HPV vaccine

The HPV vaccine (or HPV shot) is a vaccine that immunizes against various forms of (HPV), depending on which vaccine you get. There are three vaccines currently in existence: a nonavalent shot, a quadrivalent shot, and a bivalent shot. The vaccine is relatively recent; the first shot became available in the United States in 2006. The shot is so pivotal to human health that it is currently on the World Health Organization's list of essential medicines. Additionally, HPV vaccines are recommended as part of routine vaccinations in all countries by the World Health Organization. HPV vaccines were accessible in over 100 countries as of 2019.

In the beginning
In the earliest days of scientific taxonomy, a European rabbit was incorrectly taxonomized as a distinct species, Lepus cornutus. It is now believed that the rabbit(s) were actually normal rabbits that had been infected with Shope papilloma virus, a virus that causes keratinous carcinoma, and appears as horned growths around the infected rabbit's head.

Richard E. Shope, for whom the virus is named, identified the cause of the horned growths of some rabbits in the 1930s and pioneered the study of viruses as cancer-causing agents. This was initially a controversial idea but eventually led to a Nobel Prize being awarded to Peyton Rous and Harald zur Hausen for their research in the field. The studies of cancer-causing viruses eventually led to the development of the HPV vaccine.

What is HPV?
Human papillomavirus is a very common viral disease spread through skin-to-skin contact. Usually, but not always, this transmission is through sex. Alarmingly, HPV can be transmitted as a cross-infection from routine hospital procedures even when disinfection protocols are followed. As a result, it's estimated that nearly 80,000,000 Americans have at least one strain of it, making it the most common sexually transmitted disease (STD) in the United States. Additionally, more than half of infections in the US occur among those between 15 and 24 years of age. A 2007 study in the Journal of the American Medical Association (JAMA) estimated that the HPV types (6, 11, 16, 18) targeted by the vaccine are present in about 3.4% of women in the United States, as measured by vaginal swab. HPV typically goes away on its own, but occasionally it does not and is able to cause cancer (specifically, papilloma). In fact, human papillomavirus is a group of more than 100 related viruses, more than 40 of which affect the genital area. About a dozen variants can also cause cancers, some of which include oropharyngeal, anal, penile, and vulvar cancers. The HPV viruses that are the most cancer-causing include variants 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 66 and 68, some of which can be prevented by the HPV vaccine. HPV is able to cause anogenital warts (also called genital warts), causing tiny warts to appear on the hands, feet, and genital area. Finally, the infection can also cause the development of precancerous cervical lesions — so it's vital to get the vaccine. Most people who are infected with HPV are asymptomatic, so you could have sexual intercourse with someone who's infected with human papillomavirus and they would never know that they are infecting you.



High rates of HPV are present in other countries too. Over 70% of sexually active Canadians will have been infected by HPV once in their lifetimes. In Brazil, the estimated active rate of cervical HPV was at 25%, anal HPV was at 26%, oral HPV was at 12%, and penile HPV was at 36%, all high percentages. In Australia, it is predicted that the number of Australians who have been infected by HPV is 80%.

Whilst there are treatments for anogenital warts, cervical cancer, and cervical changes — the health problems that can result from previous HPV infection — there is no cure for the virus itself. That's how truly pivotal HPV vaccination is. Furthermore, it is possible to treat genital warts while remaining infected by HPV, allowing transmission of the infection to other people. Unsurprisingly, a higher likelihood of infection with HPV is associated with having had sex when young, having had many sex partners, and/or having a sex partner who themselves has had many sex partners.

The vaccines
The vaccine is recommended for use by boys, girls, men, and women ages 9 through 26, except for anyone who is undergoing pregnancy.

The vaccine is not by any means a substitute for cervical screening. HPV is known to cause 690,000 new cancer cases per year internationally, of this number more than 560,000 cases are cervical cancers. The vaccine gives one immense protection against most HPV-related cancers, but there are still HPV viruses that can give one cervical cancer and are not protected against by any of the HPV vaccines. Recall that there are more than 100 HPV viruses, and at most, one can immunize oneself from nine of them. Regular cervical screening reduces one's risk of developing cervical cancer by 90%. For people with cervixes, it is best to receive the HPV vaccine at the appropriate age and regularly get cervical screenings to receive the best protection from cervical cancer.

