Australia could become first country to eradicate cervical cancer(theguardian.com)
theguardian.com
Australia could become first country to eradicate cervical cancer
https://www.theguardian.com/society/2018/mar/04/australia-could-become-first-country-to-eradicate-cervical-cancer
91 comments
> I think this shows that a technical solution trumps social solutions. If Australia had relied on telling children not to have unprotected sex, the HPV rate would not have moved much. Now, a simple vaccine is eradicating cervical HPV.
We know telling people to not have sex doesn't work (this is what most people hear, and for many young people is functionally the same, as don't have unprotected sex).
We have HSV, high teenage pregnancy rates, etc in countries that have pushed those approaches as would-be solutions.
Taking a very specific case of trying to suppress young human sex drive with words, and extrapolating that to the general case around technical hacks versus knowledge and informed decision making is a bit disingenuous.
And 'simple' vaccine?
We just last week got rid of the deputy Prime Minister who, at the time this was being debated (debated!) claimed that the proverbial 'some people' didn't like the idea of giving their twelve year old daughters a licence to be promiscuous. I shit thee nay.
We know telling people to not have sex doesn't work (this is what most people hear, and for many young people is functionally the same, as don't have unprotected sex).
We have HSV, high teenage pregnancy rates, etc in countries that have pushed those approaches as would-be solutions.
Taking a very specific case of trying to suppress young human sex drive with words, and extrapolating that to the general case around technical hacks versus knowledge and informed decision making is a bit disingenuous.
And 'simple' vaccine?
We just last week got rid of the deputy Prime Minister who, at the time this was being debated (debated!) claimed that the proverbial 'some people' didn't like the idea of giving their twelve year old daughters a licence to be promiscuous. I shit thee nay.
>> licence to be promiscuous
From Barnaby Joyce? Ahem.
From Barnaby Joyce? Ahem.
This Hitchens quote is so relevant right now:
“Whenever I hear some bigmouth in Washington or the Christian heartland banging on about the evils of sodomy or whatever, I mentally enter his name in my notebook and contentedly set my watch. Sooner rather than later, he will be discovered down on his weary and well-worn old knees in some dreary motel or latrine, with an expired Visa card, having tried to pay well over the odds to be peed upon by some Apache transvestite.”
“Whenever I hear some bigmouth in Washington or the Christian heartland banging on about the evils of sodomy or whatever, I mentally enter his name in my notebook and contentedly set my watch. Sooner rather than later, he will be discovered down on his weary and well-worn old knees in some dreary motel or latrine, with an expired Visa card, having tried to pay well over the odds to be peed upon by some Apache transvestite.”
Yep, So ironic I want to cry. For anyone not from Australia who doesn't understand this, feel free to Google his name for a timeline of world-class hypocrisy.
Still, why are we discussing his personal life and not his abysmal policy decisions?
Still, why are we discussing his personal life and not his abysmal policy decisions?
Because he made a point of bringing that stuff into his politics, repeatedly. You can’t make up quotes as good as the real ones. “I think that every child has a right, absolute right to know her or his mother and father and also … should be given the greatest opportunity to know their biological mother and father,” Mr Joyce said. Somehow that’s in refer to gay marriage, not his own philandering.
Yes, maybe I should rephrase. Why are we discussing his personal life exclusively, and not his personal life and his abysmal policy decisions.
I'm referring to the media in Australia, not our discussion on HN.
I'm referring to the media in Australia, not our discussion on HN.
> Malthus made a big deal how people should have fewer children and the population still grew.
The demographic transition long predates the pill. The pattern was marry early, have children all through marriage, marry late, have children all through marriage, marry late, show obvious signs of controlling fertility. The first definite case of the demographic transition is 1800s France.
And while Malthus was right as a historian, he was wrong as a futurist. Things have been getting better worldwide since the Industrial Revolution even as population increased.
The demographic transition long predates the pill. The pattern was marry early, have children all through marriage, marry late, have children all through marriage, marry late, show obvious signs of controlling fertility. The first definite case of the demographic transition is 1800s France.
And while Malthus was right as a historian, he was wrong as a futurist. Things have been getting better worldwide since the Industrial Revolution even as population increased.
> The pattern was marry early, have children all through marriage, marry late, have children all through marriage, marry late, show obvious signs of controlling fertility.
Western Europe hasn't married early for hundreds and hundreds of years, since long, long before the demographic transition.
https://en.wikipedia.org/wiki/Western_European_marriage_patt...
Western Europe hasn't married early for hundreds and hundreds of years, since long, long before the demographic transition.
https://en.wikipedia.org/wiki/Western_European_marriage_patt...
And yet we’re surrounded by complex social solutions to large problems: democracy, money, rule of law, families, religion, insurance, traffic lights, meat inspectors, patents, contracts, etc etc
The fact that Australia is close to achieving this, while many other countries are far off, also points at social factors playing a role. The vaccine works the same everywhere.
