Vaccine seems to always provoke controversy, perhaps none
so much as the HPV vaccine. Here we have a collision of science, sex,
parenting, and money. Welcome to the Clinician's Roundtable.
I am Dr. Leslie Lundt, you host, and with me today is Dr.
Gregory Zimet. Dr. Zimet is Professor of Pediatrics and Clinical Psychology at
the Indiana University School of Medicine. He is also a faculty member in the
Indiana University Cancer Center and holds adjunct appointments in the
Department of Psychology at IUPY and in the Indiana University School of
Welcome to ReachMD, Dr. Zimet.
Thank you. I am very pleased to be here.
Dr. Zimet, your research focuses on the acceptability of
biomedical approaches to the diagnosis and prevention of sexually transmitted
infections. What are the potential structural obstacles that may interfere
with the widespread acceptance of this relatively new HPV vaccine.
Well, I think there are a number of structural obstacles,
you know the people have talked about quit a bit. So, for instance, this is a
relatively costly vaccine, so cost potentially can be an obstacle for those who
do not have insurance coverage and are unable to get the vaccine through the
Vaccine for Children Program, then that can be a big obstacle. Availability
potentially was an obstacle initially when the vaccine was licensed and made
available. There are a number of physicians, who were not able to carry it. I
think that probably is less of an issue now, but availability of the vaccine
may still be an obstacle for some individuals. Another obstacle that as a
3-dose vaccine, it requires young people to return twice for the second and
third dose, and that can be difficult especially when you are talking about
young people ages 11, 12, 13, 14 where they don't necessarily go to see their
family doctor or pediatrician regularly.
How soon do those doses need be repeated?
So there is the first dose and then the second dose is
given, I believe, 2 months after the first dose and then the final dose is 6
months after the first dose.
Oh, so really it can be a scheduling problem.
Yeah, it can be and if there are not other reasons for the
young woman to return to see their doctor, it means making an extra trip.
Now, I assume that there are attitudinal factors that also
interfere with this particular vaccine especially.
Yes, and of course, there are some attitudinal factors that
interfere with any vaccine, so there are a relatively small group of parents,
but very vocal group of parents, who are opposed to all vaccines, so certainly
they will be opposed and are opposed to HPV vaccine. Beyond that, at least in
my research and in actually several research projects, there are some parents
who express concern that the vaccine may lead to sexual disinhibition, so it
may lead to adolescents having sexual activity earlier than they would otherwise.
Again, we are talking about a relatively small group of parents here, but
parents who have that concern are less interested in having their daughters
vaccinated. Some parents who are interested in the vaccine express concerns
about safety and will often say that they want to wait a little while before
they have their daughters vaccinated.
Yeah, it's amazing to hear what people have to say about
this. I have a mother-daughter book club and we all have preadolescent age
girls, really the prime target group for this vaccine, and I brought it up at
our last meeting what people's thoughts were about their girls getting the
vaccine and they ranged from, oh no! all vaccines are horrible, and you know,
potentially lethal to oh my gosh! I would never do that and then one woman
already had her 10-year-old vaccinated, so it's a tremendous range of beliefs
out there in the public.
Right. There are, although I think if you're putting aside,
you know, questions of parents who want to wait because they want to make sure
that it's safe, the large majority of parents across multiple studies have
indicated really interest in protecting their daughters from cervical cancer
through use of this vaccine. I think we often tend to hear the opposition to
the vaccine because it makes it appear controversial and more interesting, but
I am not sure it's just widespread as it appears.
And what about there is some of the other thing I have heard
out there is perhaps waiting because may be the vaccine will lose efficacy over
time, so if you vaccinate an 11-year-old may be they will have to repeat it at
age 17, is there any truth to that?
I think it's a combination of things. So I think sometimes
there is a misinterpretation of the data, so what the research has shown so far
is that both HPV vaccines, the one that's currently available in the United
States and the one that is still waiting for licensure, that both of these
vaccines show pretty impressive efficacy 5 to 6 years and what's happened
though as those papers have been published showing efficacy for that long,
people have interpreted it as saying it only works for 5 to 6 years and that's
not true, it works at least 5 to 6 years. There is some evidence that the
vaccines may remain effective for many many years beyond that. Definitively,
it's going to be hard to say until, in fact, many years pass. I don't think
that's a good reason to delay vaccination because there is every reason to
believe that the vaccine will last, again, at least 5 to 6 years and probably
at least 10 years, and by vaccinating an 11 and 12-year-old you are probably
providing protection again for at least about 10 years, and if a booster is
needed, you know, that's something that would be determined in the future.
If you're just joining us, you are listening to the
Clinician's Roundtable on ReachMD XM 157, the Channel for Medical
Professionals. I am Dr. Leslie Lundt, your host, and with me today is Dr.
Gregory Zimet. We are discussing the HPV vaccine.
Tell us about your research in this area.
Well, I have done several studies over quite a few years
now. Looking at attitudes about vaccination, focusing on several different
vaccines, but including the HPV vaccine, so I've been involved in research
looking at adolescent's attitudes about vaccination, parental attitudes about
vaccination, and physicians and other healthcare providers' attitudes about
providing vaccination. So I have been doing that kind of research for about 13
years looking at different kinds of STI vaccines including HPV vaccine.
Currently, because now the vaccine is obviously available and being used, I
have shifted with some of my colleagues and, you know, we are looking at
predicators of actual vaccine acceptance.
And what is the uptake been for the HPV vaccine, are our
people using it?
I think there is a mixed data on that, so my understanding is
I do not have knowledge of sort of a national rates of vaccination, but I think
it has been accepted and utilized pretty well for the targeted, you know, the
ACIP CDC targeted age group, which is 11 and 12-year-old, that there has been
fairly good coverage, probably not as good as public health officials and
pharmaceuticals would like, but it is still been a fairly good uptake of
vaccine. I think where it hasn't gone well is in the, what they call the
catch-up age range, so the 13 to 26-year-old, especially as you get up into the
late teens or early 20s that I think that has not been as successful in
reaching those individuals.
Thinking about vaccines in general, why is this such a
lightening rod for opinion? What is it about vaccines in general that get
people so worked up?
Part of the issue is you are taking a healthy child and it's
something that is to prevent something that may or may not happen in the
future, so you are taking a healthy child, putting something inside them with
the intent of preventing something that may or may not occur in the future, and
I think that process is difficulty for people, not just understand, but also to
feel comfortable with. From one perspective, I thought of vaccines, you know,
people who are often against vaccines talk about vaccines as being unnatural,
and in a certain sense, vaccines are among the most natural pharmaceutical
products that we have in that what vaccines essentially do is get the body's
immune system to work and it kind of identifies a passage and it says
"immune systems, you know, go after this, go after this virus or go after
this bacteria," so vaccines really are about getting natural immunity to
kick into action in a specific way, but I think, you know, there is a lot of mythology
around vaccines, there are also historically times when vaccines have caused
problems and people remember that. For those reasons and others probably,
vaccines have become a lightening rod in general. This vaccine in particular,
I think, also for a couple of reasons, has led to a lot of scrutiny and one is
because it prevents a sexually transmitted infection and the second is because
of the manufacturer of the current vaccine has been under a lot of scrutiny for
other issues and I have a feeling sometimes that there is this sort of desire
to go after them on everything because of their problems with some other
Yeah, I hadn’t thought about the spillover effect. Well