All three HPV vaccines are presented in order regarding how many variations of HPV they defend the immunized patient from. Two out of the three were developed by Merck & Co (Both are known as Gardasil). There are no other vaccines than these three, anybody who says they got a different HPV vaccine is wrong. The availability of these vaccines varies between countries — for instance, as mentioned previously, Gardasil® 9 is the only receivable HPV vaccine in the United States.

The HPV vaccine does not directly protect against other sexually transmitted diseases (e.g., chlamydia, herpes, hepatitis, trichomoniasis, gonorrhea, syphilis, HIV/AIDS, etc). However, almost all diseases transmit more easily the more compromised your immune system is, and vaginal inflammation, in particular, more than doubles the risk of HIV transmission. Given just how prevalent HPV is, immunizing everyone would have a small but noticeable impact on HIV transmission rates.

Cervarix® vaccine
Cervarix® 2vHPV is a bivalent vaccine that immunizes the patient from HPV types 16 and 18, both of which are extremely deadly. The vaccine is obtainable through either a vial or a prefilled syringe. The HPV cancers that this shot protects one's body from consist of both cervical and anal cancers. Cervarix concurrently protects one from precancerous lesions in the genital areas. HPV types 16 and 18 are responsible for 70% of cervical cancers, plus 90% of anal cancers. So, this vaccine significantly decreases one's chances of being diagnosed with anal and cervical cancers — although one's best option would be Gardasil 9, as it protects you from 7 additional types of HPV. The shot has proteins that are fabricated in virus-like particles, and the vaccine is made with MPL (Monophosphoryl Lipid A). Both MPL and the virus-like particles are affixed onto an aluminum compound; this is done to greatly proliferate immunity against types 16 and 18 of HPV. Typical side effects of the shot include muscle pain, redness and swelling, tiredness, headaches, and reactions at the location of said injection. These side effects are patently mild, hence the benefits clearly outweigh the risks. Nonetheless, the protection is good but not perfect, for the shot does not provide protection against all HPV diseases, as mentioned previously. There are considerably more than just two HPV viruses—albeit, not a single vaccine is currently able to prevent all HPV diseases. People with cervices aren't going to be quite as immune if they've engaged in sexual activity prior to vaccination — ergo, the protection may not be gained by all participants. Thus, it's a good idea to continue receiving Pap smears, even after vaccination. For this shot, there is a two-dose schedule that must ensue before you are fully inoculated, as long as you are under the age of 15; if you are over that, you must get three injections as opposed to just two.

Gardasil® vaccines
Gardasil®, protects against HPV types 6, 11, 16 and 18. These strains of HPV have been associated with 70% of cervical cancer cases, and may also play a role in the development of other types of cancer. In June 2006, the U. S. Food and Drug Administration approved Gardasil — the first HPV vaccine — based on observance of elevated antibody levels in a double-blind clinical trial involving over 20,000 subjects. In addition to cancer, HPV can also cause other unwanted diseases such as genital warts. Gardasil® 9 is currently the only HPV vaccine accessible in the United States, specifically, because it protects one from Human Papillomavirus types 6, 11, 16, 18, 31, 33, 45, 52, and 58; i.e., it protects against five additional types of HPV. It is approved for people of all genders from ages 9 to 45, and it protects against HPV viruses that cause genital warts, a plethora of cancers (such as cancers of the cervical, vaginal, and vulvic areas), and from some other conditions. For those aged 9-14, one only needs two shots of Gardasil 9; but for those aged 15-45, and/or those who are immunocompromised of any age, three shots are required to become fully immunized. As reiterated earlier, this is one's best option as it immunizes one from the most types of vaccine-preventable HPV viruses.

The only people who are unable to get the Gardasil vaccines are those who are severely allergic to yeast, as yeast is one of the ingredients used in both the quadrivalent and 9-valent vaccines. Surely, all the conservatives who decry the shot being dangerous have severe yeast allergies and are acting in total rationality. Pregnant people also aren't able to get the shots.

