HPV News Provides a Shot in the Arm
June 19 was a very good day for Richard Schlegel, MD, PhD, a pathologist at Georgetown University Medical Center who is known worldwide as a co-inventor of the technology behind the two HPV vaccines.
On that day, media across the US reported results of a study in the Journal of Infectious Diseases that looked at the value of the vaccines, which was approved for use in preteen girls in 2006. The vaccine is designed to eliminate infection of two forms of the HPV virus, which is responsible for the vast majority of cervical cancer cases. According to the Centers for Disease Control and Prevention, about 80 million Americans are infected with the virus and about 14 million people become newly infected each year. In most cases HPV goes away by itself before it causes any health problems, but the hope is that the vaccine, which in 2011 was also recommended for use in boys, would eventually eliminate HPV — along with numerous cases of cervical, anal and some head and neck cancers known to be caused by the virus.
The headline of the June 19 story in the New York Times said it best: HPV Vaccine is Credited in Fall of Teenagers Infection Rate.
And the report made it clear that the news was unexpectedly good: While only about one-third of eligible girls received the full three-dose complement of the vaccine, HPV infections still fell by half — a dramatic reduction.
“This is just fantastic news — better than expected,” says Schlegel, who is chairman of the department of pathology, a professor of oncology at Georgetown Lombardi Comprehensive Cancer Center, and co-director of Georgetown University Medical Center’s (GUMC) Center for Cellular Reprogramming.
“A reduction of half of HPV infections in girls shows that the vaccine is working well in the general population — just as we saw in the clinical trials. This is very good news.”
But in the next breath, Schlegel wants to put credit where credit is due, and that is on the shoulders of people like Sherrie Wallington, PhD, assistant professor of oncology and program director of the health disparities initiative at Georgetown Lombardi.
“What good is a vaccine if our youth doesn’t use it?” Schlegel asks. “Sherrie has done magnificent work in helping parents understand why vaccinating their children against HPV helps prevent the development of cancer.”
Believing that HPV and HIV are the same…
Depending on how one sees it, the burden, or opportunity — or both — that Wallington faces is immense.
The District of Columbia has one of the highest cervical cancer rate in the United States. Because of this, DC passed a law in 2009 mandating that girls entering the sixth grade —or up to the ninth grade if they transfer into DC schools — receive the HPV vaccine, unless their parents go through a formal immunization exemption process.
Although some efforts were made by the DC Department of Health and the DC Public Schools to offer HPV vaccine information, they were, by all accounts, limited in terms of staff and funding as to what they could do. “Thus, the DC HPV legislation was implemented without a strong infrastructure for education and increasing HPV awareness. And in a place where some parents think HPV and HIV — the virus that causes AIDS — are the same thing, we have a fundamental problem,” says Lucile Adams-Campbell, PhD, associate director for minority health and health disparities research at Georgetown Lombardi and associate dean for community health and outreach for GUMC.
“When you vaccinate any child, parents need to know what that is all about, and Sherrie is making fantastic inroads in that crucial public need,” says Adams-Campbell, who co-chairs the Georgetown Initiative to Reduce Health Disparities. “The National Institutes of Health, which funds her work, is very happy.”
“The lack of access to clear, understandable and valid health information contributes to health disparities, but once people have access to accurate information that they can understand, they feel empowered, able to make an informed decision,” Wallington says.
She has conducted her research in three of DC’s most medically underserved neighborhoods — Wards 6, 7 and 8, where GUMC has established a community partnership to address such topics as physical activity, nutrition, environmental health and breast cancer. Much effort is focused on developing culturally targeted and tailored cancer education materials.
Since she arrived at Georgetown four years ago, Wallington has had several HPV studies funded. She had done considerable work conducting focus groups with Black and Hispanic mother and daughter pairs, which helps define their concerns. Black and Hispanic women locally and nationally both also have higher rates of cervical cancer. The issues Wallington identified are both fundamental — including access to care, distrust in the health care system, and literacy and language issues — as well as simple issues of misinformation, such as the notion that vaccination against HPV is only important once a child becomes sexually active. She works with girls ages 13-17 to inform them about HPV, using cell phone text messages to increase their understanding and acceptance of the HPV vaccine. Wallington also has a five-year grant from the NIH to test whether communication that is ethnically and culturally appropriate leads to increased HPV awareness.
Her latest NIH grant is focused on communicating with boys about HPV. “In all my work with parents and adolescent girls, they say, ‘What about the boys?’ Now I can say we are seeking to build on what we are learning from parents and girls about the role of health communication in eliminating HPV knowledge gaps to educate the males as well.”
And she has just started a partnership with the Hoya Clinic, a free clinic managed by Georgetown medical students that serves Washington’s homeless and low-income populations. “Parents I work with wanted to know if their children could receive the vaccine at the Hoya Clinic, and so with funds from the Paul Carey Foundation, the Ovarian and Gynecological Cancer Coalition, Rhonda’s Club, and additional funds from individuals such as Dr. Schlegel, we are able to offer the vaccines now at Hoya Clinic,” Wallington says. She, along with some of the Georgetown students, hold a brief HPV educational workshop to educate interested parents, and if they want to vaccinate their children, they can now go to the Hoya Clinic get the HPV vaccine shots at no costs.
Reframe the messaging
While her studies are either ongoing or are in the midst of data collection — so formal results are not yet published — Wallington has reached some conclusions about how to present the HPV vaccine to parents.
“We need to reframe the messaging around HPV to be more gender-neutral. Parents have said that by stressing the need for preteen girls to be vaccinated, we are sending mixed messages to girls and boys, and I agree,” says Wallington.
The HPV vaccine also needs to be presented as what it is — an anticancer vaccine, she says. “It not only helps to prevent cervical cancer in females, it also reduces the risk of anal and head and neck cancer in both sexes, and penile cancer in males. The truth that parents need to understand is that all of these cancers can be caused by HPV.”
And while discussion of the virus, which is sexually transmitted, may bring up difficult subjects — such as promiscuity and oral and anal sex — adults need this information in order to make informed decisions, Wallington says. “Whether we as adults find these issues palatable or not, young people are definitely talking about them and searching the Internet about these issues. So we need to have these conversations, and educate parents and adolescents about HPV-associated cancer prevention.”
Wallington looks forward to the day when the HPV vaccine will be regarded as simply one of the battery of vaccines that a growing child receives as part of tried-and-true preventive care. “The stigma around the HPV vaccine goes beyond the vaccine itself, but I think this will change given the success we have already seen in reducing rates of HPV infection,” she says. “At least, that is what I am working toward.”
The research described was supported by grant numbers P30 CA051008, 5K01CA155417-03, 1 R03 CA165147-01A, from the National Institutes of Health, and additional funding awarded to Wallington from the American Cancer Society, DC Consortium, Paul Carey Foundation, Ovarian and Gynecological Cancer Coalition-Rhonda’s Club and the Robert Woods Johnson Foundation.
Schlegel is co-inventor of patented technology owned by Georgetown University on which HPV vaccines were developed. Georgetown University and Schlegel receive royalty payments for the development and commercialization of the HPV vaccine technology.
By Renee Twombly, GUMC Communications