Over the holidays I was out at a bar with some old friends when one of them mentioned that Gardasil, the vaccine for the Human Papilloma Virus, was making women seriously ill. As is sometimes the case with arguments that break out in bars, the ensuing exchange with my friend about vaccines ended when he either attempted to slap me across the face or just very furtively instructed me to talk to the hand. For my part, it was too late in the evening to keep a poker face up and my response to hearing an anti-vaccine argument in the safety of my hometown dive wasn’t all that diplomatic.
So let’s start over, shall we? Those I know personally from the anti-vaccination crowd are not pie-eyed lunatics who accost people on the bus to warn them about safeguarding their precious bodily fluids. Nor am I a paid shill for some pharmacological-industrial complex. (The closest I come to “Big Pharma” is the GlaxoSmithKlein building near my office and I sometimes delight in watching the stuffier GSK employees try to figure out how to use the subway. Full disclosure.) We want fewer people to get sick and we don’t want anyone taken advantage of.
But who is better informed, the defenders of the HPV vaccine or its many discontents? The safety of a vaccine is not merely a matter of opinion, though the interpretation of the same data is leading us to radically different conclusions.
It’s important to get this right not just for epistemological reasons. Whether you go around encouraging people to get vaccinated or try to scare people away from it, there are serious implications. It is literally a question of living and dying. That much we should agree on. It’s not enough to defend your opinion with “something you read somewhere.” You’d better be asking yourself whether you’ve been spreading lies about the HPV vaccine because, if you haven’t done your research, the answer is very likely yes. If you have been ignorantly dolling out fraudulent medical advice to your friends and relations, that’s not an easily forgivable peccadillo. But I can assure you of this much: it’s not entirely your fault.
THE NEWS IS TERRIFYING
Anyone who is concerned about the safety of the Quadrivalent Human Papilloma Vaccine (qHPV) is likely to have read something about the untimely death of a young woman named Natalie Morton in 2009. Shortly after being administered a dose of Cervarix, Natalie died. (GSK’s brand name for the qHPV is Cervarix and Gardasil is the Merck marketing name.) This Daily Mail headline from September of that year is just one example of the sensationalist horror show that followed:
“PARENTS REVOLT AFTER GIRL DIES IN CANCER JAB HORROR”
After insinuating that there was some correlation between the Cervarix shot and the young girl’s death, the article ends ominously: “Over 1.4 million doses have been given … But in the U.S. 29 women died after taking similar vaccines, and scores of teenagers and women have suffered neurological paralyzing conditions.”
The Daily Mail is not exactly a bastion of reasoned science reporting. But nor was this article far outside the bounds of typical coverage from mainstream American publications.
In an article titled, “Should Parents Worry About the HPV Vaccine?” CNN announces that Gardasil is “coming under fresh scrutiny” after the CDC reported some seven thousand adverse health events in women and girls who got the shot. The article fails to mention that, also according to the CDC, the qHPV is completely safe.
“Girls and women have blamed the vaccine for causing ailments from nausea to paralysis – even death.” Yes, even “ailments” like death. And as if to minimize the need for a vaccine, the article adds that HPV “can cause cervical cancer in relatively small numbers of women and girls.”
Or consider this headline from Fox News in 2007 that upstages the ever-breathless Daily Mail: “28 Women Miscarry Receiving HPV Vaccine Gardasil: FDA Says No Reason to Re-Examine Approval.”
Christ! This vaccine is killing people and no one is doing anything about it. If you’re an average news consumer, what other conclusion could you possibly come to? While Fox, CNN, and the Daily Mail aren’t by any means the vanguard of professional journalism, they are absolutely mainstream sources of news. If you’re in a waiting room or an airport terminal – where you have no choice but to sit there in front of cable news – CNN is telling you that Gardasil is decimating the population.
Natalie Morton’s death, I’m sorry to say, is not a hoax. She did die shortly after getting the jab. The twenty-eight women mentioned in the Fox news article probably did have miscarriages. And as many similar publications rushed to point out there were thousands of adverse health effects attributed to the qHPV. (The exact number varies depending on the source and time of publication.)
POST HOC ERGO PROPTER HOC
As tragic as these stories are, one phrase should pop into your head when you read these desperate accounts: post hoc ergo propter hoc. It happened after it, therefore it happened because of it. The reporters fell headlong into this logical fallacy. In daily life, it’s pretty easy to tell why this is way of thinking leads you to a faulty conclusion. If you jump up from the couch to grab a snack from the refrigerator and at that moment the lights in your house go out, chances are the power lines didn’t collapse because you had the munchies, even if you were gripped by a sudden hunger immediately before.
Of course it’s possible that a vaccine can trigger serious health problems. Unless you got it from a homeopath, your medicine is going to have a pharmacological effect and in order to assess the safety profile of that medicine you need research data. A handful of anecdotes on the news do not constitute data.
