Keep Up the Conversation About Vaccines, Even Amid the COVID-19 Pandemic

Recently, the FDA approved the HPV vaccine Gardasil 9 for prevention of head and neck cancer. Like cervical, vulvar, vaginal, anal and penile cancer, cancers of the head and neck are also associated with particular strains of the HPV virus. 

The original version of the Gardasil vaccine was approved in 2006 for girls and women between the ages of 9 and 26 based on data from clinical trials showing that the vaccine, by preventing HPV infection, could also prevent precancerous cervical lesions. This was expanded to prevention of other forms of genital cancer. But such lesions don’t exist in head and neck cancer – such as cancer of the tonsils and throat – so it was not clear how to prove the vaccine’s efficacy. So although the link to HPV was understood, cancers of the head and neck had been left off the list, until FDA’s June 2020 approval based on “surrogate endpoints”…and the epidemiologic evidence from use of the vaccine over the past 15+ years. 

This expanded FDA approval doesn’t change recommendations regarding who and when should get the vaccine. Here in the U.S. it is already recommended for females and males ages 9 through 45 to prevent cervical, vulvar, vaginal, and anal cancer as well as genital warts. But, it does expand the conversations we can have about the importance of the HPV vaccine, the cancers it can prevent, and the lives it can save. And, perhaps it will help bolster people’s understanding of why boys should get the vaccine (as if there weren’t enough reason already!).

Even – and especially – amid the COVID-19 pandemic we should continue to educate people about the HPV vaccine and remind them to ask for it for their daughters and sons, and/or for themselves. Why? Because so many routine healthcare visits have been cancelled or postponed, bringing a new level of complications to keeping up with recommended vaccines for individuals, families and clinicians alike.

According to the National Foundation for Infectious Disease, the overall number of well-child office visits was down by about 50 percent amid the pandemic. Vaccine manufacturers reported a decline in vaccine orders, and doses distributed through the Vaccines For Children program dropped significantly.

recent New York Times article reported an alarming 50 percent drop in measles, mumps, rubella vaccinations; a 42 percent drop in diphtheria and whooping cough vaccinations; and a 73 percent drop in HPV vaccinations, according to a pre- and post-COVID-19 comparison of electronic health records from 1,000 pediatric practices nationwide. We need to avoid future public health crisis by returning to vaccine schedules, as soon as we safely can.

Many physician practices are returning to non-emergency visits from patients and are putting new protocols in place to give vaccines while keeping both patients and practitioners protected from COVID-19 exposure. Some are even offering drive-up vaccine clinics so that children don’t need to come into the office to receive some vaccines, or at least, have the car serve as the waiting room until the exam room is sanitized to avoid exposures. 

The good news is that there is quite a bit of  flexibility in the HPV vaccine schedule, so being off schedule with healthcare provider visits doesn’t mean you are off schedule with vaccine doses. 

  • For children under age 15 who had received their first dose of the vaccine, they aren’t due for the second dose for 6-12 months, so there is a lot of flexibility in the time to reschedule. 
  • Children and adults 15 and older get a three-dose schedule, with the second dose following 1-2 months after the first, and the third dose at 6 months after initial injection. But the primary impact on efficacy is getting vaccines doses too close together, not spread out too far. The CDC writes in its summary of the recommended HPV vaccine schedule that “If the vaccination schedule is interrupted, vaccine doses do not need to be repeated (no maximum interval).”

What We Can Do

Remind women to keep up with their annual women’s health visits, including Pap and HPV tests. Remind parents of tweens and teens to not forget about getting their kids the HPV vaccine and all of the protections it offers. 

Life may look different. Schools may be different. Work may be different. But the need for vaccines remains unchanged, and the protective health benefit they offer more is critical than ever!

I’m Done With Treatment, But Treatment Isn’t Done With Me

I recently celebrated my 31st birthday. Around this time last year, I was a brand new 30-year-old enjoying summer with my awesome husband and 3 amazing kids. I never suspected that two months after I celebrated that milestone birthday, cancer would invade my life.

