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Tuesday
Jan262016

Is the HPV vaccine still politically "hot"? You tell me....

Some more data from latest CCP/Annenberg Public Policy Center's latest "science of science communication" study.

I was curious, among other things, about what the current state of political divisions might be on the risk of the HPV vaccine.

At one point—back in 2006-10, I’d say—the efficacy and safety of the vaccine was indeed culturally contested.

The public was polarized; and state legislatures across the nation ended up rejecting the addition of the vaccine to the schedule of mandatory vaccinations for school enrollment, the first (and only) time that has happened (on that scale) for a vaccine that the CDC had added to the schedule of recommended universal childhood immunizations.

I’ve discussed the background at length, including the decisive contribution that foreseeable, avoidable miscues in the advent of the vaccine made to this sad state of affairs.

I was wondering, though, if things had cooled off.

There is still low HPV uptake. But it’s unclear what the cause is.

Maybe the issue is still a polarizing one.

But even without continuing controversy one would expect rates to be lower insofar as the vaccine still isn’t mandatory outside of DC, Virginia and (recently) Rhode Island.

In addition, there’s reason to believe that pediatricians are gun shy to recommend the vaccine b/c of their recollection of getting burned when the vaccine was introduced.  Their reticence might have outlived the continuing public ambivalence, and now be the source of lower-than-optimal coverage.

So I plotted perceptions of various risk, measured with the Industrial Strength Risk Perception measure, in relation to right-left political outlooks.

I put the biggies—global warming, and fracking (plus terrorism, since I mentioned that yesterday and the issue generated some discussion)--in for comparison.

Also, childhood vaccinations, which as, I've discussed in the past, do not generate a particularly meaningful degree of polarization.

So what to make of this?

Obviously HPV is much less polarizing than the “biggies.”

But the degree of division on HPV doesn’t strike me, at least, as trivial.

Political division on the risks posed by other childhood vaccines is less intense, and still trivial or pretty close to it, particularly insofar as risk is perceived as “low” pretty much across the spectrum.  In truth, though, it strikes me as a tad bigger than what I’ve observed in the past (that’s worrisome. . . .).

But that’s all I have to say for now!

What do other think?

Here, btw, are the wordings for the ISRPM items: 

TERROR. Terrorist attacks inside the United States

FRACKING. “Fracking” (extraction of natural gas by hydraulic fracturing)

VACRISK. Vaccination of children against childhood diseases (such as mumps, measles and rubella)

HPV. Vaccinating adolescents against HPV (the human human papillomavirus)

GWARMING. Global warming

 

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Reader Comments (5)

As I understand it, if someone sees an issue of "risk" of HPV vaccine, they may be getting a garbled version of the real controversy that comes from panic over the idea of doing something prophylactic in any way related to sex for girls at a very young age.

January 26, 2016 | Unregistered CommenterHal Morris

@HalMorris:

People have asserted that HPV vaccine causes various serious side effects. There are also claims that it will promote promiscuous sex and risks of other STDs and of pregnancy

Such issues claims of empirical examination, obviously.

January 26, 2016 | Registered CommenterDan Kahan

There are also claims that it will promote promiscuous sex and risks of other STDs and of pregnancy

That's consistent with my impression (ironically, any sort of provision of protection will encourage greater risk taking. Give people seatbelts and they'll just drive faster so better to have no seatbelts is the sort of thinking).

Any widely used (and tested) medicine will have its share of studies that *might* suggest side-effects, and I wonder if the foregrounding of side effects really comes from the "it will encourage sex" folks throwing these in for good measure. For the people looking at the big picture, doling out the grants to conservative non-profits, the expectation that liberals will be spluttering in shock, as well as highly dogmatic (for good reasons as it happens) in insisting it's crazy talk and of course we have to give these vaccinations -- that is part of what makes it a good issue.

