Vaccinating Against Cancer: The Ethics of the HPV Vaccine

Cervical cancer is the 2nd most frequent cause of cancer-associated death in females worldwide, and the 14th most common cancer in the United States (Chattopadhyay, 2011). Approximately 0.6% of American women are diagnosed with cervical cancer within their lifetime (NIH.gov). Cervical infection with an oncogenic type of the human papillomavirus (HPV) is a necessary precursor in the etiology of cervical cancer in almost 100% of documented cases (Chen, Jiang, Shen, & Hu, 2011). One in four Americans, approximately 80 million, are infected with HPV. It is the most common sexually transmitted infection. Approximately 30,000 cases of HPV-associated cancers occur in the United States every year. In addition to cervical cancer, HPV is the cause of many vulvar, vaginal, throat, tongue, tonsilar, anal and penile cancers (White, 2014). HPV vaccination, in conjunction with an increase in worldwide cervical screening, can significantly decrease the future incidence and morbidity rates of cervical cancer. However, ethical concerns over the morality, safety, and efficacy of the HPV vaccine have stifled the uptake of the vaccine in comparison with other vaccines (Nicol et al., 2016).

The ideal time to begin the HPV vaccine series in both sexes is before the age of commencing sexual contact. Within three years of experiencing their first vaginal intercourse, 50% of sexually active females are infected with HPV. Half of those infected contract the virus within the first three months of initiation of intercourse (Chen et al., 2011). There are two FDA approved vaccines against HPV, Gardasil and Cervarix. These vaccines target persistent infections of oncogenic HPV-16 and HPV-18. Both approved HPV vaccines help prevent HPV infection in uninfected females, and Gardasil is approved to prevent HPV infection in uninfected males. The vaccines are only effective if administered prior to initial HPV infection. Even so, some parents are hesitant to vaccinate their children and some physicians are hesitant to strongly advocate that they do. As of 2017, only 63% of girls and 50% of boys in the target age are vaccinated (White, 2014). One argument against the vaccination of younger children is that vaccinating against a sexually transmitted disease may encourage sexual contact or promote high risk sexual practices. Given the vaccine is a proven method of preventing against infection of the strains targeted in the vaccine, the argument that the vaccine can prevent cervical cancer is far more persuasive than the counterargument to discourage pre-marital sex or high risk sexual practices (Nicol et al., 2016).

Other arguments against HPV vaccination include concerns over the overall safety and long-term efficacy of the vaccine. The research shows that the most common side effects are headache and soreness at the injection site. These common side effects pose very little risk to health. Reports of more severe side effects following vaccination are rare. The majority of studies show a positive risk-benefit from vaccination with minimal adverse effects on par with the administration of most childhood vaccines (Nicol et al., 2016). Even so, the long-term efficacy of the vaccine is still uncertain. Only time will tell if vaccinating adolescent males and females against HPV will reduce the occurrence of HPV associated cancers. The vaccines undoubtedly reduce the incidence of infection and without infection, the mutagenic events that cause HPV associated cancers will likely never occur. The almost complete effectiveness of the vaccine to prevent pre-cancerous lesions caused by the HPV oncogenic viral subtypes make the minor side effects reported in the majority of cases and the lack of time to prove long-term efficacy, worth the risk of vaccination (White, 2014).

Parents and physicians need to remain actively involved in the education process and continue to advocate for children. Parents ultimately retain the right to decide whether or not to vaccinate their children. However, parents look to the clinician for the recommendation, or not, to vaccinate. Therefore, it is imperative that independent research into the safety and long-term efficacy of the HPV vaccine continues and that physicians carefully educate parents on the benefits and risks of this vaccine that may protect their children from HPV associated cancers, even into adulthood.  

References

Chattopadhyay, Koushik. “A Comprehensive Review on Host Genetic Susceptibility to Human Papillomavirus Infection and Progression to Cervical Cancer.” Indian Journal of Human Genetics (2011): 132-144.

Chen, Xiaojun, Jie Jiang, Hongbing Shen, and Zhibin Hu. “Genetic Susceptibility of Cervical Cancer.”  Journal of Biomedical Research (2011): 155-164. NCBI. Web. 16 June 2016.

“NIH Fact Sheets: Cervical Cancer.” NIH.gov. National Institutes of Health. (2013).

Nicol, A. F., Andrade, C. V., Russomano, F. B., Rodrigues, L. L. S., Oliveira, N. S., & Provance, D. W. (2016). HPV vaccines: a controversial issue? Brazilian Journal of Medical and Biological Research, 49(5), e5060. http://doi.org/10.1590/1414-431X20155060

White, M. D. (2014). Pros, cons, and ethics of HPV vaccine in teens—Why such controversy? Translational Andrology and Urology, 3(4), 429–434. http://doi.org/10.3978/j.issn.2223-4683.2014.11.02