, I too have difficulties weighing risks, but this does not prevent me from using seat belts and air-bags, even though these, too, kill several individuals on a yearly basis. This also goes for vaccines, but since it deals with our bodily integrity, we are more inclined to misjudge the risks involved.

For the rest, yes, I do believe that men should be vaccinated, too. However, this has got more to do with insurance and health care policy, because men are way less likely to suffer the consequences of HPV infections (penile cancer rates are so low, fortunately) and it therefore becomes harder to convince men, the policy makers and the insurance companies of the importance of vaccination.

"But here in the US (and other 'rich' parts of the world)"
Abbie, yes, absolutely, the same deal happened in Australia as in the USA.

And in Hong Kong, where people were saying they weren't going to get their 12 year old daughters vaccinated because they didn't want to encourage them to have sex, even though the government rolled out a program of free vaccination in schools, and all of the family doctors and clinics were trying to talk through the logic and encourage parents to get their daughters vaccinated.

Those are two places I know about first-hand.

Admittedly reactions in the USA get big airplay elsewhere and influence people's thinking (or more like unthinking knee-jerks), but we can't just blame this kind of wrong headedness on America.

"Only in America, baby..."

Nope, only in the wealthy first world, where people come to believe they deserve to be guaranteed a risk-free existence, and think they can afford the luxury of being anti-vax.

@iOnz - You get yourself vaccinated to protect yourself from being infected by someone else, just like any other vaccination; you don't leave it to them and say its them that should do it. And the risk is insignificant compared to the benefit. If you worry about that sort of risk level, then definitely you should never travel in a motor vehicle or cross the road, because the risk just isn't worth it.

By Sandgroper (not verified) on 12 Jul 2010 #permalink

@Dax
All valid arguments.

I don't have access to most of the newer publications (duh... our university is not great on journal abonnements as it seems), and in the older ones that I skimmed through I couldn't find any hints towards an increased risk of adverse side effects following usage of either Gardasil or Cervarix. And yes, the correlation of non-attributed death to the vaccination might not be due a real causality. On the other hand... one sudden unexplained adult death shortly after the vaccination: coincidence. Two?: coincidence. But according to some stuff I read on the internet shortly (okay, some of that was of these anti-vaccination people... or conspiracy theory laden) the number seems a bit high for simple coincidence. Still that might all be coincidence - as sudden heart arrest is not thaaaaat uncommon, even in young people (and I heard the risk was higher if you were an athlete or doing sports professionally) - but it makes one wonder...

From this publication I see that about 23% of vaccinated girls reported to have been experiencing adverse effect... half of these only injection site reactions. Which wouldn't worry me. I mean yeah, your arm hurts a little for a day or two or maybe a week, fine, you have bit of an inflammation around the injection site for some days, fine. But then there are also reported adverse effects like fainting and seizures... makes me wonder (and worry).

Oh and never forget that we actually don't have any info about longterm effectiveness (and what really irks me is that the control-placebo group has been vaccinated in the meantime... and yeah I know, it's ethically and morally not justifyable to not vaccinate them... but from a solely scientific point of view it's still... wrong to destroy your control group). Might be the vaccination is only effective for ten years and then you'd need a booster or something. Might be in the end it won't reduce risk of cervix cancer due to serotype selection of other high-risk HPV types. Might be in a few years they have a better working quadrivalent vaccination :D.

Ah and I almost forgot... another reason why I'm really hesitant is that's extremely expensive. I read that in the US it would be something like 375$? That's nice. Here all in all it's about 480â¬, but yeah... it's always like that (I mean, just look at the pricing for apple's products or notebooks). The fact that these vaccinations were still rushed to the mass markets despite these high prices also makes me wonder, just saying (no conspiracy theories here from my part, though).

Don't get me wrong... looking at the population as a whole, I'm all for vaccination against HPV. After all vaccination is the most powerful tool we have to battle gruesome diseases. Looking at the individual however I'm more sceptic and if I look at the media coverage and also at some of the other stuff that google digs up if you google hpv vaccination (or it's equivalent in German :D)... a lot of other people are as well.

I really don't understand people who think giving Gardasil to young girls is going to make them promiscuous. To me, it's akin to thinking people who get their Tetanus boosters are going to automatically start looking for old, rusty nails to stomp on.

And for the death of a girl in Austria supposedly linked to Gardasil - the one case I've heard of was based on the speculations of Bert Ehgartner. And I wouldn't trust him as far as I could throw him.

Feel free to correct me if I'm wrong though and there's actually a different case.

i0nz, have you done the calculations to see if coincidence is actually unlikely or just seems unlikely?