I just listened (on audible) to the just released Dark Money by Jane Meyers. I've read a lot of books about how politics got wrenched to the right through a brilliant propaganda campaign worthy of Lenin and Goebbels and way beyond the American Tobacco Institute, but this might be the most comprehensive one and certainly the most up to date. There are so many moving parts very convincingly documented. The part covering around 2006-10 is very complementary to the long Theda Skocpol paper you referenced some time back; the emphasis is quite different which is why I say "complementary".

January 26, 2016 | Unregistered CommenterHal Morris

It seems to me that it is past time to change the study of this question to one in which it is the culturally cognitive dissonance of continuing to discuss the HPV vaccine as is done above, and the absence of a deeper, more nuanced discussion, that is the actual focus of future investigations.

The broad topic at hand is supposed to be the communication of the science related to the public health implications of HPV infections. With the idea of garnering public awareness and thus ultimately support for policy initiatives which improve health outcomes. In my opinion, we have been having a substitute conversation, one that benefits the efforts of the pharmaceutical companies to get this vaccine into broad application in public schools. But that is at best, only a very long term and only at best a partial answer to combating HPV related cancer.

The major political hurdle to better health outcomes in my opinion, is really is right wing pressure. But not just as it relates to 12 year olds, but also as applied to withdraw funding and availability of women's health clinics. Cervical cancer is quite treatable if it is caught in time. Doing so requires regular checkups and Pap smears. Current efforts to withdraw state support for Planned Parenthood due to controversies about abortion funding have left women, especially low income women, in many areas of the country, without easy access to the clinics needed for such exams and tests.

HPV infections are linked to cancers, most frequently of the cervix, but also of the penis and throat. So in addition to analyzing the topic of conversations that we are too squeamish or reluctant to initiate, with with 12 year olds, the key topic that is most likely to be lacking is how is it that people get HPV infections in their throat anyway. Which we seem to be unable to do, even with adults. Michael Douglas volunteered to be the "poster child" for such an effort, but in my opinion, that has not really happened, despite a few news reports as the one here: http://www.cbsnews.com/news/oral-sex-and-throat-cancer-michael-douglas-hpv-report-spotlights-epidemic/.

The HPV vaccine is unique in that there are many strains of HPV and the vaccines only provide immunity for some of them. The two brands, Merek and Galaxo, don't even completely cover the same ones. One of the topics not deeply discussed is extending the vaccine to cover HPV more broadly.

Historically, most women have gotten infected with HPV, perhaps numerous times, cleared the infections, and become immune. And then do not go on to get cervical cancer. It is now important to study what happens to the population distribution of the remaining virus types, and how that affects HPV initiated cancers overall. It could even be true that the vaccine is eliminating more of the benign, immunity producing infections along with two types know to be most implicated in cancer formation, It could even be true that one of the remaining HPV virus types becomes more widespread, in the absence of competing types, and without that infection induced immunity, and that those remaining strains go on to expand as a cancer cause.

Now that HPV vaccine has been available for a period of time, it is crucial to know how long the immunity conferred by the vaccine remains. The 12 year old age was set with the idea of reaching girls before they become sexually active. But that effort would be defeated if the vaccine created immunity does not carry through a sexually active adulthood.

Another thing that makes this vaccine different is that there is a very long latency period between initial infection and the onset of cancer. The science of this is also worthy of discussion with regards to the implementation of HPV vaccine policy. See for example http://www.medscape.com/viewarticle/467126_3. "Although rapid progression is possible, average time from initial infection to manifestation of invasive cervical cancer is estimated at up to 15 years." "Persistent high-risk HPV infection is the key attribute of high-grade cervical disease." "HPV in adolescents is frequently short-lived and spontaneously regressive, whereas infection in older women tends to persist." That latter statement might support an argument that the focus on 12 year olds is actually misguided.

Now that we can test for immunity of the strains of HPV covered by the vaccine, it seems to me that it ought to be imperative for anyone supporting the vaccine to be campaigning for testing and then vaccination of older adults who may remain susceptible.

A significant part of any public policy is a risk/benefit analysis. If society needs to make a funding choice, pushing for better public health screening for cervical cancer and other cancers now, might be a better choice than focusing solely on the vaccine. Certainly focusing on the vaccine and not the screening can have little impact on cancer rates for years to come.