The fact that Australia is close to achieving this, while many other countries are far off, also points at social factors playing a role. The vaccine works the same everywhere.
actually the vaccine doesn't -- the standard HPV vaccine in the US for instance is not effective for the strains of HPV common in black people.
All of these work because of language in the first place. It's a technology.
Making the vaccine free is a social solution. Getting people to subsidize the vaccine is inherently political.
Jeff Bezos semi-famously worded this as "Good intentions don't work- mechanisms do".
I learn great many things in this forum. If you find my comment below as an effort of trolling, it is not. I wanted to ask this question every time I see this idea of
> how vaccines and tech are decreasing population.
If it is statistically and empirically true, then it probably is true.If people smarter than me by any measure agree with it, then it probably is true after,all.
That said:
I don't doubt that, it works in a first world nation. But third world , at least India is a different thing, people like to have two kids around here, because it looks whole some. It doesn't matter what the financial situation is , people like to have at least two kids in India(I don't have any metric for it,just a casual observation). What if people see their kids don't die out of diseases and could take food ,education,electricity,clean water and clean air and a good public transport for granted and now want to make more babies? The decrease of population if you pump these resources seems counter intuitive to me. I am not suggesting if Bill Gates should pull out of Africa, I am just not getting the logic here.
> how vaccines and tech are decreasing population.
If it is statistically and empirically true, then it probably is true.If people smarter than me by any measure agree with it, then it probably is true after,all.
That said:
I don't doubt that, it works in a first world nation. But third world , at least India is a different thing, people like to have two kids around here, because it looks whole some. It doesn't matter what the financial situation is , people like to have at least two kids in India(I don't have any metric for it,just a casual observation). What if people see their kids don't die out of diseases and could take food ,education,electricity,clean water and clean air and a good public transport for granted and now want to make more babies? The decrease of population if you pump these resources seems counter intuitive to me. I am not suggesting if Bill Gates should pull out of Africa, I am just not getting the logic here.
I don't have stats for this, but I don't think it's families with 2 kids that are causing a population explosion. That's literally just an even replacement for the parents (assuming 2 people who don't remarry before death).
Hans Rosling tackles that question better than anyone in What Stops Population Growth: https://youtu.be/ZnexjTCBksw
His first TED talk on the best data you've ever seen is also worth watching.
It's an important question, but our understanding of what causes population spikes, and how people respond to improved wealth and health in a country, can make us a little more optimistic.
His first TED talk on the best data you've ever seen is also worth watching.
It's an important question, but our understanding of what causes population spikes, and how people respond to improved wealth and health in a country, can make us a little more optimistic.
It definitely works that way in poor countries; the "poster child" is right next to India in Bangladesh: https://www.economist.com/news/briefing/21565617-bangladesh-...
It turns out that educated women with more other options almost always want to have fewer children. This should not be surprising; they don't call childbirth "labour" for nothing.
It turns out that educated women with more other options almost always want to have fewer children. This should not be surprising; they don't call childbirth "labour" for nothing.
>>We need more "fire and forget" solutions. If we want to save our environment and slow down global warming, we need solutions that at most require people to do something relatively painless 1 time.
Yeah, make sure to let the world know when you figure out what that solution is, because it will win you Nobel Prizes in multiple categories.
Yeah, make sure to let the world know when you figure out what that solution is, because it will win you Nobel Prizes in multiple categories.
Immunizing every child seems like a social solution to me.
If Australia had relied on telling children not to have unprotected sex, the HPV rate would not have moved much.
You're right -- but every single study has shown that teaching sex ed properly (covering safe sex, how STDs actually transmit rather than fear mongering) is the most reliable way of reducing STDs, unwanted pregnancy, abortions (largely due to the reduction in unwanted pregnancy), sex abuse, ...
The policy of "teach abstinence" fails people much more so than vaccinating against a single vector.
The policy of "teach abstinence" fails people much more so than vaccinating against a single vector.
I think this is a key point. To say "X has failed" when the truth is "X was done wrong / badly and it failed."
While a vaccine might not be a license to _____, it also fails to address education, personal responsibility, etc. Sure there are health benefits but if everyone gets a trophy so to speak when and how will the lack of learning Y manifest itself later?
That is, give the vaccine. Sure. But don't be so naive to think that education in some form isn't still necessary.
Furthermore, Mother Nature is clever and crafty. It's only a matter of time, now that protection is less necessary, before she comes up with something new.
I'm not a Luddite. But there are two sides to every advance, and we almost always igrore the unintended consequences until it's too late.
While a vaccine might not be a license to _____, it also fails to address education, personal responsibility, etc. Sure there are health benefits but if everyone gets a trophy so to speak when and how will the lack of learning Y manifest itself later?
That is, give the vaccine. Sure. But don't be so naive to think that education in some form isn't still necessary.
Furthermore, Mother Nature is clever and crafty. It's only a matter of time, now that protection is less necessary, before she comes up with something new.