The Center for Disease Control, however, helpfully tells us that in the initial clinical trials for the qHPV, about 60,000 women and girls were given the shot. 29,000 received Cervarix and 30,000 received Gardasil. And from 2006 to March of last year, 57 million doses of the qHPV have been administered. Of those 57 million women, 22,000 reported “adverse health effects,” which the CDC describes as “an undesired side effect or health problem that occurs after someone receives a vaccine or medicine. It may – or may not – have been caused by the vaccine or medicine.”
From this six-year study, we can conclude that if you get the HPV vaccine, there is a .003% chance of experiencing a side effect that may or may not be related to Gardasil or Cervarix. In a group of people that large, this is the rate of illness that you would expect to occur even if no medical procedure had taken place. There is no evidence that the vaccine causes serious health problems – and if it does trigger the rare complication, the effect was not statistically significant enough to register even a modest blip on the CDC’s radar. In other words, if we could prove with complete certainty that Natalie Morton died because of Cervarix, hers would be the only known case of such a calamity in a sample size of 57 million.
Compare that safety profile to the statistics on cervical cancer from the World Health Organization. In the United States, approximately 12,000 women are diagnosed with cervical cancer each year. One third of them will die from it. Worldwide, it’s about half a million cases of cervical cancer with roughly the same mortality rate. The lesions caused by the Human Papilloma Virus are a risk factor for developing cervical cancer. If you prevent the virus, you can prevent cervical cancer.
SO DOES IT WORK?
As it happens, HPV is the most common sexually transmitted disease. There are over one hundred distinct strains** of the virus and 79% of us, men and women, will get one of them in our lifetimes. While men don’t experience any symptoms from HPV and obviously are incapable of getting cervical cancer, we can still carry it and spread it. The virus is so ubiquitous that, as a doctor once told a friend of mine, “HPV is a no blame-game situation.” If you’re a sexually active woman who gets routine Pap screenings and your partners always use condoms, it’s true that the chances of you getting HPV are lower than they would be otherwise. But HPV, like genital warts, is tricky because condoms don’t always cover it – literally. Then consider the number of couples who will opt for the Pill rather than condoms, or people who have unprotected sex for any number of reasons.
The vaccine is not live, by the way, but contains only the antigen that allows your immune system to identify and attack the virus should you become infected.** The misconception that modern vaccines can give you the disease they are designed to prevent goes back to Edward Jenner’s time. Cervarix and Gardasil target different strains of the virus — but neither of them infect you with it.**
To recap: we know that HPV is extremely common, and we know that cervical cancer can kill you but the vaccine cannot. What can the vaccine do? After the third round of shots, the qHPV is basically 100% effective at preventing pre-cancerous lesions. The immunity lasts for about five years and considering that the at-risk age range for HPV is 16-26, 99.5% immunity from cancer-causing sores is pretty damn good.
Now that you’re equipped with the facts, I really recommend that you go back and read that hand-wringing clickbait from the Daily Mail, CNN, and Fox. Do you see how badly they’ve distorted the truth by emphasizing anecdote over data? Do you see how harmfully misleading they are? I hope that you feel the same wash of nagging frustration reading sloppy reportage and half-truths. The average person trying to figure out whether or not this vaccine is safe needs to cut through a dozen layers of bullshit to get to the key figures about the qHPV: it’s about 100% effective and about 100% safe. And by the way, according to Dr. Caron Grainger of the NHS, Natalie Morton’s post-mortem examination “revealed a serious underlaying medical condition which was likely to have caused death.” So stop using a dead girl and her suffering parents to spread lies about the HPV vaccine.
THE TRUMP CARD
There’s still a problem. Even if I had the presence of mind at the bar a few months ago to lay out the argument I just made, my friend’s rebuttal might have sounded much the same. In my experience a typical vaccine denialist will vacillate between the argument that the qHPV kills women (or, alternately, gives them HPV) or that it doesn’t work. Both of these arguments are so demonstrably untrue that anyone who advances these claims is admitting to never researching the subject beyond reading a Fox News headline. This isn’t just intellectually wrong. I genuinely think it’s morally suspect, too. If you tell someone that a vaccine is unsafe, you are spreading a toxic lie that, if successful in sowing doubt, has a significant chance of damaging her health.
If you just perused the headlines and were mislead by shoddy reporting, that’s a mistake that can be corrected. But behind this scattershot criticism there is an underlying ideology as tedious as it is intellectually lazy. If you think all this vaccine business is just a plot by Big Pharma to sell drugs, I’m talking to you.
It’s lazy because the idea that the FDA – or whoever – is controlled by political operators who take money from lobbyists from the pharmacological industry allows you to discount the fact that the qHPV is, again, about 100% effective and about 100% safe. But GlaxoSmithKlein and Merck conduct the clinical trials themselves – of course they’d say that the vaccine is safe! The FDA is corrupt! They’re all in it for the money! How can we trust anything they tell us? In order assert any of this, you have to believe that GSK, Merck, the FDA, and the CDC spend thousands of hours falsifying years worth of research, involving tens of thousands of medical professionals and researchers, risking millions of lives so that they could make money off of a dangerous or ineffective drug; and that making money off a dangerous or ineffective drug would be more profitable than making a safe, effective one and doing real research.