February 1, 2016 | Unregistered CommenterGaythia Weis

If we are going to have a real conversation about public health policy, we need to start with providing the public with insights as to how our public health policies are translated from science to policy to implementation. And the power to make changes to those mechanisms where needed.

One of the key Federal agencies involved in those efforts is the Center for Disease Control. Which it turns out, has a supporting foundation that includes all of the major players in Big Pharma, Health Insurance, and Institutional Medicine: http://www.cdcfoundation.org/what/partners#category-299. Including some of the "best" players, such as Vertex Pharmaceuticals, currently testifying before Congress along with Martin Shkreli.

In my opinion, current conversations with the public regarding vaccines ought to center around the emerging threat of viruses such as Zika, and on what we ought to have learned from the recent measles outbreak that started at Disneyland.

The place where these two issues intersect is globalization. This is not new. The book, Pox Americana details what happened in the 1700's when smallpox met the New World. http://www.amazon.com/Pox-Americana-Smallpox-Epidemic-1775-82/dp/080907821X/ref=sr_1_1?ie=UTF8&qid=1454608951&sr=8-1&keywords=Pox+americana. These days, no disease is further than an airplane flight away.

Places like Disneyland ought to be viewed as locations of concern from a true standpoint of Homeland Security. The sheer numbers of visitors and their their global diversity makes this a high risk location. And one that blows up conventional analyses of herd immunity. Especially if the infection gets into the staff before it is recognized.

This makes it all the more imperative that people understand the importance of having their families immunized with the best vaccines currently available.

But our analysis and communication of the science behind public health ought to go well beyond that. In the aftermath of the measles epidemic, Disneyland rushed lobbyists to the California State capital. In my opinion, greater focus should be aimed at Disney, which has a long history of blocking health care and sick leave for its largely part time staff. Additionally, the measles vaccine first became available in 1963 with an improved version in 1968, and the combined MMR vaccine in 1971, A booster shot was added in 1989. Since then, improvements have stalled. The vaccine cannot be given to infants under 1 year of age. Exposures at Disneyland are hard to measure, but tracing the virus through subsequent exposures may indicate that those who had the original vaccine but were too old to have gotten the booster may be more vulnerable. In my opinion, not enough publicity has been given to bridging that gap: http://abc7chicago.com/health/some-adults-may-need-2nd-measles-vaccination/507475/. Infants are obviously vulnerable. Newer vaccines that can be administered at younger ages need to be develped. Or perhaps we need to give greater concern to a "cocoon of safety" around too young to immunize infants. Perhaps infants do not belong at places like Disneyland. Another vulnerable group are those people currently receiving immune suppressing drugs. I know of one instance in which such a person contracted measles because they went to their clinic for treatment. Measles can be airborne which makes it especially risky. This highlights the woeful state of infection control in many of our medical centers.

Thus, anti-vaxxers are only one competent of the problem. In my opinion, the media focus on anti-vaxxers is a way of deflecting attention from institutional and corporate issues, and prevents those issues from being addressed.

These problems are highlighted in the case of emerging tropical diseases. Without a ready monetary payback, Big Pharma is not willing to invest in vaccine development. This means that these new diseases can't be addressed in a proactive fashion. Ebola studies have stalled, and those for Zita have not geared up in time to prevent the global spread of that disease.

In the US, problems with further expansions of the research into the basic science behind vaccines and other pharmaceutical products, is inhibited by the financial tax evasions of Big Pharma. The trend of the moment is tax inversions in which corporations move offshore to avoid paying taxes. I believe that this will ultimately make US investments through the National Institute of Health and other agencies unsustainable. For all the talk of the need for students in STEM fields, the hiring situation for chemists is actually quite poor.

In my opinion, these ought to be the politically hot conversations. Perhaps Martin Shkreli's actions will turn out to have been a good thing to have happened to the world after all.

February 4, 2016 | Unregistered CommenterGaythia Weis

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