Saturday, March 27, 2010

Opinion: HPV Policy

With all the HIV talk and my laborious posts on restriction factors I think this article is a good opportunity to branch out a little bit. Lets talk a little HPV policy.

Fighting viruses is tough. They don’t play by the same set of rules that other pathogens play by. At some point during my first semester in gradschool while drinking with fellow virologists we drafted a poem about the epic journey gradschool was going to be (yes ,we really are that lame, please facepalm for us….now). One of the last stanzas is.

For the virus is an awesome foe

Against which mankind has little to show

For how much time must mankind give

To finally kill that which does not live

Although corny, it is true, we have had trouble fighting viruses. The distribution of Cervarix from Glaxo Smith Kline and Gardasil, from Merck are one of the highlights of virology in the last 10 years. Not only is it a vaccine against a virus, it is a vaccine against cervical cancer. The Merck vaccine also has the added benefit of protecting against some types of genital warts, this may not be a lifesaver but from what I have seen in high school health class, that is one hell of a benefit.

Vaccinology can bridge the gap between bench science and public policy. Lets face it, public policy can be a complicated thing. Since men lack a cervix this vaccine was not initially approved for them (in the USA), many doctors do not stress its importance for men and I am not sure if it is even covered by most insurance companies yet. Despite the fact that something that would protect me from warts down there would be much appreciated (yes I had to link it). I am sure the cost benefit analysis has a little something to do with the decision, these vaccines are expensive to make.

It has been my opinon (I am not a doctor) that it is stupid not to vaccinate men. We sometimes forget in our self-centered society that vaccines are not for the individual. Vaccines do not do too well if most of the population is not vaccinated, especially when dealing with pathogens that can mutate quickly. Vaccines work best through herd immunity. Aggressive vaccination and high compliance rates protect the whole population, including those who have not received the vaccine. This is how smallpox and hopefully shortly polio will be eradicated.

Although, men cannot get cervical cancer from HPV 16 and 18, they can carry the virus and not even know it. Unless 100% of women get the vaccine before they become sexually active (putting a good age on this has been problematic) then women will still die from a preventable form of cancer. Things like that really bother me. Now, if you vaccinate both the carrier (men) and the women you lower the chances two individuals will transmit the virus. The occurrence of infection goes down over time in the population and the chances an unvaccinated person becoming infected rapidly decrease. Unfortunately, policy does not always work that way.

It is more unfortunate that the rise of another form of cancer may help me get my wish. It turns out that HPV 16 and 18 can cause another type of cancer, and it is on the rise. This one knows no gender barrier. Rates of HPV positive oropharyngeal squamous cell carcinoma (OSCC), a so called “head or neck cancer” have gone up by 70 percent in Stockholm since the 1970s and by 50-100% in the last 10 years in the United States. Oral sex is thought to account for the increase.

These findings are going to force the policy makers to reconsider a lot of positions. First, they are going to have to decide if men should be strongly encouraged to be vaccinated. They are also going to have to wrestle with the question of at what age the vaccine should be administered to women (hopefully men too) to insure they receive the series of shots before they become sexually active, including oral sex. Many have oral sex before having other more penetrative forms of intercourse. For OSCC prevention it may turn out to be too late for teenage and young adults, particularly men. Hopefully policy goes at a faster pace than science.

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