The HPV Vaccine and Autoimmune Disease

Theme: Ethics and Controversy

Carlotta Ceccarelli

We have been told that the future of cervical cancer may lie in a Human Papillomavirus Vaccine. For women that may have their bloodline tainted with it, this could sound like a miracle. With just two vaccination shots, both males and females can eliminate the risks of a woman obtaining some of the rarest and most aggressive forms of cervical cancer: small cell neuroendocrine carcinoma [1]. In countries like Malaysia, school-based free immunisation programmes are highly successful, having roughly a quarter of a million girls between 12-13 years old vaccinated annually [2]. As an immunized person myself, it was an unquestionable decision my family made to vaccinate myself and my two little sisters. But there are cases like Ruby Shallom’s that leave a bad taste in your mouth: today she is left wheelchair bound, her entire body paralysed apart from her left arm. Whether the link between autoimmune diseases and immunisation is evident or not, here we will be addressing the rather contentious implications about vaccinating at present day.

Ruby Shallom, an 18 year old from Bracknell is suffering from Functional Neurological Disorder allegedly stemming from the vaccine shot she took from school 5 years prior. Severe psychological issues from this leave her battling with depression to a suicidal degree; although it remains unclear as to whether the vaccine truly played a role in this unfortunate situation, cases like these can influence societal stigma surrounding it [3].

Firstly, it is important to outline what HPV actually is, establishing its role in cervical cancers. HPV is an abbreviation of the ‘Human Papillomavirus’, a sexually transmitted infection that produces papillomas (a small wart-like growth on the skin). HPV is the most common type of STI, most people are infected with it at one point in their lives- some even live without ever knowing. Approximately a dozen out of the 200 types of HPV can infect your genital area and cause complications that are higher in risk such as cancer, whereas only 2 types can result in the formation of benign warts [4]. In Malaysia, immunisation is provided free for all citizens and permanent residents. The types of Vaccines offered and managed by hospitals are the Cervarix, Gardasil 4 and Gardasil 9 [5].

Despite all types of HPV vaccines granting at least 70% of protection against cervical cancers [6], immunisation rates remain critically low in countries such as the USA. Approximately 16% of adolescents in the US have been fully vaccinated [7], which is nowhere near an adequate proportion for a shot that is deemed as highly functional. A contributing reason for this would be the common perception that adolescents are not sexually active; with healthcare already being expensive there, parents often can’t construct the necessity. However more significantly in females, it is the concerns regarding the safety of the vaccination [8]. More often than not, extreme cases like Ruby Shallom’s and reports of adverse autoimmune events repel caretakers from immunizing their children.

According to the US national library of medicine, a study in 2014 found that out of 67 million administered doses, there were roughly 25,000 adverse event reports. 92.4% of these adverse reports were not considered serious- meaning they were not life threatening and did not result in death, permanent disability or abnormal conditions at birth [9]. However the issue lies within the spectrum of ‘serious’. Autoimmune diseases such as rheumatoid arthritis may not result in death nor result in a severe case of disability, however the lifelong physical and mental debilitation could be truly undermined. A case like this could contribute to the 92.4%, and some families would opt to not risk it. In addition to this, reports and conclusions made by the Various Adverse Event Reporting System remain unclear from the increase in syncope and pulmonary emboli cases compared to other vaccines. The link to this is drawn from adolescents who took contraceptive pills from the same study. These contributing risk factors and findings have been detrimental to the stigma behind HPV vaccine safety; false associations regarding safety influence people to believe notions spread such as the big issue of HPV vaccines and autoimmune diseases, especially in concoction with the adolescent ‘need’ for immunisation in respect of sexual activity.

The clinical trial concludes that “The risks of the vaccine are within the range of complications noted with other vaccination programs that have been maintained for decades.” Meaning, despite the current extent of adverse effects posed by the HPV vaccine today, screenings have not been able to deduce any patterns that would suggest a direct correlation with the vaccine- especially as female adolescents of the corresponding age category of 9-26 years of age make use of contraceptive pills, making them more prone to blood clots and leading to various potential complications.

