There has been a hue and cry regarding the HPV vaccination and its potential side effects, with rumours circulating that the vaccination will make girls infertile. People have been asking that if HPV is equally dangerous for both men and women, then why are only girls being vaccinated. And so on.
Therefore, it is imperative to address concerns, create awareness about HPV’s deadliness and highlight the global need for vaccination for HPV eradication.
The Human Papillomavirus (HPV) is one of the deadliest viruses, first linked to cervical cancer in the 1980s. Later studies showed that HPV is not only responsible for cervical cancer but also for anal, penile, vulvar, oropharyngeal and throat cancers in humans.
HPV is the most common sexually transmitted infection (STI) in the world, and over 80 per cent of sexually active men and women acquire at least one HPV exposure and infection in their lifetime. HPV has a number of variants, but HPV16 and HPV18 are the deadliest. Most HPV infections are asymptomatic and typically resolve on their own within one to two years. However, under symptomatic conditions, low-risk variants (HPV6, 11) lead to genital warts and recurrent respiratory papillomatosis (a rare condition), whereas exposure to high-risk variants (HPV16, 18) usually shows no symptoms initially but may lead to precancerous lesions and eventually to cancers if persistent.
Globally, over 600,000 cases and more than 340,000 deaths are reported annually. Over 5,000 women are diagnosed with cervical cancer in Pakistan each year and 60 per cent (3,000) of them die annually, making it the second most prevalent cancer in the country. This conspicuously establishes how deadly and dangerous HPV is, and highlights the dire need for HPV prevention and vaccination to save women, especially young girls.
The first HPV vaccine was approved and introduced in 2006, targeting HPV types 6, 11, 16 and 18. Similarly, GlaxoSmithKline developed and obtained a license for a bivalent vaccine, Cervarix, targeting HPV types 16 and 18 in 2009. Gardasil 9, which covers nine HPV types, including high-risk ones like 31, 33, 45, 52 and 58, was approved in 2014. In countries with high vaccine uptake (such as Australia and New Zealand), cases of genital warts and cervical precancers have dropped by over 90 per cent and efforts are underway to eradicate cervical cancer by 2035.
Recently, WHO, GAVI and Unicef launched this campaign in 150 countries, including Pakistan, aiming to save over 70 million women. In Pakistan, eight women die daily due to cervical cancer and 13 million are at risk and need protection.
Establishing the fact that HPV vaccination is indispensable for our girls' protection, let us review the public’s and parents’ concerns over the vaccine’s side effects. Parents are confused and concerned about whether HPV vaccination could make girls infertile. To date, over 120 million doses have been administered; however, no serious side effects, including infertility, have been documented. Like other vaccines, HPV vaccination may also have similar side effects, including injection pain, headache, fever, fatigue, fainting, etc. Hence, this fertility-related concern is baseless. On the other hand, persistent HPV-mediated infection and refusal of vaccination may make a girl more prone to infertility.
HPV equally infects men; however, anatomical differences make it a higher risk for women. In men, HPV clears up more quickly and efficiently than in women. At the same time, it is also a major cause of oropharyngeal and penile cancer in men. Hence, men should also be vaccinated. Vaccinating men would not only greatly help reduce HPV transmission and viral exposure but also contribute to herd immunity. Genital warts, oropharyngeal, anal and penile cancers in men are increasing, but still at a very low rate; therefore, the government of Pakistan, Unicef and Gavi have targeted young girls for free vaccination. I do recommend that parents also get their boys vaccinated, regardless of the extra cost.
Another common logic presented when refusing vaccination is: ‘Why are international organisations and the government of Pakistan so concerned about our girls' health and offering free vaccination? There must be some malicious intent behind it’.
The world has become a global village, and thousands of skilled individuals and students migrate to various parts of the world. These people could carry and transmit HPV to others. As a result, this exposure could reintroduce the virus into those environments, undermining all past efforts. Therefore, this campaign has been initiated simultaneously in 150 countries, including Pakistan, as part of collective efforts to eliminate HPV.
The HPV vaccine is solely designed and administered for the elimination of HPV-mediated cervical cancer, and the belief that it results in infertility is simply a misconception. Therefore, rather than believing such myths, parents must appreciate and thank the government of Pakistan, WHO, GAVI and Unicef, and get their daughters vaccinated and protected.
The writer is an assistant professor at MNSU, Multan. He can be reached at: muhammad.faisal@mnsuam.edu.pk
