Luistro on the HPV vaccine

“I did not rule out the HPV vaccine program, I merely asked for more time to study it,” Education Secretary Armin Luistro said in a phone conversation yesterday. The head of the Department of Education was reacting to Tuesday’s column (“Morals and HPV”) on the decision of the DepEd not to include the vaccine program on HPV in the just-launched national immunization program in public schools.

Luistro explained that the childhood immunization program has been routinely held in public schools for some years now, but that this year the Department of Health decided to include HPV vaccination, targeted at girls as young as nine years old, and on to preteens, in public schools in the 20 poorest provinces.

HPV, or the human papillomavirus, is a pretty common infection that causes warts. Most individuals would have experienced an HPV infection at one time or another in their lives, but these are most often fleeting and harmless. But there are certain types of HPV that can lead to more serious consequences, and certain individuals who can develop persistent infections. A persistent HPV infection can develop, in women, to lesions which can, in turn, develop into invasive cancer, most commonly cancer of the cervix.

Warts caused by HPV can also develop, in men, into other forms of cancer: of the anus, mouth or throat. But cervical cancer, which takes a decade or more to develop from lesions to cancer, is the far more common consequence of HPV infection. In the Philippines, it is estimated that the disease kills as many as 12 women a day. It is the second most common cancer killer of Filipino women today, next only to breast cancer.

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Now, to most parents, thinking about their elementary-age children at the same time as a sexually transmitted infection is, I’m sure, uncomfortable, if not off-putting. (HPV is said to be the most common STI.)

But parents must begin thinking of their children’s long-term welfare as early as infancy, which is why it is now routine to bring babies on their first monthly checkups for their “shots” that assure protection against the most common and pervasive childhood diseases. For sure, there are parents out there who are also “anti-vaxxers” or who adamantly oppose vaccination for their children. But they are, thankfully, in the minority, although they still pose a public health risk as every unprotected child threatens the integrity of the “herd immunity” that a population cohort enjoys. (The more children immunized, the fewer chances for a child to be exposed to an infectious disease.)

Girls (and boys) may not be exposed to HPV until they become sexually active (the virus is spread most commonly through intimate contact, specifically skin-to-skin transmission), but health authorities, including the World Health Organization, recommend that the HPV vaccine be given to prepubescent individuals because, first, they would most probably have not yet been exposed to HPV; and second, their immunity levels are at their highest and most effective at that age.

That may be why the DOH decided to include the HPV vaccine in the school-based immunization program. It “captures” the segment of the population most vulnerable to future HPV infection, and provides them free lifetime immunity against a disease that costs millions to treat.

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There had been speculation, mentioned by Health Secretary Janette Garin in news reports, that Luistro’s opposition to the HPV vaccine may have been based on his “discomfort” about a vaccine that may give young girls an “excuse” to engage in sex and thus “promotes promiscuity.”

But in our conversation, the good Christian brother from La Salle vehemently denied that that had been a reason for his action. “I talked with Secretary Garin and asked her if we could have more time to discuss the logistics and the science behind the program,” Luistro said, explaining that he knew very little about HPV and its links to cervical cancer beyond a preliminary “Google search.”

Also, said Luistro, he had been receiving countless e-mails, letters and phone calls from concerned individuals, including some medical doctors, questioning the efficacy of the HPV vaccine, the expense involved, and whether other, more common diseases did not deserve greater attention and funding.

The education secretary assured me that he would keep in touch with Garin and settle the issues raised against the HPV vaccine and work out the logistics of “singling out girls for another shot” should the HPV vaccine be included in the school-based program. (I have a suggestion: Include the boys, too! They also deserve protection from cancers linked to HPV.)

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For now, according to news reports, the HPV vaccine will still be given for free to girls in the 20 targeted poorest provinces in health centers. This entails more complicated arrangements, though: tracking the girls of the same age group in their homes; getting the parents’ permission and convincing them to bring their daughters to the health center; and keeping track of them for their second (or third) shots. Expectedly, given the difficulties of going door to door, such a program would net a much narrower field, a much smaller number of girls protected against the deadly consequences of a cancer-causing viral infection.

The girls in the original target group, mind you, live in the poorest provinces and belong to the poorest families. If and when they fall prey to persistent HPV infection and its deadly outcome, the chances of their overcoming and surviving the disease are dim, at best.