I'm not a Luddite. But there are two sides to every advance, and we almost always igrore the unintended consequences until it's too late.
It has always seemed like Malthus simply made the mistake that a logistic function looks a lot like an exponential function early on during a transition to a new equilibrium.
Maybe he was saying that a decrease in fertility had to be an explicit goal, without realizing that decreases in fertility could be a side effect of other social developments.
Maybe he was saying that a decrease in fertility had to be an explicit goal, without realizing that decreases in fertility could be a side effect of other social developments.
Malthus was not wrong at all, we just got lucky in that we were able to grow production faster than the population.
The reason he said fertility had to be an explicit goal is he lived before we learned how to grow the economy faster than the population. I guess you could blame him for not seeing the industrial revolution coming, but given nobody else at the time did either I think it is a little harsh.
The reason he said fertility had to be an explicit goal is he lived before we learned how to grow the economy faster than the population. I guess you could blame him for not seeing the industrial revolution coming, but given nobody else at the time did either I think it is a little harsh.
I think it would be more accurate to say that human population growth rate has never been exponential and was never going to be, than to say that production has grown at a faster exponential rate.
Malthus has historically been excused with "just wait and see" explanations about his ideas, but no one seems able to say what is the kernel of truth in his theory or framework remains after you wipe away the details that were based on misunderstandings about his own time or about the actual dynamics of population growth.
For instance he paid almost no attention whatsoever to mortality rates or the disposition of ages within a population and their effect on growth rates. He also paid no attention to the relative fertility of families with different levels of wealth identified by Adam Smith long before him.
One way to summarize his work is that people's biological capacity to reproduce exceeds their physical capacity to increase the food supply, and that food supply is the ultimate constraint on human population that will be hit without other active constraints on population growth.
Of course humans have the ability to grow faster than their conditions support, or they would not be able to grow when conditions improved, or recover from traumas to a population. But they also have the capacity to not reproduce, and not replace people as quickly as they are dying. It seems like a real leap of faith, to claim that people can only be actively constrained in their fertility, since there hasn't been any evidence that people only limit family size when actively compelled to.
It is also strange to say that if there is no other limit on population growth, food will limit population growth. That's like arbitrarily stating that the only limit on fire is fuel, or that the only limit on fire is oxygen, or temperature. Population growth is a function with many inputs, and populations would approach some equilibrium even if food was hypothetically limitless.
Maybe the excuse is that food is just a metaphor for the basket of all resources that people need, and that it can still be argued that populations without active constraints on growth increase exponentially until they inevitably result in famine, plague or war to decrease their numbers.
What human populations work that way? They tend to ebb and flow in size around an equilibrium, then with a technological advance or environmental improvement they shift from one equilibrium to another at an increasing rate then a decreasing rate, just like a logistic function. Even with a collapse of a civilization the numbers decline like a logistic function. The curve might be steep, but it starts slowly, decreasing faster and faster then more slowly again as it gets close to zero.
Malthus has historically been excused with "just wait and see" explanations about his ideas, but no one seems able to say what is the kernel of truth in his theory or framework remains after you wipe away the details that were based on misunderstandings about his own time or about the actual dynamics of population growth.
For instance he paid almost no attention whatsoever to mortality rates or the disposition of ages within a population and their effect on growth rates. He also paid no attention to the relative fertility of families with different levels of wealth identified by Adam Smith long before him.
One way to summarize his work is that people's biological capacity to reproduce exceeds their physical capacity to increase the food supply, and that food supply is the ultimate constraint on human population that will be hit without other active constraints on population growth.
Of course humans have the ability to grow faster than their conditions support, or they would not be able to grow when conditions improved, or recover from traumas to a population. But they also have the capacity to not reproduce, and not replace people as quickly as they are dying. It seems like a real leap of faith, to claim that people can only be actively constrained in their fertility, since there hasn't been any evidence that people only limit family size when actively compelled to.
It is also strange to say that if there is no other limit on population growth, food will limit population growth. That's like arbitrarily stating that the only limit on fire is fuel, or that the only limit on fire is oxygen, or temperature. Population growth is a function with many inputs, and populations would approach some equilibrium even if food was hypothetically limitless.
Maybe the excuse is that food is just a metaphor for the basket of all resources that people need, and that it can still be argued that populations without active constraints on growth increase exponentially until they inevitably result in famine, plague or war to decrease their numbers.
What human populations work that way? They tend to ebb and flow in size around an equilibrium, then with a technological advance or environmental improvement they shift from one equilibrium to another at an increasing rate then a decreasing rate, just like a logistic function. Even with a collapse of a civilization the numbers decline like a logistic function. The curve might be steep, but it starts slowly, decreasing faster and faster then more slowly again as it gets close to zero.
I don't know that your conclusion really follows. Technical progress rarely happens in completely isolation form social mechanics. Things like government funding for research, subsidies for deploying or developing particular renewable energy technologies, and even the environment in which private innovative companies operate are entirely influenced by the government which in turn is ultimately influenced by social action. You're discussing a very particular kind of social action.