Nevertheless, all three vaccines protect one from HPV types 16 and 18, which together cause the majority of HPV cancers. HPV types 6 and 11 cause 90% of genital warts, which are both prevented by the two Gardasil shots. HPV types 16 and 18 cause about 70% of recorded cervical cancers (which is by far the most frequent HPV-related disease), and these are covered by the Cervarix® bivalent shot and the Gardasil® 9-valent shot. Rates of cervical cancers in the world are very high, and the hysteria against HPV vaccination only serves to proliferate this problem. HPV types 31, 33, 45, 52, and 58 all are labeled as high-risk HPV, meaning that they can cause several types of cancer easily.

Vaccine injection
The physician injects the HPV vaccine into the body in the same way as any other vaccine. The inoculation stimulates the antibodies of the recipient. These antibodies recognize the husk of the virus as a threat and thereupon build immunity by responding to it. Moreover, the HPV vaccine utilizes virus-like particles (VLPs). It may sound hazardous, but since VLPs lack viral DNA, they are unable to reproduce and become pathogenic. VLPs strongly resemble the natural virus, and they are extremely immunogenic, precisely why the vaccine boasts an overly high efficacy rate.

Laws and public opinion
The US public has been somewhat ambivalent when it comes to the HPV vaccine. Since there is an underlying stigma regarding sex, a vaccine that immunizes constituents from an STI has received rather lukewarm responses, especially among conservatives. Despite a goal of immunizing 80% of the United States population against various HPV viruses, only 54% of the population of the United States is vaccinated as of 2019. Unsurprisingly, studies show that misinformation about the vaccine vastly influenced parents' views of the inoculation to HPV. In the United States, public opinion seems to waver with HPV vaccine policies based on its scientific certainty or uncertainty. Only five jurisdictions in the United States (Rhode Island, Virginia, Washington, D.C., and Puerto Rico) require HPV vaccination for school attendance.

Unsurprisingly, requirements to get vaccinated to attend school in the United States were found to increase the usage of the HPV vaccine, likely because there was no opt-out option with the introduction of a mandatory vaccine passport. What this indicates is that mandatory vaccination once again prove to be an effective solution to anti-vaccine hysteria.

The opinions on HPV vaccination in Europe are particularly eye-opening, as vaccine misinformation, concerns over the safety of immunization, issues of trust, and a wide variety of other problems dominate. For example in Romania, the campaign for HPV vaccination that started in 2008 was discontinued in 2014 due to public mistrust. Vaccine hesitancy does not in all cases result in vaccine refusal, but it's based on misinformation.

A survey conducted by JAMA Pediatrics found that as many as 25% of parents who refused to inoculate their children with the HPV vaccine, cited adverse reactions as the main reason for refusal. The rates of those who are up-to-date with the HPV vaccine in the United States, i.e., those with at least 2 doses of the vaccine, have begun to stagnate over time, with HPV-UTD rates in most US states below 50%.

As of the year 2017, only 22 states in the United States had laws that authorized pharmacists to inoculate cohorts with the human papillomavirus vaccine in the 11-12 age group, which is particularly absurd because the Centers for Disease Control and Prevention themselves specifically aims at vaccinating preadolescent children.

Inequalities
An actual issue with the HPV vaccine concerns not the vaccine itself but the unequal access to it. Lower and middle-income countries receive many fewer doses compared to their richer counterparts. This certainly curtails efforts to eradicate most cervical cancers as many people are unable to have access to the vaccine. In response, the two companies that sell vaccines (Merck and GlaxoSmithKline) reduced the prices for the vaccines to less than $5 (USD) per dose in poorer countries.

A study conducted in 2012 concluded that less than half of poor and minority adolescents in the United States underwent vaccination for HPV; only 20 percent of these adolescents even completed the vaccination series. The low rates of HPV vaccination in poor and minority adolescents would increase class and racial disparities in cervical cancer incidence.

Effectiveness
The HPV vaccines, as they all currently stand, have shown to be very effective in those who are injected with them. Bear in mind that the vaccine is somewhat new; it would be absurd to expect studies on the HPV jab spanning several decades, as the vaccine first became available in 2006. Despite these difficulties, as it currently stands, the HPV vaccine has been shown to work well; sometimes even better than previously anticipated.

