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The Pros and Cons of Mandatory HPV Vaccination: The Pro Argument

The Pros and Cons of Mandatory HPV Vaccination: The Pro Argument. Warner K. Huh, MD Division of Gynecologic Oncology University of Alabama at Birmingham. Smallpox. The great scourge of mankind Has crippled, disfigured and/or killed one quarter of all humanity

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The Pros and Cons of Mandatory HPV Vaccination: The Pro Argument

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  1. The Pros and Cons of Mandatory HPV Vaccination: The Pro Argument Warner K. Huh, MD Division of Gynecologic Oncology University of Alabama at Birmingham

  2. Smallpox • The great scourge of mankind • Has crippled, disfigured and/or killed one quarter of all humanity • In the 20th Century alone, nearly 200 million deaths

  3. Vaccines Are Always Political But, what happens if there is a mandate?

  4. Perfect political storm in 2006 • qHPV vaccine approved by the Therapeutics Goods Administration. • Australian vaccine with an iconic inventor. • National Immunization Program initially rejected it. Prof Ian Fraser

  5. Perfect political storm in 2006 • qHPV vaccine approved by the Therapeutics Goods Administration. • Australian vaccine with an iconic inventor. • National Immunization Program initially rejected it. • Election year, with a budget surplus. • Health Minister with a dubious reputation in women’s health. “I won’t be rushing out to get my daughters vaccinated…” Tony Abbott

  6. Perfect political storm in 2006 • qHPV vaccine approved by the Therapeutics Goods Administration. • Australian vaccine with an iconic inventor. • National Immunization Program initially rejected it. • Election year, with a budget surplus. • Health Minister with a dubious reputation in women’s health. • First Lady with cancer of the cervix John Howard Janette Howard

  7. Perfect political storm in 2006 • qHPV vaccine approved by the Therapeutics Goods Administration. • Australian vaccine with an iconic inventor. • National Immunization Program initially rejected it. • Election year, with a budget surplus. • Health Minister with a dubious reputation in women’s health. • First Lady with cancer of the cervix • De-stigmatized the disease • Influenced husband John Howard Janette Howard

  8. National HPV vaccination program From April 2007: school-based 12-13yo girls – ongoing. school-based 13-18yo girls – ended 2009. From July 2007: community-based 18-26yo women – ended 2009.

  9. Proportion of Australian-born females with GW, by age group, 2004–2011 20 qHPV vaccine introduced <21 Years (n=9,405) 21–30 Years (n=15,228) >30 Years (n=10,246) 18 16 14 12 Ptrend=0.89 10 Percent Ptrend=0.23 8 Ptrend=0.99 6 4 –72.6% –92.6% Ptrend=0.07 Ptrend <0.001 2 Ptrend <0.001 0 2004 2005 2006 2007 2008 2009 2010 2011 Year Ali H et al.BMJ2013;346:f2032.

  10. Proportion of Australian-born heterosexual males with GW by age group, 2004–2011 qHPV vaccine introduced 20 <21 Years (n=3,982) 21–30 Years (n=15,147) >30 Years (n=13,647) Ptrend=0.32 16 Ptrend=0.17 12 Ptrend=0.45 –15.3% Percent –51.1% Ptrend<0.001 8 Ptrend=0.007 4 –81.8% Ptrend<0.001 0 2004 2005 2006 2007 2008 2009 2010 2011 Year Ali H et al. BMJ 2013;346:f2032.

  11. High-grade cervical abnormalities in young Victorian women, by age group, 2003–2010 1.60 qHPV vaccine introduced Prevaccine period Vaccine period 1.20 0.80 HGA Incidence (%) 0.40 0 Year 2003 2004 2005 2006 2007 2008 2009 2010 Brotherton JM et al. Lancet 2011; 377: 2085

  12. High-grade cervical abnormalities in young Victorian women, by age group, 2003–2010 1.60 qHPV vaccine introduced Prevaccine period Vaccine period 1.20 0.80 HGA Incidence (%) 0.40 0 Year 2003 2004 2005 2006 2007 2008 2009 2010 Brotherton JM et al. Lancet 2011; 377: 2085

  13. TdAP vs. MCV4 vs. HPV

  14. So, why wouldn’t the US want to seriously consider making HPV vaccination mandatory, when: • Current HPV vaccines provide nearly 90% coverage of types that cause cervical and other HPV-related malignancies • We are already witnessing dramatic reductions in HPV related disease • There is no question this will have a dramatic impact on screening practices (in fact, cervical cancer screening may go away in 20 years) • High likelihood that cervical cancer is something you learn about in a textbook • Vaccination is a social obligation and responsibility

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