Saying Yes to the HPV Vaccine

When I told my 13-year-old daughter Alice I was taking her to get a vaccine that could help prevent cancer, she was mildly intrigued. “Cool,” she allowed, “but I hate shots.” Luckily, she didn’t put up much resistance, and so we plunged into the heart of the most heated public-health matter of the moment: vaccinating tweenage girls against a sexually transmitted virus long before (one hopes!) they become sexually active.

For me, the decision to take her wasn’t difficult. Gardasil, which was approved by the FDA last June, protects against four strains of human papillomavirus (HPV). Two are believed to cause 70% of cervical cancer, which strikes about 11,000 U.S. women a year. The other two strains cause 90% of genital warts–so the vaccine is a twofer.

The American Academy of Pediatrics and the Centers for Disease Control and Prevention (CDC) have recommended Gardasil for girls at age 11 or 12, though it may be given any time from ages 9 through 26. The idea is to deliver protection before or not long after their “sexual debut.” About 40% of girls become infected with HPV within two years of becoming sexually active. By age 50, 80% of women have had the virus at some point, though many have no symptoms, and only a small percentage of infections lead to cancer.

My pediatrician’s office has been doing a brisk business in Gardasil, but a lot of parents are deeply uncomfortable with it. Texas Governor Rick Perry found that out last month when he tried to make the vaccine mandatory for girls entering sixth grade, an idea that many Texans felt contradicted the state’s abstinence-only message in sex education. Since then, Merck, which makes Gardasil, has stopped lobbying states to require the vaccine for school. No other vaccine mandated for school targets a microbe that is spread mainly through sex.

To me, protecting my child from cancer outweighs any reluctance to ponder her sexual future. “But some parents are totally in denial,” says my longtime pediatrician, Dr. Marc Wager of New Rochelle, N.Y. It’s his practice to discuss the vaccine when parents bring a daughter for a checkup at 11 or 12. But he doesn’t force it on those who resist, and he’s willing to edit his discussion of HPV transmission for those who don’t want a child to hear it.

Alice managed to tolerate our brief discussion of HPV without rolling her eyes. While explaining, Wager slipped in the needle–an old distraction trick that worked. “I didn’t really feel it,” said Alice.

“You were brave,” said Wager. “Most girls say it stings more than most shots.”

And it stings the wallet too. Alice will have to return for a second dose in two months and a third four months after that. The vaccine costs $120 a dose. Luckily, most private insurers are covering Gardasil, so I’ll be out just $25 for each of the three visits. Kids without coverage can get the vaccine free through the federal Vaccines for Children program.

As with any new vaccine, there are plenty of unknowns about Gardasil. The CDC’s Advisory Committee on Immunization Practices recently studied 542 reports on side effects out of 2.1 million doses given. Most were minor and expected: pain at the injection site, fever, dizziness and fainting. “Any procedure involving a needle has a risk of fainting,” says Dr. John Iskander of the CDC’s immunization safety office, which recommends waiting in the doctor’s office for 15 minutes after any shot. Another unknown: how long the protection will last and whether a booster will be needed. Merck says its studies so far show that protection lasts at least five years.

My next challenge: persuading my 18-year-old daughter to go for the shots. “Better hurry,” warns Wager with a twinkle. “You’ll want to get it in before she’s off to college.”