Overall the adoption of the HPV vaccination remains challenging, but continues to be increasing gradually as public education improves. What we can deduce is that there is an overwhelming amount of evidence in favour of the vaccine, preventing the precancerous and malignant disease conditions potentially deriving from HPV infections. Therefore at the current stance, declining immunisation is the risky choice, not taking it.

Glossary:

• Functional Neurological Disorder

• Benign- A disease not harmful in effect.

• Cervarix- Protects against 2 types of HPV that are primarily linked to cervical cancers (16,18)

• Gardasil 4- Protects against 4 types of HPV (6,11,16,18)

• Gardasil 9- Protects against 9 types of HPV (6,11,16,18,31,33,45,52,58)

• Autoimmune- A condition in which your immune system mistakenly attacks your body.

• Rheumatoid arthritis- A chronic progressive disease causing inflammation in the joints and resulting in painful deformity and immobility, especially in the fingers, wrists, feet, and ankles.

• Various Adverse Event Reporting System- A computerized information database designed to support the FDA's post-marketing safety surveillance program for all approved drug and therapeutic biologic products.

• Syncope- Temporary loss of consciousness caused by a fall in blood pressure.

• Pulmonary Embolism- A blockage of an artery in the lungs by a substance that has moved from elsewhere in the body through the bloodstream.

References:

1. Anderson, M., 2011. Q&A: Focus On Small Cell Cervical Cancer. [online] The University of Texas. Available at: <https://www.mdanderson.org/publications/cancerwise/qa-focus-on-small-cell-cervical-cancer.h00-158676579.html> [Accessed 10 May 2020].

2. Asiah Muhamad, N. and Norbaya Buang, S., 2018. Achieving High Uptake Of Human Papillomavirus Vaccination In Malaysia Through School-Based Vaccination Programme. [online] Biomed Central (BMC). Available at: <https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-6316-6> [Accessed 10 May 2020].

3. Chalmers, V., 2019. Girl, 18, Who 'Was Left Paralysed After Being Given The HPV Vaccine' Needs £10,000 For Private Mental Health Therapy. [online] Daily Mail UK. Available at: <https://www.dailymail.co.uk/health/article-6963047/Ruby-Shallom-paralysed-HPV-vaccine-needs-10-000-mental-health-therapy.html> [Accessed 10 May 2020].

4. Planned Parenthood. n.d. Human Papillomavirus (HPV). [online] Available at: <https://www.plannedparenthood.org/learn/stds-hiv-safer-sex/hpv> [Accessed 10 May 2020].

5. Shiow Chin, T., 2017. New HPV Vaccine Prevents 90% Of Cervical Cancer Cases. [online] The Star. Available at: <https://www.thestar.com.my/news/nation/2017/01/13/new-hpv-vaccine-prevents-90-per-cent-cervical-cancer-cases> [Accessed 10 May 2020].

6. National Cancer Institute. 2019. Human Papillomavirus (HPV) Vaccines. [online] Available at: <https://www.cancer.gov/about-cancer/causes-prevention/risk/infectious-agents/hpv-vaccine-fact-sheet> [Accessed 11 May 2020].

7. Science Daily. 2019. HPV Vaccination Rates Remain Critically Low Among Younger Adolescents In The U.S.. [online] Available at: <https://www.sciencedaily.com/releases/2019/01/190117090506.htm> [Accessed 11 May 2020].

8. John Hopkins Medicine. 2018. The HPV Vaccine: Why Parents Really Choose To Refuse. [online] Available at: <https://www.hopkinsmedicine.org/news/newsroom/news-releases/the-hpv-vaccine-why-parents-really-choose-to-refuse> [Accessed 11 May 2020].

9. White, M., 2014. Pros, Cons, And Ethics Of HPV Vaccine In Teens—Why Such Controversy?. [online] PMC. Available at: <https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4708146/> [Accessed 12 May 2020].