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Or in other words solutions that are applied have a possibility of working. The solution of no genital contact with others isn't inferior, it wasn't applied.
I find it interesting that, AFAIA HPV is a sexually transmitted disease but that, certainly in the UK, healthcare professionals seemingly lie (by omission at least) in order to further vaccination.
Also, that insistence on screening seems likely to have been a major cause of widespread infection (eg https://obpmedical.com/resource-center/blog/non-sexual-trans...), though I've never heard of this from a major news outlet?
It amazes me that until 2016 it seems no-one bother to check that sterilised reusable gynaecological instruments were actually sterile, mind-blowing.
I find it interesting that, AFAIA HPV is a sexually transmitted disease but that, certainly in the UK, healthcare professionals seemingly lie (by omission at least) in order to further vaccination.
Also, that insistence on screening seems likely to have been a major cause of widespread infection (eg https://obpmedical.com/resource-center/blog/non-sexual-trans...), though I've never heard of this from a major news outlet?
It amazes me that until 2016 it seems no-one bother to check that sterilised reusable gynaecological instruments were actually sterile, mind-blowing.
> but that, certainly in the UK, healthcare professionals seemingly lie (by omission at least) in order to further vaccination.
I mean, you can't just leave a claim like that dangling. A source would be ideal, but at least explain the claim of what the lie is would be nice.
I mean, you can't just leave a claim like that dangling. A source would be ideal, but at least explain the claim of what the lie is would be nice.
You may get less downvotes if :
- you link to peer reviewed science, rather than the manufacturer of devices who have reasons to profit from misleading information (hint : there's a reason you haven't heard about it from major news outlets).
- you back up inflammatory statements (like "healthcare professionals seemingly lie (by omission at least) in order to further vaccination.") with some evidence, particularly where the common narrative disagrees with your statement.
- You avoid misleading arguments ("The solution of no genital contact with others isn't inferior, it wasn't applied" - this is misleading, many have attempted to apply it, it's their attempts that have failed).
- you link to peer reviewed science, rather than the manufacturer of devices who have reasons to profit from misleading information (hint : there's a reason you haven't heard about it from major news outlets).
- you back up inflammatory statements (like "healthcare professionals seemingly lie (by omission at least) in order to further vaccination.") with some evidence, particularly where the common narrative disagrees with your statement.
- You avoid misleading arguments ("The solution of no genital contact with others isn't inferior, it wasn't applied" - this is misleading, many have attempted to apply it, it's their attempts that have failed).
The US has thankfully provided us with more data on the effectiveness of abstinence only education than we could ever need. Just check the data on teenage pregnancies in the Deep South.
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This is amazing!
"As a result, the HPV rate among women aged 18 to 24 dropped from 22.7% to 1.1% between 2005 and 2015."
"As a result, the HPV rate among women aged 18 to 24 dropped from 22.7% to 1.1% between 2005 and 2015."
Not amazing at all to me, considering that they are completely different populations.
The youngest subject at the start of that window dropped out of that population 7 years ago (3 years before the last survey). The figure doesn't count cures, or even reduced transmissions, among the original subjects.
That said, I find the quoted statistic suspect. First of all, the first vaccine wasn't even licensed until 2006, and there wasn't a vaccine that addressed more than 4 of the cancer-causing subtypes until 2014[0]. Second, they only targeted girls of age 12-13 (although they provided free vaccinations on manual request through age 19), leaving out girls in the upper 70% of the age range altogether from the survey population.
So, I don't take those numbers at face value, although I don't debate the safety or efficacy of these particular vaccines, being genetics-based. It's the profiteering by the planned-obsolescence model of the manufacturers that bothers me. If you're a parent and you followed the public-health experts' recommendations, and you wanted the full (nonavalent vaccine) functionality, you would have given a three-injection treatment of the bivalent spanning 6 months, then (later) a three-injection treatment of the quarivalent spanning 6 more months, then another cycle of the nonavalent vaccine... giving the manufacturers a lot of money out of your public health budget and a proof-of-concept for the drug companies to do this in lots of other vaccines and drugs in the future.
[0] http://apps.who.int/iris/bitstream/10665/255353/1/WER9219.pd...
Human papillomavirus vaccines: WHO position paper, May 2017
The youngest subject at the start of that window dropped out of that population 7 years ago (3 years before the last survey). The figure doesn't count cures, or even reduced transmissions, among the original subjects.
That said, I find the quoted statistic suspect. First of all, the first vaccine wasn't even licensed until 2006, and there wasn't a vaccine that addressed more than 4 of the cancer-causing subtypes until 2014[0]. Second, they only targeted girls of age 12-13 (although they provided free vaccinations on manual request through age 19), leaving out girls in the upper 70% of the age range altogether from the survey population.
