The HPV vaccine is on trial as anti-vaxxers mobilize against effective cancer prevention

The safe, heavily researched HPV vaccine remains tragically under-used — and anti-vaccine movies and conferences could make it more so if we’re not careful.
Illustration of hand grabbing the wrist of a nurse about to inject a vaccine.
Fighting an organized misinformation machine can be tough — but it's worth it.Anuj Shrestha / for NBC News
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By Tara C. Smith, professor of epidemiology at Kent State University

New research shows that the HPV vaccine is exceeding expectations in protecting individuals from HPV infection and precancerous cells. The study’s lead author, Mélanie Drolet, touts the potential “elimination of cervical cancer as a public health problem.” The new study, which is an analysis of 60 million individuals from 14 countries, found that vaccination protected both the vaccinated and the larger population via a “herd immunity” effect. In other words, even those who were not vaccinated were indirectly protected. And while HPV is most typically associated with cervical cancer, the virus can also cause other cancers, such as anal and penile cancer, and cancers of the head and neck, as well as nonfatal conditions such as genital warts.

This is all great news. It now looks like we have a safe, highly effective vaccine that has the potential to significantly reduce many forms of cancer. So why is it also becoming a key target of many anti-vaxxers?

It now looks like we have a safe, highly effective vaccine that has the potential to significantly reduce many forms of cancer. So why is it also becoming a key target of many anti-vaxxers?

Robert F. Kennedy Jr., one of the leading lights of the anti-vaccine movement, recently published a lengthy article intent on scaring parents and teens away from the HPV vaccine. A new anti-vaccine documentary, “Vaxxed 2: The People’s Truth,” will reportedly focus on the HPV vaccine. This follows three other films which similarly attack this vaccine. They have even hosted an entire conference on the topic.

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I asked Dr. Abbey Berenson, an Ob/Gyn at the University of Texas Medical Branch who studies women’s health and the HPV vaccine, why this vaccine in particular has become such a target of the anti-vaxxer crowd. She suggested four reasons for why it’s recently generated such controversy. Some of these have to do with the vaccine’s efficiency and others are based more in abstract questions of morality, which is reflective of the changing nature of the anti-vaccine movement as a whole. No longer are anti-vaxxers simply claiming vaccines cause autism, as they once did. Now the movement has become more complicated and its motivations at once more diverse and more obscure.

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First, she noted that many don’t realize the magnitude of the risk from HPV infection. “More than 80 percent of sexually active individuals will acquire an infection during their lifetime," Berenson told me. Once they have the virus, many will clear it without further issues, but the virus lingers in about 10 percent of infected women and can lead to precancerous cervical lesions. While these abnormalities can often be caught by Pap smears and removed by procedures such as LEEP (a minor surgical procedure), such medical interventions that may be painful and psychologically distressful. And they can be largely avoided now via vaccination. (Full disclosure: I’ve had a LEEP procedure previously, and it was both painful and a cause of later stress.)

Counterintuitively, these interventions, which prevent early stage pre-cancers from progressing, add to the misconception promoted by anti-vaxxers “that HPV is rare, and that cervical cancer is even more rare,” cautions Berenson. If it is so rare, some opponents of the vaccine argue, why do we need a vaccine? The reality is that many cervical cancer deaths are only prevented by screening and surgical removal of these pre-cancerous cells; the vaccine can prevent those pre-cancers from occurring in the first place.

Morality also comes into play here. An early argument against the vaccine was that it would promote promiscuity; multiple studies have demonstrated it doesn’t. Even so, “social conservatives have used this argument to counter HPV vaccine mandates, arguing that it would infringe on the rights of parents to discuss sex with their children when and how they want to,” says Berenson. It’s understandable that the idea of frank discussions about sex is concerning to parents — I have two teens myself — but avoidance only leaves them vulnerable to infection.

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Then there’s the idea that the vaccine hasn’t been tested enough. “Though it has been on the market in the U.S. for 13 years, there is the misconception that the vaccine is still ‘new,’” notes Berenson. Yet there are newer vaccines that lack such controversy, including several of the vaccines that prevent meningitis.

Anti-vaxxers are playing into Americans’ existing fears and concerns about “Big Pharma,” a savvy strategy right now.

And finally, people may think that because protection is not perfect, it’s not worth getting (something also known as the “Nirvana fallacy"). One of the first HPV vaccines, Gardasil, protected against four strains of HPV: types 6 and 11, which cause genital warts, and types 16 and 18, which cause cancer. Berenson notes that as there are over 100 types of HPV, this vaccine did not prevent infection from all of them — but it’s still highly effective. The new version, Gardasil-9, adds protection against five more types of cancer-causing viruses, and is estimated to prevent about 90 percent of cervical cancers.

Money is also a factor. Anti-vaxxers are playing into Americans’ existing fears and concerns about “Big Pharma,” a savvy strategy right now. But the fact is that most vaccines make very little money for drug companies. The HPV vaccine is one of the few that has been profitable for the manufacturer (drug company Merck). But this is relatively rare in the vaccine industry. Many companies have abandoned the vaccine business due to low profit margins. For Merck, global sales for the first quarter of 2019 totaled $10.8 billion; Gardasil and Gardasil-9 accounted for $838 million of that sum. That seems high, but it should be noted that figure is sales, not necessarily profits. In the U.S., vaccination has been found to be cost-effective when compared to treatment of HPV-associated cancers. And while anti-vaxxers may suggest physicians who recommend the vaccine are profiting, research shows that vaccines as a whole are often money-losers for doctors. They recommend vaccines because they work, not because they are making doctors wealthy.

As part of the government’s Healthy People 2020 goals, 80 percent of adolescents would be vaccinated for HPV by age 15. We’re currently hitting about half that rate nationally, with considerable variation state-by-state. In contrast, Ireland has recently increased their HPV vaccination rate to 70 percent; in Australia, where the vaccine was developed, about 75 percent of boys and 80 percent of girls are vaccinated. We can do better.

We have a vaccine that prevents an assortment of cancers, but we cannot allow misinformation and anti-scientific mumbo jumbo to slow our progress. The HPV vaccine remains under-used, and anti-vaccine movies and conferences could make it more so if we’re not careful. We all need to step it up to protect our children: parents, physicians, legislators. Fighting an organized misinformation machine is an upward climb, but 60 million kids have shown the benefits of the vaccine. Australia is setting its sights on the elimination of cervical cancer. We sent a man to the moon; surely we can fight harder against a mere virus — and those determined to enable it.

CORRECTION (July 25, 2019, 6 p.m. ET): A previous version of this article misstated Del Bigtree's role. He is not connected to the documentary, “Vaxxed 2: The People’s Truth.”