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In Ireland, a "scandal" is breaking over just under 150 girls who have come forward to report adverse effects from Gardasil, a widely-used HPV vaccine that's been the cause of much moral panic ever since it hit the market in 2006. In a rather slanted piece, the Irish Independent indicates that the vaccine is responsible not just for complications in Ireland, but also abroad, where "Japan has stopped recommending the vaccine and petitions have been initiated by experts in Spain and France."
The brewing panic over the vaccine, complete with parent groups like "Reactions and Effects of Gardasil Resulting in Extreme Trauma (REGRET)," is evidence of the growing absurd backlash to vaccines, paired with a deep streak of slut shaming. Research has amply proved that Gardasil and other HPV vaccines are generally recognized as both safe and effective, and that they could prevent not just HPV, but also some forms of cervical cancer, which makes them a double win.
However, they have to be administered in people between the ages of nine and 26 to be effective, and with pressure to avoid the vaccine, many parents are restricting access and youth may be thinking twice as well. That's frustrating in an era where vaccine refusal is such a problem that we're having to pass legislation to aggressively counter it, as in California, where a radical new law severely restricts vaccine exemptions.
Here's what we know about vaccines, including HPV vaccines: They are rigorously tested by the FDA and very closely monitored, with an extensive reporting system in the U.S. dedicated solely to keeping track of adverse incidents involving vaccines — health effects which occur within a set time period, in fact, regardless as to whether they can be clearly linked to the vaccine. That includes any kind of illness, death, or other problem that happens on or around the time a vaccine is given, even if followup later indicates that the vaccine had nothing to do with it. The U.S. is extremely serious about vaccine safety, and no wonder, with millions of units administered per year.
Drug companies and medical offices, which have a very low margin on many vaccines, also accept a considerable degree of risk when it comes to liability. The U.S. maintains a fund specifically intended to compensate victims of vaccine injury, in the rare cases where vaccines do cause severe complications — usually because of previously unknown allergies or freak incidents.
Like all medical treatments, vaccines come with risks. Those risks are extremely low, and the medical establishment as well as researchers and most people generally agree that these risks are acceptable when compared to the risks of not vaccinating: Runny nose, or death? Risk of fainting within 15-20 minutes of administration, or cancer?
In the case of Gardasil, the CDC reports that 80 million units of the vaccine were delivered in the United States between 2006 and September 2015. Of these, roughly 33,000 triggered reports of adverse events. 14 percent of those had nothing to do with health problems experienced by individual patient, instead focusing on issues like improper storage. 79 percent involved mild responses that resolved quickly — like the temporary dizziness, headache, nausea, and swelling at the site of administration that accompany many vaccines.
Only 7 percent were considered "serious," as in life-threatening or linked to complications that required hospitalization. No deaths could be definitively linked to the vaccine*. That means that over the past nine years, 2,310 people experienced serious side effects from the vaccine, which is no small potatoes, but 4,100 patients die from cervical cancer every year — a number which, incidentally, improved radically after the introduction of the Pap test.
Worldwide, 187 million people have received the vaccine, and it's recognized as safe by major health authorities like the World Health Organization. "Recognized as safe" isn't a 100 percent all-the-time every-time safety guarantee. Complications and adverse reactions happen, and there's no way to control for them other than using reasonable precautions — sterile production and packaging methods, routine inspections throughout the supply chain, proper training for clinicians that discusses administration methods, risk factors, and patient evaluation, disclosures about allergens (if you're allergic to yeast, don't get Gardasil).
The problem is that once rumblings about problems associated with vaccines start to spread, suddenly people start seeing them everywhere. Infamously, this came up after the retracted Andrew Wakefield study falsely connecting vaccines to autism: Suddenly, there were scores of parents leaping forward to claim that vaccines had caused autism in their children, even though no study could corroborate the findings. His study led to a widespread rejection of vaccines, particularly among white middle class people in the West, and directly contributed to outbreaks of vaccine-preventable diseases like measles.
So the stage is set for people to start reconsidering whether they want to vaccinate themselves or their children for HPV, and the fires are fueled by TV specials like "Cervical Cancer Vaccine: Is It Safe?"