So, I don't take those numbers at face value, although I don't debate the safety or efficacy of these particular vaccines, being genetics-based. It's the profiteering by the planned-obsolescence model of the manufacturers that bothers me. If you're a parent and you followed the public-health experts' recommendations, and you wanted the full (nonavalent vaccine) functionality, you would have given a three-injection treatment of the bivalent spanning 6 months, then (later) a three-injection treatment of the quarivalent spanning 6 more months, then another cycle of the nonavalent vaccine... giving the manufacturers a lot of money out of your public health budget and a proof-of-concept for the drug companies to do this in lots of other vaccines and drugs in the future.
[0] http://apps.who.int/iris/bitstream/10665/255353/1/WER9219.pd...
Human papillomavirus vaccines: WHO position paper, May 2017
Lots of vaccines require multiple doses and boosters, it isn't anything new.
I don't think this represents a planned obsolescence scheme, just stages of progress in the development, testing and approval of successively better vaccines.
Check the dates again. The quadrivalent (4 strain) vaccine was licensed before the bivalent (2-strain Cervarix) vaccine, and Cervarix is inferior in other respects. Yet medical systems paid $50-2000 a dose for hundreds of millions of doses, knowing that it was obsolete.
Sorry, you're absolutely right on the dates! But how would planned obsolescence work if the inferior product is made by a competitor? It sounds more like a me-too drug scenario. Was Cervarix competing with Gardasil on price, with a tradeoff of less protection for lower cost?
> That said, I find the quoted statistic suspect. First of all, the first vaccine wasn't even licensed until 2006, and there wasn't a vaccine that addressed more than 4 of the cancer-causing subtypes until 2014[0]. Second, they only targeted girls of age 12-13 (although they provided free vaccinations on manual request through age 19), leaving out girls in the upper 70% of the age range altogether from the survey population.
I'm guessing herd immunity kicked in at some point between 2005 and 2015
I'm guessing herd immunity kicked in at some point between 2005 and 2015
Just a sidenote from the other side of the world: Brazil has been offering free HPV vaccines for girls under 15 for a while and since last year to all boys at 12; they plane to have it available to both sexes between 9 and 15 in the next couple of years. It is estimated that nearly half of young people (16-25 years of age) have some form of the HPV in the country. I don't have any results numbers to share or source from now, however, my apologies. Let's hope Australia is not the only country to do that though!
Australian parents lose their childs tax benefits if they refuse vaccination, it's an enormous incentive (thousands per year) for the average wage earner.
The article seems to not mention this.
Sadly it still doesn't stop entire communities of well-off antivaxxers forming, these particular areas are now ravaged by whooping cough outbreaks, a disease that was almost eliminated ten years ago.
The article seems to not mention this.
Sadly it still doesn't stop entire communities of well-off antivaxxers forming, these particular areas are now ravaged by whooping cough outbreaks, a disease that was almost eliminated ten years ago.
Australia does have a variety of no-jab, no-pay programs to promote pediatric vaccines, but I believe HPV vaccine (which is given later) is not included in them
May have not been the case before, some angry politicians have managed to tighten up tax and conscientious objection laws in the last few years.
So HPV vaccine is now on the national immunisation program which your child must be up to date with to claim family tax benefits.
https://www.humanservices.gov.au/individuals/enablers/immuni...
So HPV vaccine is now on the national immunisation program which your child must be up to date with to claim family tax benefits.
https://www.humanservices.gov.au/individuals/enablers/immuni...
So basically, only people that are rich AND dumb fall though the cracks?
So what percentage are we talking? Single digits, I hope.
So what percentage are we talking? Single digits, I hope.
Considerable numbers of parents in wealthy suburbs have not vaccinated their children:
https://www.theage.com.au/national/victoria/melbournes-antiv...
The next pressure point will be that if parents don’t vaccinate their children, child-care centres will be forced to refuse to take children. This will actually work because the vast majority of these wealthy suburbs have both parents working, and they must use child care.
https://www.theage.com.au/national/victoria/melbournes-antiv...
The next pressure point will be that if parents don’t vaccinate their children, child-care centres will be forced to refuse to take children. This will actually work because the vast majority of these wealthy suburbs have both parents working, and they must use child care.
You ultimately _can_ force enough people to stop taking the piss with laws. It mostly ends up being about whether you can convince parliament to pass the right ones. I like to think we (Australia) get it right at least some of the time.
Kinda dropped the ball on the NBN though, and it was entirely over politics, not reasonable policy.
I don't know about in Australia, but here in NZ it's illegal to deny access to public schools or other state funded institutions based on vaccination status. I'm not sure about private schools though.
They had to pass a law in Australia to take away benefits if you didn't vaccinate, and they could pass a law if needed regarding childcare too.
Texas tried to make it mandatory in 2007, under Gov. Rick Perry no less. Unfortunately, a combination of anti-vaxxers and social conservatives sunk this initiative using a combination of innuendo and shaming. In 2011 [1], one observed the shameful debacle of him reversing himself while begging for votes for his first presidential run.
