The truth about the HPV vaccine

Presidential hopeful Michele Bachmann drew ire last week when she stated that the human papilloma- virus vaccine "could potentially be a very dangerous drug" with serious side effects. Responding to a ques- tion on The Today Show about her criticism of Texas governor Rick Perry, who issued an executive order man- dating the HPV vaccination for pre- teen girls in his state, Bachmann cited an incident in which a Tampa woman apparently confided that her daughter had suffered mental retardation after getting the HPV vaccine.

The American Association of Pe- diatrics quickly refuted Bachmann's implication, stating that there was "absolutely no scientific validity" to her claim, and Bachmann herself ad- mitted in a Fox News interview that she had "no idea" if there was a causal link between the HPV vaccine and mental retardation. Nonetheless, the inflammatory comments prompted public health figures to speculate that already-dismal HPV vaccination rates in the U.S. may decrease further due to the negative publicity, with one expert estimating that the vaccination rate will decline for the next three years due to this single incident.

Political fear mongering about important health issues is never war- ranted, but the potential effect of Bachmann's statements reflects a greater complication in the public health sector. An alarming proportion of the American public is misinformed about its health care choices, and con- sequently, bases important decisions

on emotional factors derived from cultural tensions agitated by barely- evinced statements like Bachmann's— and this is the real danger.

The New York Times reports that in the U.S., 44 percent of women in the 20-24 age group have been infected with HPV. It is the most common sexually transmitted infection, yet somehow, it has largely escaped public awareness. If parents are reluctant to give consent for their daughters to re- ceive the HPV vaccine, they are likely unaware that half of sexually active men and women contract HPV at some point in their lives. Some parents point to the relatively low rate of cervical cancer in the U.S. as an indication that the vaccine is unnecessary, but they may not realize that the HPV infection is linked to other sexually transmitted infections and other types of cancer. Others are outraged that STIs should be a concern for pre-adolescent chil- dren, but the ideal vaccination age of 11 or 12 makes sense because the drug works most effectively if administered well before a patient becomes sexu- ally active. Because of extensive media coverage, most parents do know that the HPV vaccine was once linked to autism. However, this link was proven false by a recent report by the health arm of the National Academy of Sci- ences, the Institute of Medicine. Final- ly, because the vaccine only safeguards against one of the myriad potential consequences of high-risk behavior, there is no rational basis that vaccinat- ing young people against HPV permits or encourages promiscuity.

Why is the general public ill-in- formed about HPV? In short, because politicians, journalists, and even par- ents choose to focus on more interest- ing aspects of the HPV vaccine rather

than the more mundane truth about what it can offer. A sensational contro- versy about the sexualization of young girls, an archaic resistance to the idea of vaccinations in general, and a (now– broken) link to the pressing medical issue of autism all compete for our at- tention against the facts of the matter. This conscious choice to get caught up in controversy is aided by an exagger- ated cultural aversion on the part of pediatricians and parents to approach a topic mildly related to children's fu- ture sexuality. This results in a climate in which parents are hypersensitive about the HPV vaccine and doctors are apprehensive about discussing it in depth. Controversies, like Bachmann's recent unfounded link between mental retardation and the vaccine, overshad- ow the presence of credible sources of factual information about the real dan- gers of HPV.

In order for parents to make in- formed decisions, however, they must set aside emotional obstacles that are motivated by controversies that reso- nate with cultural and religious factors. Instead they ought to listen to medical experts to truly understand what's at stake. At the same time, health ex- perts must overcome their discomfort with parents' emotional concerns and strive to convey the necessary facts in a sensitive manner. Should HPV awareness and vaccination rates in- crease, the HPV vaccine could serve as a model for public health movements. For patients, it could set the tone of a decision-making process that is largely informed by medical expertise and the bigger picture of public health, not driven by politics, culture or religion. It's time we distinguish between our emotional comfort and our physical health.