vaccine

Last week, the NYT reported “Merck: Studies Boost Gardasil for New Uses“; this week the CDC’s Advisory Committee on Immunization Practices (ACIP) met to discuss these new results. It will be interesting to see what, if any, changes result from new clinical evidence that (1) the vaccine is effective in preventing anal precancers in males and (2) the vaccine is effective in women 27-45 years old.

Those who’ve followed HPV research for the past decade were not surprised by the findings of either study. What has surprised me is how little attention ‘male’ Gardasil has attracted since receiving FDA approval last October. Writing a feature article for the Winter 2010 Ms. magazine gave me the opportunity to more deeply explore this topic and hopefully raise awareness — not only about Gardasil, a.k.a. the “cervical cancer” vaccine, but also about the full range of male HPV-related cancers that it might also prevent. 

So, this month’s column is inspired by my desire to respond to some of the interesting questions, comments and accusations that I’ve received via the blogosphere (like WashingtonCityPaper and HugoSchwyzer) in these first days following the publication of my article. I’ll start by acknowledging that my article’s title seems to have pushed more than a few buttons: apparently not everyone wants to know “Why Men’s Health is a Feminist Issue.” One comment asked “Why does the burden for sexual health need to fall, yet again, to women?” My response: It’s a burden for only girls/women to be responsible for sexual health, so prioritizing equal access to STI/STD vaccines results in a more fair sharing of this ‘burden.’ From the opposite side, a comment criticized this angle as being self-interested: “…when feminists speak of male health issues, it is usually in the context of the way they affect women.” To that, I reply: if you read the full article, you’ll see that boys/men have plenty of reasons to care about having access to this vaccine that have to do with protecting their own health, regardless of whether or not they ever have a female sexual partner.

This leads to another trend in responses: What’s in it for men?  Or, as one comment put it, “The only reason for males to get the vaccine would be to prevent HPV in women.” Really? How about the variety of serious HPV-related male cancers (oral, penile, anal, and others) that are (1) on the rise, (2) often fatal due to lack of accurate testing/screening, and (3) in the U.S. likely result in more combined deaths in men than cervical cancers in women? (See my Ms. article for an overview of these stat’s or, if you love charts check out p. 4 of the American Cancer Society’s 2009 report).

And, media coverage of Gardasil would not be complete without questions/concerns focused on whether or not Gardasil does more harm than good. For the record: I have not taken a pro-vaccine or anti-vaccine stance on Gardasil or any other vaccine. But, I speak in favor of equal access to vaccines, support the conducting and media coverage of medical studies that reveal the full range of potential health costs and health benefits of any vaccine,  and argue for funding public health campaigns about HPV and other sexually transmitted epidemics. And, though some blog comments reveal confusion over the possibility of being “required” to get the Gardasil vaccine, I’m not aware of any current U.S. vaccination policy that does not allow for ‘opting out.’ (Note: as of December 14, 2009 Gardasil was no longer required for female green card applicants.)

A less popular theme, though one that intrigues me, came from those who took the angle of “What’s in it for big pharma?” One comment hypothesized, “…you can’t help but suspect Merck’s money motive is playing a role in the push for expansion to men.”  And, I reply, what PUSH? If money was their motive, then wouldn’t they have updated the Gardasil.com website to encourage male consumers? Visit that site prior to March 1, and you’d think that it was still only approved for girls/women.

I’ll end this post by expressing my thanks to all of the journalists and blog authors who are raising awareness about this topic, including Ms.‘s own Executive Editor Katherine Spillar on the Huffington Post. I also send out my gratitude to blog readers who add insightful, thoughtful, sociological, and truly feminist comments like Annie‘s. In my opinion, to be feminist is not to be pro-women, it is to be pro-equality and pro-justice (not to mention anti-sexism, anti-racism, anti-homophobia, anti-ageism…you get my drift). I don’t know if the pro- and anti-vaccine folks will ever see eye to eye, but there’s absolutely nothing to lose and everything to gain by being pro-HPV-education.

Some would say this has been true since 2006, when the FDA approved Gardasil for exclusive use in girls/women, and finally the FDA agrees. Last week Merck received FDA approval for Gardasil to be used as a genital warts vaccine in boys/men (ages 9 to 26 years old). However, yesterday, the CDC Advisory Committee on Immunization Practices voted for only “permisive” use in boys, rather than voting for the stronger recommendation of “routine use,” as they had for Gardasil’s use in girls/women.

As reported in Bloomberg.com, this decision had been predicted by some experts:

William Schaffner, chairman of the department of preventive medicine at Vanderbilt University in Nashville, Tennessee, said the panel will be asking itself “if we vaccinate all the girls, how much additional benefit will we get by vaccinating the boys?”

The Atlanta Journal-Constitution cited a similar argument from a different expert:

Debbie Saslow, director of breast and gynecologic cancer at the American Cancer Society, agreed with the findings. “If we can vaccinate a high enough proportion of young girls, then vaccinating boys is not cost-effective,” she said.

This line of reasoning and the ACIP’s conclusion are problematic on two levels. First, there seems to be a privileging of female health over male health. There are compelling reasons “ other than the prevention of cervical cancer” for the ACIP to recommend “routine use” of a safe and effective male HPV vaccine. Second, there seems to be a heterosexist assumption in the ACIP’s decisions — that all boys/men are sexually attracted to (and sexually active with) girls/women and vice versa.