Nowadays, Texas shows up in the news for the converse reasons: alarming growth in maternal mortality during childbirth [2].
[1] https://www.washingtonpost.com/politics/rick-perry-reverses-... [2] http://time.com/5088014/maternal-mortality-pregnancy/
Nowadays, Texas shows up in the news for the converse reasons: alarming growth in maternal mortality during childbirth [2].
[1] https://www.washingtonpost.com/politics/rick-perry-reverses-... [2] http://time.com/5088014/maternal-mortality-pregnancy/
Same (possibly different ages) in Canada (Alberta at least), it's not mandatory, but offered in school, and most people go with it.
When HPV vaccination in Australia was first being considered, there was a bit of debate - of course it works best if given prior to any sexual activity, which meant telling parents of young girls you were vaccinating their child against a sexually transmitted disease (eg see [1] for typical concerns).
The policy makers were undeterred, and strong advocacy from doctors and scientists pushed things forward. The vaccine was partially developed in Australia which also helped.
[1] https://www.theguardian.com/science/blog/2016/jan/11/why-is-...
The policy makers were undeterred, and strong advocacy from doctors and scientists pushed things forward. The vaccine was partially developed in Australia which also helped.
[1] https://www.theguardian.com/science/blog/2016/jan/11/why-is-...
>... works best if given prior to any sexual activity,...
Not entirely correct. The HPV vaccine works best in the young for the best immune response. If I were a 40 year old virgin and wanted the shot, the vaccine probably wouldn't be effect as my immune system would not respond.
Yes the shot should be administered before sexual activity, and it just happens the best immune response happens in these youngish teenage years, far earlier than a lot of parents are comfortable.
Not entirely correct. The HPV vaccine works best in the young for the best immune response. If I were a 40 year old virgin and wanted the shot, the vaccine probably wouldn't be effect as my immune system would not respond.
Yes the shot should be administered before sexual activity, and it just happens the best immune response happens in these youngish teenage years, far earlier than a lot of parents are comfortable.
By 'works best' I'm talking about preventing HPV infection, so giving it before one encounters HPV is pretty important.
I agree. But it is worth noting that there are multiple types of HPV and an initial infection may be with one not targeted by the vaccine. So receiving the vaccine after that may still provide protection against subsequent infections.
I'm confused.
Maybe a dozen strains of HPV cause cancer.[1] Only two are covered by Gardisil (~70% of cancers), and seven are covered by Gardisil 9 (~90% of cancers).[2]
Therefore, with a vaccine that only vaccinates against ~90% of HPV cancers, how can we hope to eradicate cervical cancer?
Additional reading:
[1] https://en.wikipedia.org/wiki/Human_papillomavirus_infection...
[2] https://arstechnica.com/science/2015/02/new-hpv-vaccine-is-e...
[3] https://www.cancer.gov/about-cancer/causes-prevention/risk/i...
Maybe a dozen strains of HPV cause cancer.[1] Only two are covered by Gardisil (~70% of cancers), and seven are covered by Gardisil 9 (~90% of cancers).[2]
Therefore, with a vaccine that only vaccinates against ~90% of HPV cancers, how can we hope to eradicate cervical cancer?
Additional reading:
[1] https://en.wikipedia.org/wiki/Human_papillomavirus_infection...
[2] https://arstechnica.com/science/2015/02/new-hpv-vaccine-is-e...
[3] https://www.cancer.gov/about-cancer/causes-prevention/risk/i...
From your second article:
> There is some evidence that the bivalent and quadrivalent vaccines already provide some protection against additional strains of HPV. A recent paper in Clinical and Vaccine Immunology reporting on the clinical trial for Cervarix reported that the vaccine is more than 96 percent effective against disease associated with strains 16 and 18, and more than 50 percent effective against diseases associated with any HPV strain.
There are network effects in disease transmission. In order to catch a disease, not only do you have to be susceptible, but you have to catch it from someone. If you cut the risk of contracting HPV by 90%, then not only has the chance of a vaccinated person contracting the disease gone down by 90%, but the chance that an unvaccinated person will come in contact with a carrier goes down by 90%. Eliminate all the most prevalent strains and provide some protection against the remainder, and you can cut the virus's ability to replicate itself below the threshold needed to sustain itself in the population. Same reason that anti-vaxxers can get away without vaccinating their kids for measles as long as they don't come in contact with too many other unvaccinated people.
> There is some evidence that the bivalent and quadrivalent vaccines already provide some protection against additional strains of HPV. A recent paper in Clinical and Vaccine Immunology reporting on the clinical trial for Cervarix reported that the vaccine is more than 96 percent effective against disease associated with strains 16 and 18, and more than 50 percent effective against diseases associated with any HPV strain.
