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.
A 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!