What does the term “medically effective” mean to you?

On January 25th, 2015, the Tampa Tribune published an article with the following headline: “Despite benefits, vaccination rate for HPV remains low in Florida”.  In the article, Dr. Susan  Vadaparampil of the University of South Florida Moffitt Cancer Center was quoted as saying that the reason to give the HPV vaccine to children at age 11-12 is because it is “the most effective at that age”. 

This statement seemed odd to me: why would it be more effective at 11-12 than at say at age 16-17? I looked around for scientific articles to back up Dr. Vadaparampil’s claim, and found nothing to support her claim. In fact, I found a scientific study showing there was no special benefit to giving the vaccine at such an early age.

Therefore, I wrote to Dr. Vadaparampil and asked for substantiation. She kindly responded and said a few things. First, she said “immunogenicity is greater in younger versus older adolescents”. However, the study she cited said they found noninferior immunogenic responses”,  regardless of age or gender. In other words: good results, regardless of age at vaccination.

Also, it seems that what is most important is the chance of being infected after being vaccinated. The study I cited to Dr. Vadaparampil showed that “zero HPV breakthrough was seen in a group of 776 patients vaccinated and then followed for 6.4 years.” These women were ages 15-25 when vaccinated…..not 11 or 12. And yet no infection followed after vaccination.

Secondly, Dr. Vadaparampil said that “as a preventative strategy, the vaccine is most effective when administered prior to the onset of sexual activity”. However, to vaccinate all 11-12 year old children because some may become sexually active seems misguided, given that newer and better HPV vaccines keep coming out. If possible, it is better to wait until your children are older and let them weigh the benefits and make the decision themselves.

Thirdly,  Dr. Vadaparampil  stated that “other routine adolescent vaccines (against tetanus, diphtheria, pertussis, and meningococcus) are also recommended to be administered at age 11 or 12 years, “this making it an viable time to “effectively” get the vaccine to this age group.” Such use for the term “medically effective” is problematic.

When hearing the term “medically effective”, most people think this is a scientific term based on outcomes. They don’t think it is a term based on how hard it is to get kids to visit the pediatrician’s office after after 12.

Unbeknownst to Dr. Vadaparampil, I also asked the American Cancer Society (“ACS”) for support for their own “medically effective” claim. I did this because Dr. Debbie Saslow of the ACS, had also been quoted in the same Tampa Tribune article. Dr. Saslow also kindly answered.

Dr. Saslow cited two different studies (Pedersen et. al. study, and Block et. al. study) showing a “greater” immune response when the vaccine is administered earlier. Dr. Saslow also cited the issue of HPV exposure, saying that the study I cited was for “individuals who were not previously exposed to the virus”. Taking this point, I would then ask if the breakthrough rate is any different for those who have been exposed. “Getting infected”….that is the only thing that matters in the end.

The third thing Dr. Saslow cited was the same as Dr. Vadaparampil did, but in different words. Dr. Saslow wrote:

“The implementation of vaccination is more effective for ages 11-12 than older. While many parents do continue to take their teen children to health care visits, the numbers decline rapidly during the teen years. So for the population as a whole, it is more effective to vaccinate when more kids go to the doctor and when they are getting other shots as well .”

My concern is with the questionable use of the term “medically effective”….and nothing else. “Medically effective”  has a very precise meaning in e.g. pharmacology, and that meaning has nothing to do with whether you can get the patient to come to the doctor’s office in the first place to get the prescription. If the general public is to trust the medical establishment when they speak, they should take care to how they use terms like “medically effective”.

Merck managed to have Gov. Rick Perry  mandate Gardasil as a vaccine in Texas in 2007. Think about that: the governor didn’t mandate that kids be vaccinated….he mandated that they be vaccinated with one particular company’s product. This after governor received a campaign contribution and was lobbied by his former chief of staff, who was by then the Merck lobbyist in Texas.

Merck was also the manufacturer of the now withdrawn drug Vioxx, a drug used to treat arthritis. Merck had to withdraw the drug when data showed that Vioxx caused an elevated risk of heart attacks and strokes. This was major news back in 2004.

Sometimes, people just want to wait for as much information as possible to come in before making a decision. Being hustled along to make unnecessarily early decisions is not helpful in that process.

P.S. I am not a doctor, but have two science degrees. My kids are vaccinated for everything except HPV. They will have to make their own decision regarding HPV vaccination.