There are network effects in disease transmission. In order to catch a disease, not only do you have to be susceptible, but you have to catch it from someone. If you cut the risk of contracting HPV by 90%, then not only has the chance of a vaccinated person contracting the disease gone down by 90%, but the chance that an unvaccinated person will come in contact with a carrier goes down by 90%. Eliminate all the most prevalent strains and provide some protection against the remainder, and you can cut the virus's ability to replicate itself below the threshold needed to sustain itself in the population. Same reason that anti-vaxxers can get away without vaccinating their kids for measles as long as they don't come in contact with too many other unvaccinated people.
I assumed the tetravalent vaccine only worked against the four named strains. If it's semi-effective against all strains, then I see how eradication is possible. Thank you for the clarification.
Edit: Wait, the article does not say the vaccine is semi-effective against all strains. It says the vaccine is semi-effective against cervical cancer caused by all strains. My confusion is not removed.
Edit: Wait, the article does not say the vaccine is semi-effective against all strains. It says the vaccine is semi-effective against cervical cancer caused by all strains. My confusion is not removed.
I would assume that the vaccine couldn't be semi-effective against cervical cancer caused by all strains without it being effective against all strains, since your first link says 95%+ of cervical cancer is caused by HPV and there's no known mechanism for the vaccine to act directly against cervical cancer without first acting against the HPV virus.
I apologize for the ambiguity of my prior comment. To illustrate what I'm thinking: Suppose cervical cancer is caused by two strains, 1 and 2, which are equally present in the population. A vaccine works 100% against strain 1 and 0% against strain 2. That vaccine is 50% effective against all strains causing cancer, despite having 0 power to eradicate strain 2.
Therefore, it's not clear to me that being 'semi-effective against all strains' implies 'semi-effective against each strain.'
I am now looking for sources that say Gardasil is semi-effective against each strain of HPV.
Edit: Reading this source[1] I see that Gardasil protects against strains 31/33/45/51 (grouped) with 33%-51% effectiveness. Still can't find conclusive evidence that Gardasil protects against each strain.
[1] http://cvi.asm.org/content/early/2015/01/29/CVI.00591-14.ful...
Therefore, it's not clear to me that being 'semi-effective against all strains' implies 'semi-effective against each strain.'
I am now looking for sources that say Gardasil is semi-effective against each strain of HPV.
Edit: Reading this source[1] I see that Gardasil protects against strains 31/33/45/51 (grouped) with 33%-51% effectiveness. Still can't find conclusive evidence that Gardasil protects against each strain.
[1] http://cvi.asm.org/content/early/2015/01/29/CVI.00591-14.ful...
I would assume that the context ("already provide some protection against additional strains of HPV") implies that it provides additional protection against additional, individual strains, but will grant that the wording doesn't conclusively say that and alternate interpretations are possible.
Agreed. From the evidence I was able to find, certainly Gardasil seems to prevent at least some closely related strains. I am wondering if it prevents all cancer-causing strains though, which would be needed for eradication. Probably, given the title of the article, but I wish I could find a primary or secondary source.
I'm not clear on the distinction that you're drawing - cervical cancer is almost always caused by HPV. What were you alluding to?
(Cervarix) is more than 96 percent effective against disease associated with strains 16 and 18
In other words, that's admitting to a 4% failure rate where not only did the HPV infections occur despite those subjects being vaccinated, but they proceeded to cause disease (aside from the HPV presence itself).
No, it didn’t cause the disease.
Please re-read your first link.
"Most HPV infections of the cervix are cleared rapidly by the immune system and do not progress to cervical cancer (see below the Clearance subsection in Virology). Because the process of transforming normal cervical cells into cancerous ones is slow, cancer occurs in people having been infected with HPV for a long time, usually over a decade or more (persistent infection)."
1) Not every person with HPV gets cervical cancer.
2) Many people will get into a monogamous relationship, it will not spread further.
3) It is not necessarily spread in every sexual encounter.
Therefore eradication is definitely possible.
Therefore eradication is definitely possible.
90% is still a ginormous reduction over 0%. And as with most communicable diseases, once their incidence falls below a certain threshold, they fail to spread in effective numbers to keep themselves alive.
You're misunderstanding though, it only works on certain strains of HPV, for the unaffected strains we wouldn't expect a reduction in incidence. You are thinking of Herd Immunity, which is what allows for a disease to be wiped out and protects unvaccinated/immunocompromised individuals in a population.
The article indicates that the vaccine provides a minimum of 50% reduction in all variants of HPV.
No, it projects a 50% reduction in disease caused by HPV without giving supporting science. The bivalent vaccine does not prevent infection with other strains (it can't; it doesn't work via recruiting the immune system like most vaccines do).
90% is still a ginormous reduction over 0%
Still valuable, but hardly eradication.
This is as much a marketing press release as an interim report on the efficacy of HPV vaccinations. For the points you mention as well as the 70+ lifespan ahead of vaccine recipients.
The spread of infectious disease is a dynamics problem, as is eradication.