On the day my OBGYN found my tumor, I left her office sobbing. I walked the long way through the parking lot, sobbing. I didn’t care who saw me. The diagnosis was so hard to cope with. I couldn’t align myself with my new reality. I searched every part of my soul to come to grips with what I felt was the end of my life.

“I can’t have cancer. I’m young! My kids are so young! My husband’s going to be a widower, he doesn’t deserve this! My kids are going to grow up without me! They won’t remember me. I have so much left to do here,” I thought, my brain in overdrive. I felt betrayed by my body. 

Treatment was the longest, weirdest dream I’ve ever had

I began treatment. The plan was 6 rounds of chemotherapy, 30+ rounds of external radiation, and 5 internal radiations (brachytherapy). I now call treatment the longest, weirdest dream I’ve ever had because I felt like I was in a fog the entire time. My body was so weak. I barely ate. I slept all the time, but not deeply or comfortably. I felt restless. Thank goodness for my husband, my sister and my dad. They helped me daily. I remember trying to vacuum one day and nearly collapsing. It was so hard to take a back seat to everything. From not working or doing basic chores to watching as others took care of my children daily. That wasn’t me. Everyone who knows me knows that I am fiercely independent.

At the beginning of treatment, I had hand-drawn a calendar to count down to when I’d be done. With each day that passed, no matter how weak I felt, I always remembered to make another “X” on the calendar. It was a long 9 weeks. Treatment ended for me on December 13th, 2019. It was a Friday, and I joked that this nightmare was ending on Friday the 13th. To live up to its name, on that day – my last round of external radiation – the radiation machine that worked so faithfully all those weeks was broken. I stood there with my family (who all came for my last day) and waited around with a full bladder – which was the requirement before receiving radiation – for over an hour. I remember thinking, “Can’t I just get this over with?! I’m so ready!” Right at my breaking point, I heard my name over the intercom and 10 minutes later, I was done. I said goodbye to the amazing doctors and nurses who took care of me all those weeks.

I did it! I’m done!  I can move on forever. Or so I thought…
How naive I was to think that! I’ve learned over the past months that even though I’m done with treatment, treatment is not done with me. I’ve dealt with a plethora of side effects:

For a whole month after treatment, I had what felt like a never-ending UTI.

My bowels are a mess.

What I thought was an upset stomach one late February night has proven to be another side effect from radiation.

My joints ache.

My body doesn’t feel like a 31-year-old. I’m going through menopause! The physical symptoms are many, but the mental stuff is particularly hard. There are highs and lows. I’ve lost two friends over the past few months to cervical cancer. It does something to you to see other women with the same disease pass away. My heart breaks daily for their families.

NED (but there is still the physical and mental evidence of my cancer)

I had my first post-treatment PET scan in March and received the wonderful news that I had “No Evidence of Disease.” In the cancer world, “NED” is a term everyone wants to hear.

NED brings people to their knees.

We rejoice. We celebrate. We still worry, of course. I think I always will, and the aftereffects of treatment continue to bring challenges. But having cancer has given me the gift of perspective. I gladly accept each day that comes. I am thankful for my family and friends. I am thankful for all of the small things that bring me joy.

Even with everything I’ve been through – all the procedures, side effects, and pain – I’d do it all again to be here with my husband and children. I’d do it a thousand times over.

My body: How can I not love something that has fought so hard for me to be here?

I am most thankful for my body. I’m proud of it for everything it has been through and how it still keeps going. All of my physical insecurities have been put to rest.

How can I not love something that has fought so hard for me to be here? That’s what I am. I’m here.  I’m still here! 

About Natasha:

Natasha is full time work-from-home/homeschooling mom of three who enjoys taking photos of anything and everything, traveling, reading multiple books at the same time, and finding new places to show her kids. Read Natasha’s Cervivor Story here.