Stop an STD-Before 6th Grade?

Stop an STD-Before 6th Grade?

March 2007 story in Time magazine calls HPV vaccination “the most heated public health matter of the moment.” Even if states like Michigan weren’t considering school mandates, the notion of vaccinating preteen girls against sexually transmitted disease still would be pushing hot buttons across the social spectrum.

Two SPH faculty members are at the forefront of discussion nationwide about Gardasil, Merck’s newly FDA-approved vaccine against four strains of human papillomavirus that cause the majority of genital wart outbreaks and precursor lesions for cervical cancer.

Gary Freed, a professor of health management and policy and director of general pediatrics at UM, also chairs the U.S. Department of Health and Human Services’ National Vaccine Advisory Committee. Taking HPV “to the population level” with a school mandate will not ensure that it reaches all young women, unless there is adequate funding that is made part of any legislation, he said in a recent UM Ethics in Public Life discussion about pending bills in the Michigan legislature.

“This vaccine has caused a lot of public consternation for better or worse,” Freed said. Although he recognizes the difficulty some parents are having with the idea of vaccinating young girls with Gardasil before they are sexually active, he cautions against creating “a culture of vaccine refusal” through legislative actions that come close to encouraging parents to reject the vaccine, which could in turn threaten success with other recommended childhood vaccines.

Janet Gilsdorf, professor of epidemiology and director of pediatric infectious diseases and immunology at UM, headed the federal Advisory Committee on Immunization Practices that gave Gardasil a green light in 2006.

Gilsdorf says that “good science” was behind the ACIP’s recommendation. To begin with, the problem is prevalent: up to a million cases of genital warts occur each year in the U.S., and 4,000 American women annually die of cervical cancer, with women of color disproportionately affected. About 80 percent of women acquire some form of HPV by age 50.

Gardasil could change that. Because clinical trials showed it to prevent HPV infection so well, Gilsdorf deems it a “very effective vaccine.” The key to prevention, she explains, is vaccination before the girl’s first sexual encounter. That’s why ACIP recommends the HPV vaccine be routinely given to girls ages 11–12. She doesn’t worry about the safety of the vaccine, because it’s “not a live virus.” Rather, it's a protein that clears from the body quickly after stimulating the immune system, leaving behind only antibodies. The duration of its efficacy is not yet clear.

Gardasil currently costs a hefty $360 and must be administered in a three-shot series across six months. Expense is one kind of roadblock. Lack of understanding about the vaccine and its benefits is another, and that’s the one Freed and Gilsdorf are working to overcome.

The UM Global Health Research and Training Initiative co-sponsored the March ethics panel where Freed and Gilsdorf spoke. Director Sioban Harlow said health experts in the developing world are closely watching the debate about HPV vaccination in Michigan and the rest of the U.S. In parts of Africa, cervical cancer is a leading killer of young women.

By Mary Beth Lewis.

Send correspondence about this or any Findings article to the editor at sph.findings@umich.edu. You will be contacted if your letter is considered for publication.

The key to prevention is vaccination before the first sexual encounter.

AUGUST 2007 UPDATE from UM Health System:

Millions are parents are struggling to decide if the HPV vaccine is right for their child. To help, a University of Michigan pediatrician looks into the fact and fiction of this controversial vaccine, and offers parents some advice and guidelines (with video).