Your posts read like someone who doesn't have any good reasons to not be vaccinated, and knows she doesn't have any good reasons, but is trying to add together a lot of not-so-good reasons to justify not being vaccinated.

I really don't understand people who think giving Gardasil to young girls is going to make them promiscuous.

Seriously. "Wow, I wasn't going to have unprotected sex before, but now I'm protected against most strains of one type of STD, well just show me to the football team's dressing room!"

By theshortearedowl (not verified) on 13 Jul 2010 #permalink

i0nz: If you're giving a vaccine a time when things like sudden adult death syndrome/any of the other mysterious conditions that make apparently healthy adults and teenagers just drop dead start to manifest themselves - yeah, it'll look suspicious. The same way that *opens a can of worms* MMR vaccine and autism can *appear to be* correlated, because MMR (certainly in the UK) is/was (we're on a pentavalent/hexavalent vaccine now?) given at the same developmental stage as autistic symptoms start to appear. Never mind recent studies that found relatively more genomic rearrangements in autists compared to non-autistic controls which couldn't possibly have been caused by the vaccine...

I work with viruses (although not HIV, like Abbie) and I'm currently having to be vaccinated for a lot of things (Hep B and typhoid for starters; possibly swine flu/seasonal flu; and I have to have my measles antibody titre checked, and be re-vaccinated for that if my protection level isn't good enough). Yes, there are risks - but the risks of picking up something nasty outweigh, to my mind, an adverse reaction risk (and I have no personal or family history of these reactions). I also have - to my mind - a duty to protect those around me from these diseases as well - I might be naturally immune to these diseases, or have a mild case if I do become infected - but what about my boyfriend? My colleagues, my house mates, my family?

The sensible thing to do is look at your family history with vaccines. Do you normally react badly to vaccines? Has anyone in your family had a bad reaction? If yes to either of these - then you might want to think a little more carefully. If not... think about eg what getting mumps will do to your testicles, if you're male. Believe me, it's not pretty. Although having an infertile boyfriend is a great way to avoid unwanted pregnancy!

@iOnz - "Don't get me wrong... looking at the population as a whole, I'm all for vaccination against HPV." Right.

@Ellyn - Exactly.

By Sandgroper (not verified) on 13 Jul 2010 #permalink

I've considered getting a HPV vaccine, but after a lot of my friends were violently ill (vomiting, headaches, one actually fainted and had to go to hospital) I'm thinking I'll wait for Version 2. We had free vaccinations (Gardisil, if I remember rightly) at school as well, but my mum balked when she saw that it was an experimental vaccine and said no. While I don't normally react badly to vaccines, I'm not going to take chances with a vaccine that has only just been created and hasn't had any long-term tests conducted. I'd rather risk HPV for 6-7 years and then get the vaccine than have it now and find out 6-7 years down the track that it's stopped working, or that it does something nasty.

(Off-topic, but why the hell do they still use gigantic needles from tetanus boosters?! My left arm feels like it's been run over. I'm sure there's a less painful way of giving a tetanus vaccine.)

Hey Erv,

I managed to use the post you created on why Gardasil and some of the other vaccines that don't trigger viral countermeasures provide superior resistance. I talked a former anti-vaxer into getting her daughter the shot and she is excoriating her fellow anti-vaxers who are glamorizing "natural" resistance.

As things are going, odds are ERV prevents cancer....well at least a cancer or two.

High five!

By Prometheus (not verified) on 13 Jul 2010 #permalink

@dartigen: to answer the off-topic: Tetanus needs to be given deep into the muscle so they use gigantic needles to reach it. Unfortunately, there are very few LONG needles that are also very THIN (and the needle needs to be thick enough for the vaccine to be pushed through easily to prevent more tissue trauma)

Re: HPV vaccines: A lot of people react negatively to ANY injection, so I would wonder if your friends reacted to the HPV vaccine in specific or just to a shot? (My sister typically hyperventilated with any shot and has fainted and actually had petit mal seizures from her breathing patterns. Doesn't matter what the injection is. Perfectly plain normal saline caused the same reaction)

As far as deaths: I believe in searching the VAERS database, no death has been found to be attributed directly to the HPV vaccine. The deaths in the US have generally occurred a few weeks to months after the vaccine (except for 1 death - motor vehicle accident - that occurred as the girl drove home from the MD appointment which her father is blaming on the vaccine as she would not have had the accident except for the vaccine!)

I read the story of the girl in Australia who died within 24 hours of the vaccine and IIRC the final autopsy report actually showed a congenital cardiac malformation which would have probably killed her at a young age as it was.