The nonvalent vaccine, Gardasil 9, provides almost 100% protection for all the HPV virus types it covers; those being HPV types 6, 11, 16, 18, 31, 33, 45, 52 and 58-as long as one receives doses at the precise intervals — and if one hasn't been exposed to any of the nine HPV viruses beforehand. It is anticipated that the immunity will be long-lasting, and the vaccine still offers nearly 100% protection after major vaccine studies in 2003. The vaccine has also been shown to reduce the rates of pre-cancerous lesions in the cervix and genital warts.

Merck manufactures the HPV vaccine (Gardasil) and sells it for $360 ($120 per shot in a three-shot series). Its package insert explains the limitations of the vaccine and describes its testing for safety and efficacy.

In the decade after 2006 in the United States, quadrivalent type HPV infections fell by 86T in AFAB teenagers and by 71% in AFAB 20-year olds. It also has shown that rates of genital warts and cervical precancers have fallen in correlation with the HPV vaccine. This situation is also observable in other nations with HPV vaccine programs. Studies of the bivalent (Cervarix) and quadrivalent (Gardasil) vaccines over a period of a decade have shown no sign of decreasing protection.

In AFAB individuals in-between the ages of 14 to 19, the four variants of HPV covered by the quadrivalent vaccine were at 11.5% from 2003 to 2006, and fell to 4.3% from 2009-2012. That is a decrease of 64% in just a few years. Concurrently, those four variants saw an 18.5% prevalence amongst AFAB individuals in-between the ages of 20 and 24 from 2003-2006, and this fell to 12.1% in 2009-2012; a decrease of 34%.

"Alternatives"
Putting all of the seemingly perpetual data aside, it may still seem unnecessary to get vaccinated against HPV to many people, particularly for those who aren't sexually active. Some might even go to proclaim that alternatives are better. So then, what is with these proposed "alternative" ways of avoiding HPV infection? Do they hold any water?

Alternative means of protection against cervical cancer include abstinence and condom use, which does not provide absolute protection but does significantly reduce the likelihood of HPV transmission. This still is inferior compared to HPV vaccination as these methods of HPV prevention are never guaranteed protection.

However, these aren't the only supposed alternatives; HPV infection can be detected via a Pap smear, which is effective if done regularly, but it does not prevent infection, rather it allows for treatment to prevent progression from infection to cancer. So Pap smears aren't better than vaccination because they cannot hinder any HPV infections. Furthermore, HPV is transmitted via skin-to-skin contact, which does not require sexual activity to take place. Finally, rape is entirely possible, and in that terrible situation, you cannot be protected from HPV without the vaccine.

These alternatives are inherently flawed: None of these "alternatives" will create antibodies, nor will they ever be recommended in place of the vaccine. So, one shouldn't avoid HPV vaccination for any of these things.

Reactions and debunking
The long-term consequences of the HPV vaccine are not known and there have not yet been any long-term studies — however, as it currently stands, the vaccine has shown no signs of being hazardous. Children in the 9-year-old age group have been monitored for 18 months, and there have been no studies of possible longer-term risks of the vaccine. Between June 2006 and March 2014, there were 25,063 reports of adverse events compared to 67 million vaccinations with 92% of the adverse effects being non-serious. Under clinical trial conditions, the reports of adverse or severe reactions were not any higher for those receiving the vaccine versus those receiving a placebo.

Despite a very large amount of research proving that all three currently available HPV vaccines do not cause serious, life-threatening adverse effects, are effective and safe and are forms of cancer prevention, this has been unable to halt cranks from contending that the vaccine is tremendously dangerous and not worth receiving. A common tactic is to point to a random reaction to the vaccine as proof that the vaccine must be prohibited. Some of the side effects of the HPV vaccine include headaches, redness at the spot of injection, nausea, syncope, etc. But what is commonly ignored is that the side effects that occur after vaccination are totally normal, and they occur because of the immune responses to the administration of a vaccine. However, because the HPV vaccine has been stamped as a threat by the anti-vaccination movement, the existence of minor adverse reactions may seem like a confirmation of their erroneous beliefs.

