HPV and the future of our girls

There are more than 100 types of the human papilloma virus, or HPV, which causes warts or kulugo, including genital warts. But two types—16 and 18—have not only been linked to cervical cancer but have also been found to cause 71 percent of all cervical-cancer cases worldwide. Other types—45 and 31—have been linked to another 9 percent of cervical cancers, but there has as yet been no vaccine created for these types, or for other types that affect the remaining 20 percent of affected women.

Clarice (I will not use her surname) thought she had been protected from cervical cancer when she took shots of the required three doses of the HPV vaccine some years back. Imagine her shock when, just two months ago, she went for a checkup because she had been bleeding—and was diagnosed with cervical cancer. After genotyping, her doctor told her that the HPV type that infected her is not covered by the current anti-HPV vaccines, meaning she fell among the 29 percent of cases for which no protection is as yet available.

Now 36, Clarice admits that the first question that occurred to her was “Why me?” But after talking things over with her husband and two sons, they collectively decided that “we won’t let cancer beat us.” So after 28 sessions of radiation, six rounds of chemotherapy, and three brachytherapy sessions, a fully made-up Clarice showed up at a forum on HPV, cervical cancer and prevention through vaccination called “Do Women Really Need Cervical Cancer Vaccine?” to tell her story and announce her resolve. She shared the stage with two other women who both confessed to reluctance to call themselves “survivors” because, said one, “cancer is cancer.”

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Clarice’s case is also stark proof that the HPV vaccine is not the “magic bullet” that some have portrayed it to be. Certainly, it will not protect all women who have been vaccinated from getting cervical cancer. Although, to my mind, protecting 71 percent of women from a debilitating, fatal disease like cervical cancer is nothing to sneeze at either.

Recently, there have been reports that the Department of Health is embarking on a revivified vaccination drive timed with the opening of school. This year’s program, said Dr. Minerva Vinluan of the DOH’s school-based vaccination program, starts in August, which is designated as “Adolescent Immunization Month.” The DOH will provide free vaccinations to all students in Grade 1 or higher in public schools against the diseases tetanus and diphtheria, and measles and rubella. At the same time, it will provide free HPV vaccinations to all girls from nine to 13 years old in public schools in 20 priority areas of the country. (The National Capital Region, though, is not among them.)

The reason the HPV vaccine is targeted toward girls in their teens and preteens is “they stand to benefit the most” from the vaccine, said Dr. Ricardo Manalastas of the UP College of Medicine/Philippine General Hospital. This is because the girls are presumed to be, in Manalastas’ words, “virgin to HPV”—that is, they have not been exposed yet to HPV, which can be transmitted by “skin-to-skin” contact with no need for penetrative sex.

Another reason, said Dr. Cecilia Llave also of UP-PGH, is that “you have higher immunity levels when you are younger.”

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Apparently, some groups are against this program of the DOH for the reason that, in the words of Princess Nemenzo of WomenHealth, “this is the first time we have heard about the vaccine and already it will be offered to girls all around the country.”

Well, actually, the HPV vaccine has been around for some years. It already has local approval and accreditation from the Food and Drug Administration, and is supported by the World Health Organization. In Australia, the vaccine (the quadrivalent type) is offered for free to girls and to boys for protection, not just against cervical cancer (which affects only women), but also genital warts which have been linked to such cancers as penile cancer and oral and throat cancer. In the United States and the United Kingdom, the vaccine is offered through health providers and covered by health insurance.

Nemenzo’s major argument was also based on the quality of consent which is asked of the parents of the girls receiving the HPV vaccine. Dr. Vinluan said they not only seek consent but also offer parents and even students orientation on the mechanisms and side effects of the three-cycle vaccines offered to the girls.

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Having covered and written about HPV, including the HPV vaccine for a good number of years, and been long frustrated with the lack of interest among health policymakers in the existence of a vaccine that could prevent over 70 percent of all cases of a form of cancer that mainly afflicts women, my initial reaction to news of the DOH vaccination program was elation.

Finally, I thought, the government found it in its heart, and its budget, to respond to a disease that kills on average 12 women a day—about the same rate as maternal deaths.

That the vaccine was not being made available to Filipino women and girls mainly because it is deemed expensive seemed to me the height of injustice and inequality. Isn’t it about time we used our tax money (funding for the program is supposed to come from “sin taxes”) to save the lives of women? Aren’t our women and girls worth the expense and the effort?

Of course, the vaccine is not all there is to prevent and treat cervical cancers. We still haven’t touched on screening and treatment. Indeed, the HPV vaccine is really an investment in the future—in the future of the girls whose lives as women will, we hope, be free of at least this one debilitating and deadly disease.