On February 6, the first Park Street Corporation Speaker Series lecture of the semester was held in Boston College’s Gasson Hall. Indiana University medical school professor Dr. Gregory Zimet presented his research on school-age entry requirements for HPV, also known as human papillomavirus.
The HPV vaccine, which protects against six different cancers, is only required for school entry in Rhode Island and Virginia, as well as the District of Columbia. In comparison, the Tdap vaccine, which protects against tetanus, diphtheria, and pertussis, is required in all 50 states, including D.C.
The BC lecture, titled “Hard Choices: Ethical, Political, and Pragmatic Challenges Around HPV Vaccine Delivery”, covered school-entry requirements, and gender and sex, in regards to the vaccination. Zimet also discussed global shortages, and a new process for vaccination called shared clinical decision making. He ended by taking questions. Approximately 80 people attended the talk.
“HPV is really the most common sexually transmitted infection,” said Dr. Natalie Joseph, a BU medical school professor. She said that HPV can become dormant after you acquire it, or the virus can stay in your body to become pre-cancerous cells that will lead to cancer.
Doctors perform both primary and secondary preventions for diseases, said Joseph. Primary is used if you’ve never been exposed; with HPV, that would be if you’ve never been sexually active, but received the vaccine anyway. The vaccine is still beneficial if you’ve been exposed, because there are over 100 types of HPV, some cancerous and others not, such as the sexually transmitted infection genital warts.
Zimet, after giving a brief overview of the HPV vaccine’s history, spoke about his research into Rhode Island’s 2015 implementation of a vaccine school-entry requirement.
Zimet first looked at parent-reported HPV vaccine data, comparing Rhode Island’s vaccine rates since the 2015 vaccine implementation to the rest of the U.S. Over time, the U.S. has had a gradual increase in HPV vaccination, and Zimet couldn’t attribute the increase to policy decisions alone. Therefore, he looked at whether the increase was significant compared to the country overall.
“What we found in the first paper was that there was a significant increase for males in Rhode Island compared to the rest of the states,” said Zimet. There was not a similar increase for females, however. Since Rhode Island was already doing a good job with vaccinating females, it would be difficult to improve when the rate was already so high.
The second paper, done a year later, focused on provider-verified data. Zimet found similar results: male vaccination sharply increased in Rhode Island compared to the general increase in the rest of the country, and female vaccination saw no major effect.
Zimet explained why the HPV vaccine is underutilized in comparison to a common school vaccine such as Tdap. One argument against the HPV vaccine is that the mandates interfere with parental autonomy, and they pose an unfair burden on parents. Another opposition is that people don’t see cervical cancer as an important issue, which Zimet disagreed with.
Zimet’s talk was part of the Park Street Corporation Speaker Series, which began in 2016 after a bequest from the Quinn family. The series encourages students to engage in topics related to ethics and healthcare. Each academic year, the organizers choose a different theme to focus on. This year’s is ‘hard choices’.
Summer Hawkins, a BC social work professor, wants students to understand the challenges the health community is facing. She said, “We’re seeing decreasing uptake, we’re seeing vaccine hesitancy among parents and communities.” Hawkins wants to know what can currently be done to prevent disease outbreaks and increase vaccine usage. She teaches a class on contemporary health issues, and her students attended Zimet’s talk.
A recent study primarily done by researchers from Massachusetts General Hospital in the Journal of the National Comprehensive Cancer Network found that non-white and uninsured patients with HPV-positive orophyrangeal (throat) cancers had a higher mortality rate than white patients in 2013 and 2014.
A 2019 Massachusetts bill calling for school-entry requirements to include immunization against HPV, tdap, measles, and polio is currently making its way through the legislature, with the reporting date set for April. An amendment requested that the department of public health share regulations to put this vaccine usage into effect.
The HPV vaccine has a short history. In 2006, the first vaccine was licensed for women ages 9 to 26. It wasn’t until three years later that a vaccine was licensed for men, which led parents to believe the HPV vaccine was mainly for women because of its wide-spread prevention of cervical cancer. Both Zimet and Joseph spoke of people who didn’t see the benefit for males. That is not the case, and the vaccine is encouraged for both sexes.
Holly Fontenot, a BC nursing professor, said Zimet’s insights were timely. “There’s open communication and research and evidence; there’s a discourse without flaring emotions,” she said. “We’re able to have different perspectives and different opinions.” Fontenot introduced Zimet at the talk.
Zimet reminded the audience of the work still yet to be done. The World Health Organization recently called for wealthy countries to stop vaccinating males until all females receive the vaccine. The plan is to eliminate cervical cancer. “I was flabbergasted,” said Zimet, “by the idea that you can turn off policy like a light switch.”