Conservative fear-mongering has brought about anecdotal examples of an adverse event occurring at the same time as a vaccination (e.g., Guillain-Barre syndrome) and immediately claiming that the HPV vaccine itself can cause these conditions to materialize. While this may be a brilliant scare-tactic that is effective temporarily when looked at skeptically these arguments almost instantaneously fall apart at once.

To make matters worse, there's one other substantial problem; a substantial number of physicians don't encourage HPV vaccination. A study conducted in 2015 found as many as 27% of physicians do not strongly encourage the HPV vaccine or give HPV vaccine recommendations to AFAB individuals (26% refusal) and AMAB individuals (39% refusal).

Infertility
A repeated myth presented by those who oppose the HPV vaccine is that the injection has links to infertility. For example, from 2014 to 2017 there were three reports that somehow the HPV vaccine resulted in the loss of fertility, specifically premature menopause/premature ovarian failure (POI). Nonetheless, it was later determined to be nothing more than gossip. There was indeed a temporal association of these three cases to inoculation, but there was no causal association between the vaccine and ovarian failure. There is no evidence that the vaccine can cause infertility. For example, a study conducted in 2018 on 199,078 people who of which were able to conceive no association between HPV vaaccination and POI. In truth, despite what you may commonly hear, when it comes to infertility the same goes for HPV itself — HPV infection is not known to engender infertility, in contrast to most STIs when left untreated.

In an ironic twist for those who trumpeted a causal association between infertility and the HPV vaccine, the shot is theorized to literally improve fertility rather than reduce it, since the inoculation will be able to prevent precancerous and cancerous cells from developing in the cervix as a result of previous HPV infection.

Waning protection
One myth speculates that the immunity that the vaccine provides wanes over time by claiming that the antibodies produced by the vaccine supposedly become ineffective, ergo making one's protection from HPV diminish in just a few years. In that hypothetical case, it could be argued that the vaccine is not something to bother taking. However, there is not a shred of evidence to suggest the vaccine's protection wanes over time. In fact, the antibodies that are gained from HPV vaccines are actually rather strong. The vaccines are known to be extremely immunogenic and more than 98% of patients develop an antibody response a little over a month after the full completion of an HPV vaccination series. In one of the many examples, a study done on the quadrivalent vaccine for 14 years showed no signs of waning protection in inoculated people.

Autoimmune diseases
Antivaxxers often allege that there is a connection between vaccination and chronic diseases, including autoimmune disorders (typically chronic), and therefore argue that to prevent the chronic condition one should not get vaccinated. As anticipated, this couldn't be further from the truth. Studies on the HPV vaccine, in particular, show no correlation and causation between autoimmune disorders and HPV immunization. The reports of autoimmune disorders occurring after HPV vaccination among AFAB individuals are consistent with the rate of autoimmune disorders among all people in this age group.

Promiscuity
A commonly recited myth by conservatives regarding HPV vaccines is that it could discourage sexual abstinence and ergo promote promiscuity. This led to political issues for Rick Perry, who initially supported mandatory vaccinations against HPV before members of his base pressured him to change his mind. The promiscuity argument is far from unique to HPV; conservatives have a long history of using the threat of disease to push for their own values on human sexuality, or opposing important medical advances for similar reasons.

It should be obvious that this concern has no bearing on reality. Various studies have concluded that promotion of the HPV vaccine, including in schools, has no connection to increased teenage sexual activity. A study conducted in Canada, particularly with regards to a school HPV vaccine program that was implemented from 2003 to 2013 in British Columbia, found that sexual activity stayed the same or even decreased after patients were immunized with the vaccine. Given this, one could only assume that the people opposing the HPV vaccine secretly have a fetish for genital warts.

This also ignores that HPV infections can and do occur from non-sexual activity. Even if one is completely abstinent, one could still catch HPV from other means, so even if one is a completely isolated, self-centered loner it's still to their advantage that they and everyone else gets vaccinated.

This myth ignores yet another fact — the reason that people are commonly vaccinated at a young age is simple; it immunizes cohorts to HPV before their sex lives begin. Once one gets infected by one of the variants that the HPV vaccine covers, it's over; one can't get immunized from that particular variant (however, the vaccine is still recommended as there are other HPV variants that one can still become immunized to). The vaccine produces the strongest immune responses in preteens, therefore it's best that one get inoculated between the ages of 9-12.