If that weren’t implausible to the point of absurdity already, let me point out that of the many thousands who need to be implicated in this plot – the clinicians, the researchers, the patients, and the regulators – not one of them has leaked a single word of it to an alarmist media who are already poised to print stories about the dangers of vaccines. This isn’t an argument. Hell, it’s not even a hypothesis, because there’s no way of falsifying a claim that doesn’t rely on evidence in the first place. It stems wholly from one’s ill will towards government and business.
Look. I get it. I’m also reflexively anti-authority and I’m leery of the motives of for-profit pharma companies and the aristocrat-managed agencies charged with monitoring them. But you have to think, and think critically. It’s not enough to just feel like something is wrong. If you content yourself with basing your opinions on a vague wariness about these institutions, you veer into the realm of conspiracy thinking (which is in itself a misnomer.)
This conspiracy wouldn’t just implicate American institutions like the Food and Drug Administration and Centers for Disease Control. It would require international collusion with the World Health Organization, the UK’s National Health Service, and the comparable regulatory agency for every country on the planet that is administering the vaccine. There would have to be millions of co-conspirators falsifying research, making up data entirely, and somehow concealing thousands of unexplained deaths. The size of your conspiracy theory balloons out so quickly that it collapses under the weight of its own preposterous conclusions.
Ditch this mode of non-thinking. Really. It will make people stop taking you seriously. (Either that, or find me a copy of the sinister memo addressed to UN General Secretary Ban Ki Moon trying to convince him that Operation: Fake Vaccine isn’t the stupidest way of making easy money since Tupperware parties.) It’s the kind of rambling, freewheeling trash Donald Trump was talking on Fox News in 2012 linking vaccines to Autism:
Donald Trump doesn’t need evidence because Donald Trump knows cases.
And don’t forget Rep. Michelle Bachmann, whose countless embarrassments during the 2012 presidential election included her claim that the HPV vaccine causes mental retardation. During a Republican primary debate where Texas governor Rick Perry prided himself for an executive order mandating that adolescent girls be given the HPV vaccine, Bachmann retorted:
Let’s leave aside the fact that a case of crony capitalism – which I’m not defending – has nothing to do with the efficacy of the vaccine. Bachmann wasn’t content with that. The next morning she went on Fox News – are you noticing a pattern here, yet?
Yes, Michelle Bachmann is claiming that a presumably adolescent girl became “retarded” because of the qHPV. Who was it? When did it happen? It doesn’t matter. Who needs evidence when you have a really good feeling that something is really bad? Bachmann’s opposition to the HPV vaccine is also rooted in her religious fanaticism. Because the Human Papilloma Virus is a sexually transmitted disease, helping to prevent cancer by creating a vaccine for it will – obviously – make teenage girls go out and have lots of sex. (Consider for a second that the fanatics who tell people they can’t have sex outside of marriage have resorted to threatening girls with cancer in order to keep them chaste. As Rebecca Watson put it, “No one should be allowed to have fire extinguishers because it will encourage people to start fires.”)
Listen, I know it’s easy to make fun of Michelle Bachmann and Donald Trump. But you should know at least this is what you sound like when you toss out all the evidence because it doesn’t fit into your worldview. This isn’t only a smokescreen that obscures the truth about vaccines’ efficacy. It also diverts us from several valid concerns about pharmacological industry, how they market drugs, the prohibitive cost of said drugs, as well as arguments about women’s health and reproductive rights.
But don’t take my word for it. Check out the sources for further reading.
**CORRECTION: I originally wrote that there were four distinct strains of HPV and that Gardasil and Cervarix targeted two of them. In fact there are over one hundred strains. Gardasil contains the antigens for two strains that cause cervical cancer and two strains that cause genital warts. Cervarix targets just two strains. Additionally, the antigens in the qHPV do not “kill” the virus, they allow your immune system to identify and destroy it should you be exposed to it. Many thanks to my friend the brilliant Peggy Nguyen, who is working on her Pharm.D. and actually knows what she’s talking about, for offering the corrections.
“The HPV Vaccine,” Stephen Novella. Neurologica Blog. 30 September 2009.
“The HPV Vaccine (Gardasil) Safety Revisited,” Joseph Albietz. Science-Based Medicine, 18 September 2009.
“Keep Faith With Cancer Jab Plea,” BBC. 30 September 2009.
“Cost effectiveness of HPV vaccination compared with Pap smear screening on a national scale: A literature review,” Techakehakij, Feldman. Vaccine, Vol. 26, Issue 49, 18 November 2008.
“Condom use and the risk of genital human papillomavirus infection in young women,” Winer, Hughs, et al. New England Journal of Medicine, June 2006.
“Postlicensure safety surveillance for quadrivalent human papillomavirus recombinant vaccine,” Slade, Leidel, et al. JAMA, August 2009.
“HPV Vaccination Misinformation and Bias on Medscape,” David Gorski. Science-Based Medicine, 4 August 2008.
“Toxic Myths About Vaccines,” David Gorski. SBM, 18 February 2008.