Maggie Fox of Reuters offered a more complete assessment in her article published yesterday:

The main reason the vaccine was approved was to prevent cervical cancer, which kills 4,000 women a year in the United States alone. But various strains of HPV also cause disfiguring genital warts, anal and penile cancers and head and neck cancers. “We know that the later the cancer is discovered, the lower the chance of survival is,” David Hastings of the Oral Cancer Foundation told the committee, asking for a recommendation to add the vaccine to the standard schedule for boys. However, ACIP decided only to consider its use based on its ability to prevent genital warts.

Did the ACIP adequately factor in the clinically proven causal links between certain strains of HPV and potentially life-threatening oral cancers — which do not discriminate on the basis of sex? This seems important, particularly if, “The death rate for oral cancer is higher than that of cancers which we hear about routinely such as cervical cancer” (Oral Cancer Facts)?

A recent New York Times article reports that the committee will “take up the issue of the vaccine’s effectiveness in preventing HPV-related male cancers at its next session in February, when more data should be available.”  But data has been available since 2007, when results of clinical studies were reported and the Oral Cancer Foundation issued a press release urging male HPV vaccination?

If the FDA believes Gardasil is safe and effective, then we deserve a more thorough explanation of why the vaccine’s potential to protect against oral cancers — in both men and women — is not reason enough for the federal advisory group to issue as strong a recommendation for male vaccination as for female vaccination.


Here today is Adina Nack with a fantastic guest post on how STD stereotypes have led to the mismarketing of the HPV vaccine as a cervical cancer vaccine. An associate professor of sociology, who has directed California Lutheran University’s Center for Equality and Justice and their Gender and Women’s Studies Program, and author of Damaged Goods?, Adina asks some provocative questions about the consequences this gendered mislabeling will have for public health awareness. –Kristen

The “Cervical Cancer” Vaccine, STD Stigma & the Truth about HPVby Adina Nack

You’ve probably seen one of Merck‘s ads which promote GARDASIL as the first cervical cancer vaccine. Last year, their commercials featured teenage girls telling us they want to be “one less” woman with cervical cancer. GARDASIL’s website features new TV spots which say the vaccine helps prevent “other HPV diseases,” too, and end with, “You have the power to choose,” but do you, the viewer, know what you are choosing?

 

A clue that this is a STD vaccine appears briefly at the bottom of the screen: “HPV is Human Papillomavirus.” Merck’s goal may have been to appeal to parents who are squeamish about vaccinating their daughters against 4 types of virus which are almost always sexually transmitted. This marketing strategy means that the U.S. public, currently undereducated about HPV, is none the wiser about this family of viruses which infect millions in the U.S. and worldwide each year. When the ads briefly mention “other HPV diseases,” how many realize they’re talking about genital/anal warts and that recent studies link HPV with oral/throat cancers? [You don’t need to have a cervix (or even a vagina) to contract any of these “other” HPV diseases.] Why don’t they want us to know the whole truth about the vaccine?

Branding GARDASIL as a cervical cancer vaccine was aimed at winning public support. But, what are the consequences of a campaign built on half-truths? Today, only females, ages 9-26, can be protected against strains of a virus that may have serious consequences for boys/men and women past their mid-20s. If public health is the goal, then let’s question how our STD attitudes shaped a marketing plan which has, in turn, influenced drug policy.

Marketing a “cervical cancer” vaccine may have appeased some social conservatives who don’t want their daughters vaccinated against any STD, fearing it might promote premarital sex. But, the vaccine will likely soon be available to males, and their anatomy does not include a cervix — will girls get a “cervical cancer” vaccine and boys get a HPV vaccine? The current gender-biased policy supports a centuries old double-standard of sexual morality. Most view STD infections as more damaging to women than to men. Many believe that STDs result from promiscuity — girls/women deserve what they get. So, are we ready to embrace any STD vaccine (including a future HIV vaccine) as a preventive health measure?

Having studied women with HPV, I know that a person can contract the virus from nonconsensual sex or from their first sexual partner — you could still be a ‘technical’ virgin since skin-to-skin contact, not penetration, is the route of transmission. In my new book, Damaged Goods?, I take readers inside the lives of 43 women who have struggled to negotiate the stigma of having a chronic STD. One chapter delves into stereotypes about the types of people who get STDs: these beliefs not only skew our perceptions of STD risk (bad things only happen to bad people) but also can psychologically scar us if we contract one of those diseases. Merck’s branding of GARDASIL makes sense: a typical U.S. teenage girl or young woman has good reason to fear others’ judgments of her — thinking her to be promiscuous, dirty, naïve, and irresponsible — if they knew she’d sought out a STD vaccine. Whereas, getting a “cervical cancer” vaccine feels more like something that a responsible girl/woman would do.

Unfortunately, with GARDASIL taking the easy way out, the U.S. public misses a prime opportunity to learn about this prevalent, easily transmitted disease that is unfortunately difficult to test for. We’ve also lost a chance to take on STD stigma and challenge the population to view sexually transmitted infections as medical problems rather than as blemishes of moral character.

No vaccine is 100% effective and neither are the treatment options for HPV infections. STD stereotypes (particularly negative about infected women) come back to haunt those of us who become infected with diseases like HPV and herpes, which are treatable but not curable. Until there’s a ‘magic bullet’ cure, we should educate ourselves not only about medical facts but also about STD stigma — the anxiety, fear, shame and guilt — that often proves more damaging to the lives of those infected than the viruses, themselves.