But in this case, the groundwork was already laid for people to dislike Gardasil, because of the purpose of the vaccine: It's expressly designed to prevent a sexually transmitted infection, and social prudery plays a very strong role in approaches to medical treatment. Just as parents reject comprehensive sexual education in schools or refuse to allow children access to birth control and barrier methods under the mistaken belief that these things somehow increase promiscuity (they don't), many were reluctant to vaccinate, and continue to be, because of the mistaken belief that being vaccinated for HPV would lead youth to increased sexual activity.
In fact, multiple studies prove this is not the case. A 2015 study found no real difference in STIs between unvaccinated and vaccinated girls, suggesting that the vaccine doesn't promote unsafe sex. A Canadian study came to the same conclusion, finding that vaccination didn't seem to affect "clinical indicators of sexual activity" among teens. The American Academy of Pediatrics also couldn't find evidence that girls made any changes to their behavior after being vaccinated.
Vaccinating your children protects them from preventable and often terrible diseases. With a few exceptions, it carries extremely low risks and offers substantial benefits to both your child and the population at large — including those who genuinely can't receive vaccinations because of increased risks caused by allergies, immune conditions, and other medical issues. Claiming that a vaccine causes health problems is irresponsible, and reinforcing that with a dose of slut shaming is even worse — it creates a false linkage in the public imagination between a vaccine, which offers a net positive, and sexual activity, which is the subject of considerable social stigma in teens and young adults.
That false connection — not that sexual activity should matter in the first place — is helping to drive continued resistance against the HPV vaccine even in the face of concrete evidence that it's generally safe and well-tolerated.
Fictitious reports and scaremongering about the dangers of Gardasil help to reinforce the existing fears over the vaccine: Now it will make your daughter sick AND turn her into a slut. The moral panic and prudery could contribute to a decrease in use of a vaccine that already isn't used as much as it should be — with a narrow window of effectiveness, it's critical for patients to have access to the vaccine as soon as possible (ideally before they engage in sexual activity).
We're not going to cure cervical cancer with a jab, but increasing coverage of HPV vaccines will reduce the number of cases diagnosed every year, and the number of deaths.
Instead, members of the public are hearing claims like this one, from Danish researcher Jesper Mehlsen: "We have also noted that the same set of symptoms are seen in other countries, but under different names — chronic fatigue, fibromyalgia, chronic regional pain syndrome (CRPS), postural tachycardia syndrome (POTS)." When these conditions aren't being treated as made-up "yuppie flu," they're a source of considerable concern, in part because we don't have information about what causes them and how to resolve them. Even he admits, however, that research on the subject is complicated by lack of firm diagnostic criteria for these conditions paired with inadequate data, making it impossible to definitively claim they're linked to Gardasil, so media manipulation of his comments and data feeds a fire that doesn't necessarily really exist.
One thing we do know, though, is that Gardasil isn't likely to be one of the causes of these chronic illnesses, something Ireland's health agency has stressed: "The Pharmacovigilance Risk Assessment Committee concluded that the available evidence does not support that CRPS and POTS are caused by HPV vaccines. Reports of CRPS and POTS after HPV vaccination are consistent with what would be expected in this age group." Vaccinated or not, teens and young women develop these conditions at similar rates. Instead of attributing the problem to vaccines, people should be focusing on research into the actual origins of these conditions, and into how to treat them effectively.
The unfolding situation in Ireland, which is already a fairly sexually conservative place, is going to make HPV vaccines harder to get and it will contribute to attitudes of sexual repression — which makes it more difficult for everyone to obtain safe and appropriate reproductive health care. Without such care, people are going to get sick, and it's all because people want to convince themselves that vaccines are hazardous. A moratorium on vaccination would reinforce the incorrect belief that it's dangerous, and it would reinforce anti-vaccination attitudes in other nations. Irish officials faced with a vocal minority should be thinking carefully about how they want to proceed.
* It's worth noting that the way death certificates are handled in the United States is highly variable. Most are extremely vague. If a medical record indicates that a patient recently had a vaccine, it doesn't mean the vaccine caused the death — for example, I could get a flu shot tomorrow and get in a car accident next week. For more on how administrative issues can complicate death certificate reporting and mortality studies, check out this article on maternal death rates.
Photo: BSIP/Getty Images
Editorial note: This article initially identified 5.6 million instances of adverse side effects and has been corrected.