Disclaimer: my daughters both elected (I stayed out of the decision making entirely and would have supported them either way) to be vaccinated with the HPV vaccine. Neither had any reactions other than mild soreness at the injection site for a day or so. If it is found that a booster is needed - like it is for many other vaccines - then they can decide whether to get that or not. However, I don't give them the option on other vaccines.

dartigen-- No joke, the HPV shots hurt. I believe thats whats causing the fainting. The one that hurt the worst was the second, because the nurse didnt warm it up enough before she stuck me. The other two I dont think were any worse than a tetanus shot.

I fainted after getting some shot of antibiotics (it felt like they were shooting molten lead into my thigh-- worst. shot. ever.) Nothing to do with the actual shot or what was in it, it just hurt like a mother fucker, LOL!

Orac pointed out on interesting dilemma in the HPV-vaccine discussion. It would be best to vaccinate both boys and girls to reduce the spread of the virus, but since HPV doesn't do much negative for boys, it violates ethic rules to have them "risk" vaccination for no (personal) benefit.
Makes me think that a totalitarian regime isn't all bad when it comes to matters of overall population health, you rarely hear about anit-vaxers in China. Alas, that's the price we pay for freedom.

I didn't want to be vaccinated (although I'm vaccinated against everything else there is :D), because the freaking side effects were a little too risky (there are reported deaths due to the HPV vaccination, I know of one in austria and I think three or so from the US and there migth be more unreported), whereas infection with the "dangerous" kinds of HPV might also be avoided using condoms.

There is an enormous amount of FUD generated regarding HPV by the antivaxx set. The "reported deaths" are from VAERS and are completely unfiltered for anything remotely like causation; they include auto accidents where the vaccinated woman was a passenger in an auto accident, one girl who died days after the vaccination from a massive slow-growing thoracic tumor, and deaths months post-vaccination from unrelated causes.

Someone has been lying to you.

Plus... they always talk about vaccinating ONLY women. Which is, according to my virology prof total bs as the disease is usually spread by MEN. Women will get cervix cancer, but they get ill because the guy had HPV to begin with. So actually both genders - and maybe even primarily men - should be vaccinated.

The reason for this is a matter of medical ethics. It's unethical to recommend that one party undergo medical treatment which does not benefit that party. It's harder to make a case for vaccination to prevent genital warts than it is to justify vaccination to prevent cervical or anal cancer, so the recommendation for females and gay males came first.

The recommendation for straight males is in the final stages now.

By D. C. Sessions (not verified) on 13 Jul 2010 #permalink

Mu@#18

"....since HPV doesn't do much negative for boys"

I maintain a rather dismal view of genital warts lesions and anal cancer but I'm dark....and broody.

By Prometheus (not verified) on 13 Jul 2010 #permalink

@daedalus2u: No I didn't calculate anything about the coincidence, because as I said I was just wondering about that and I'm sorry if that didn't come across - might be a communication/formulation problem. And yeah maybe I don't have a "real" reason to not get vaccinated except being probably irrationally worried about certain things I read on the internet or heard on the news. Actually when the existence of this vaccination was first mentioned in our virology lecture I was totally set on getting it but with the sometimes pretty negative media coverage showing up I got doubts.

@Ellyn: Yeah... the name Ehgartner was linked to that case - I didn't know he was not trustworthy.

@Charl: I know the reasons behind vaccination - I get my flu shot each year and I get the boosters for all the other stuff (mumps, measles, rubella, tetanus, diphtheria, polio, you name it...) when it's time.

On the other hand... one sudden unexplained adult death shortly after the vaccination: coincidence. Two?: coincidence. But according to some stuff I read on the internet shortly (okay, some of that was of these anti-vaccination people... or conspiracy theory laden) the number seems a bit high for simple coincidence.

The total number (including the tumor and the auto accidents) that the antivaxx crew have scrounged up at last word was ... eighteen. Out of many millions of vaccinations. The numbers are the same as background fatality rates.

By D. C. Sessions (not verified) on 13 Jul 2010 #permalink

I fainted after getting some shot of antibiotics (it felt like they were shooting molten lead into my thigh-- worst. shot. ever.) Nothing to do with the actual shot or what was in it, it just hurt like a mother fucker, LOL!

Many years ago (as in Abbie wasn't born yet) a neighbor came down with HepA and my lover and I were advised to get the immune globulin shot. Since she was working as a nurse, they checked out the shot to her and she brought it home from work after the evening shift and gave it to me.

For those who don't know, immune globulin shots have to be refrigerated, are the consistency of honey, and are nailed in deep IM. See comments about "worst shot ever."

Except ... it was at room temp by the time she got home, I was sound asleep, and she just took advantage of the conveniently-presented and totally relaxed rump. I never even woke up.

The lesson is ... it's all in the preparation.