Strains
A common rebuttal might entail an anti-vaxxer mentioning that at most nine strains of HPV are prevented by the jab. This blatantly ignores the fact that of these nine strains, all have been linked to over 90 percent of genital warts cases and over 70 percent of anal and cervical cancers.

Blood clots
Certain individuals might attempt to impugn the HPV vaccine via unabashedly proclaiming it causes blood clots. However, there is no increased risk of blood clots in those inoculated with the HPV vaccine. In one notable example, a study that involved half a million vaccinated Danes found no increased risk of blood clots. Another study was conducted in Denmark and Sweden, which also found no increased risk of blood clots among the vaccinated. Blood clots can happen to anyone for a myriad of reasons. Vaccines do not increase the chances of someday getting a blood clot.

Complex regional pain syndrome
Complex regional pain syndrome (CRPS) is a variant of chronic pain that affects a certain area (usually on an arm or leg) that tends to develop after surgery, injury, stroke, or heart attack. Despite the definition that was just given, some people claim that the HPV vaccine caused CRPS in some patients. There is no evidence to suggest that the HPV vaccine causes complex regional pain syndrome. Here's the thing about CPRS; it's indeed a rare event, and it typically develops after a surgery, injury, stroke, or heart attack-but we don't actually know what causes it. So to say that the vaccine causes CPRS is already incorrect because no one clearly knows what the cause of CRPS is. The site of injection can be painful for many, but the pain goes away on its own. Because it does this, it isn't chronic.

Pre-cancer
Another counterpoint is that HPV vaccine research was initially done on pre-cancerous lesions that resulted from HPV, but not cancers themselves. This might seem like a reasonable argument about HPV vaccine research, but it was just a matter of expediency in initial research; pre-cancerous lesions often develop into cancerous lesions. HPV cancers can take decades to develop, so initial clinical trials were managed using pre-cancers as the endpoint of the research. After continued monitoring and more research, it was confirmed that the rates of HPV cancers decreased among those vaccinated with the HPV shots.

Guillain-Barré syndrome
Another claim that's made by antivaxxers is that there is a linkage between HPV vaccination and Guillain-Barré syndrome. This is easy to debunk; studies conducted by the Global Advisory Committee on Vaccine Safety (GACVS) have found no increased risk of Guillain-Barré syndrome in recipients of the HPV vaccine. Guillain-Barré syndrome is brought up by opponents to any vaccine as a scare tactic, so one might come across this claim if one monitors anti-vaccine spaces.

Death
Some who oppose HPV vaccines have taken their farcical logic to such a degree that they resort to alleging the vaccines can cause death. Indeed, there have been cases of deaths after inoculation, but this assumes that the death was caused by the vaccine, and there is no evidence to suggest this. Remember, 100% of people will die within two centuries of been born.

Again, HPV-related cancer kills thousands of people each year, and HPV spreads so easily that even abstinence is not a guarantee of protection.

Imagine you are in a burning building. Sure, there's some bizarre scenario if you leave you would slip on the stairs and die, but do you believe you are safer staying put in a burning building and hoping the firefighters put it out before you burn to death?

Conclusion
In contrast to what the right-wingers have argued, all three HPV vaccines are not hazardous in the slightest. Depending on which vaccine one gets, you are either protected from two, four, or nine variants of HPV, and of these, they are the most dangerous viruses in the HPV group. The vaccine has been tested for years and it's evident that the jab is overwhelmingly effective and safe; vaccines do not impair fertility, they don't result in neurological problems such as Guillain-Barre syndrome, they don't cause blood clots, they won't make one more promiscuous, and they don't cause death. The hysteria against the HPV vaccine is not just connected to anti-vaccination movement, but the panic can also be attributed to poor education on sex, which leads people not to consider HPV as a major threat to their health. Perhaps the most terrifying aspect of this is not that people deny the seriousness of HPV, but that so many people are outright oblivious to the mere existence of HPV, and thus are not inclined to get vaccinated.