By D. C. Sessions (not verified) on 13 Jul 2010 #permalink

I actually didn't think it hurt that much. I was really expecting it to burn, based on what other people had said, but it wasn't all that bad; better than my last tetanus for sure. Frankly, I don't consider "can't sleep on that arm that night" to be a side-effect worth reporting. I mean, that's not even necessarily the vaccine, it's just the mechanical damage of the needle.

(I can't *wait* to get my pertussis booster with my next tetanus. I'm pretty sure the one I got as a kid was in the "wears off early" category, and I really don't want to get pertussis.)

By JustaTech (not verified) on 13 Jul 2010 #permalink

With a sexually transmitted disease, protecting women would be fairly effective, I would have thought. If all women are protected then the only means of transmission would be male to male, and of course they wouldn't be passing it on to their children.

I don't remember finding tetanus shots at all painful. The only one which caused me any problems was a BCG, which led to a small ulcer. Oh: and a cortisone injection into my shoulder. That wasn't a lot of fun but it's a different kettle of fish.

Only 300k dead worldwide? Huh, I thought it was more than that.

Of course, I'm a horrible misanthrope, and I'm increasingly doubtful that we'll ever get population growth under control. I'd rather less people were born in place of real people dying horrible, painful deaths, but needs must when the Devil drives.

@D.C. Sessions #23 - What I'm surprised is that it was recommended you get immunoglobulin because your NEIGHBOR had Hepatitis A? Usually they give you this if a household member gets sick. Strange.

Now I think there is an actual Hepatitis A vaccine.

What I'm surprised is that it was recommended you get immunoglobulin because your NEIGHBOR had Hepatitis A? Usually they give you this if a household member gets sick.

Two words: dinner parties.

Now I think there is an actual Hepatitis A vaccine.

As I mentioned, it was a long time ago. IIRC Nixon was President.

By D. C. Sessions (not verified) on 13 Jul 2010 #permalink

Prometheus@20: We're having a hard enough time as it is convincing conservative people to give the vaccine to their daughters for fear that it will increase the chances they'll participate in vaginal sex.

I can't imagine the kerfuffle that would occur if you started offering it to their teenage sons with the line "This vaccine against a sexually transmitted disease will reduce your son's risk of anal cancer!"

(I'm ignoring the fact that HPV isn't 100% sexually transmitted, as that's what the hypothetical listeners would do.)

>@Ellyn: Yeah... the name Ehgartner was linked to that case - I didn't know he was not trustworthy.

That's my personal opinion of him - he's said some rather foolish things regarding vaccination and asthma (Asthma foolery is a personal berserk point of mine,) as well as the cervical cancer jab that makes me skeptical. He used to have a page on scienceblogs.de until others started to object to his writings.
--

Three years ago, when the jab was first introduced here in Australia, the main concerns we had were focused on just how quickly it was added to the government program upon getting regulatory approval. (And how unlike the then Health Minister it was to do something positive for women's health - some members of the public found this very disconcerting.) But Ian Frazer is pretty well liked and trusted around here, and I think that quelled concerns in some circles.
According to this article that popped up on my newsfeed this morning, http://tinyurl.com/25j48bh, we've started to see a drop in pre-cancerous lesions in young women since the introduction of Gardasil. It's not a high drop, but it's significant when you consider we've had the cervical cancer jab program running for only three years.

Imagine all the saved lives and uteruses(uterii?) Yay science!

Ellyn - "unlike the then Health Minister"

That wouldn't have been the Mad Monk, would it? I was living overseas at the time, but it sounds like his style.

By Sandgroper (not verified) on 14 Jul 2010 #permalink

^^^Certainly was.

It figures - good old Wingnut Tony.

http://www.the-peak.ca/article/17404

"Religion, for instance, has been a huge contributing factor in vaccine avoidance. Christian churches have been speaking against the HPV vaccine, which can prevent cervical cancer, because they think cervical tumors are a great deterrent to teenage sex."

By Sandgroper (not verified) on 14 Jul 2010 #permalink

Vaccination is an organised criminal enterprise disguised as disease prevention.

By Erwin Alber (not verified) on 20 Jul 2010 #permalink

Erwin Abler, spokesperson for the Society for the preservation of Smallpox.

The recommendation for straight males is in the final stages now.

I heard about this and plan to get it. Anyone know if it's available now for straight males or will doctors not do it until the recommendation goes through?

By Kemanorel (not verified) on 21 Jul 2010 #permalink

"Vaccination is an organised criminal enterprise disguised as disease prevention."

For it to be criminal it has to be illegal. Is it? ... *crickets* ...

No, I guess.

I0nz it was never disputed that hpv affects men as well, just that infection has more concerning consequences for females and so they are a priority. Rubella vaccination was initially only given to females due to the risk of infection during pregnancy