It doesn't require 100% effective vaccines nor 100% coverage of vaccines to wipe out an infectious disease, typically it requires far less.
Break it down to the simplest terms. On average in an environment where nobody has immunity to disease an average infectious person will spread the disease to N other people, this is the "basic reproduction number" for that disease. If that number is more than 1 then in a simple model more people will get the disease over time, the disease has the ability to spread. If that number is less than 1 then fewer and fewer people will get the disease over time, leading eventually to eradication.
If you introduce immunity into the situation via vaccines then you change the whole scenario. If, an infectious person has a chance to infect some number of people but now most of those people are immune, the disease won't spread to them, it'll instead only spread to some of the people in the non-immune subset. Meaning that the effective reproduction number is reduced. And if that number is reduced below 1 due to immunization then on average the disease won't spread, it will die out. Infectious diseases rely on luck, and we can hurt their luck substantially with mass immunization programs. All that matters is pushing that effective reproduction numbers across the line from above 1 to below 1, and then ordinary population dynamics will play their part. This is how "herd immunity" works. It doesn't require 100% of people to be immune, it just requires enough immunity to flip the switch between a disease that is commonly circulating in the bulk of the population (measles, polio, HPV, etc.) to one that does not circulate and only a very small number of individuals may have at any time.
It doesn't require 100% effective vaccines nor 100% coverage of vaccines to wipe out an infectious disease, typically it requires far less.
Break it down to the simplest terms. On average in an environment where nobody has immunity to disease an average infectious person will spread the disease to N other people, this is the "basic reproduction number" for that disease. If that number is more than 1 then in a simple model more people will get the disease over time, the disease has the ability to spread. If that number is less than 1 then fewer and fewer people will get the disease over time, leading eventually to eradication.
If you introduce immunity into the situation via vaccines then you change the whole scenario. If, an infectious person has a chance to infect some number of people but now most of those people are immune, the disease won't spread to them, it'll instead only spread to some of the people in the non-immune subset. Meaning that the effective reproduction number is reduced. And if that number is reduced below 1 due to immunization then on average the disease won't spread, it will die out. Infectious diseases rely on luck, and we can hurt their luck substantially with mass immunization programs. All that matters is pushing that effective reproduction numbers across the line from above 1 to below 1, and then ordinary population dynamics will play their part. This is how "herd immunity" works. It doesn't require 100% of people to be immune, it just requires enough immunity to flip the switch between a disease that is commonly circulating in the bulk of the population (measles, polio, HPV, etc.) to one that does not circulate and only a very small number of individuals may have at any time.
Sure they might eradicate cerival cancer - but at what cost? Parents having to deal with the fact that their kids just might not be reduced to terrified neurotic messes when it comes to their own sexuality! Certainly that might be OK in some nations, but not in the USA. Our neurosis, especially when it comes to this, is far more important than any reduction in suffering or saved lives such vaccines might promise.
(This comment has been sarcasm, but bears the unsaid words believed by the groups in the US who oppose these vaccines because they are terrified adolescents might have healthy active sex lives.)
(This comment has been sarcasm, but bears the unsaid words believed by the groups in the US who oppose these vaccines because they are terrified adolescents might have healthy active sex lives.)
This is fantastic.
I have a friend that recently had a cervical cancer scare (reasonably small op to remove some worrying cells). When someone you know gets something like this you tend to gather a lot of info about it. And in this case it is remarkable how closely linked it is to a single cause (hpv)
I have a friend that recently had a cervical cancer scare (reasonably small op to remove some worrying cells). When someone you know gets something like this you tend to gather a lot of info about it. And in this case it is remarkable how closely linked it is to a single cause (hpv)
Good progress, while in Kenya a national roll-out was postponed because of high global demand for the vaccine.
https://www.nation.co.ke/news/Demand-for-cervical-cancer-vac...
https://www.nation.co.ke/news/Demand-for-cervical-cancer-vac...
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That's a pretty clickbaity title. It's really an article about increasing HPV vaccination and plummeting cervical cancer rates. But I'm skeptical that you can ever "eradicate" cancer as a form of disease, even a particular type of cancer.
I believe they are discussing eradication of the HPV virus, which the article states causes 99.9% of cervical cancer.
We do have proof of humanity once before successfully eradicating a virus, namely smallpox: https://en.wikipedia.org/wiki/Smallpox#Eradication
We do have proof of humanity once before successfully eradicating a virus, namely smallpox: https://en.wikipedia.org/wiki/Smallpox#Eradication
An interesting titbit:
>In 2017, Canadian scientists recreated an extinct horse pox virus to demonstrate that the smallpox virus can be recreated in a small lab at a cost of about $100,000, by a team of scientists without specialist knowledge. This makes the retention controversy moot since the virus can be easily recreated even if all samples are destroyed. //
>In 2017, Canadian scientists recreated an extinct horse pox virus to demonstrate that the smallpox virus can be recreated in a small lab at a cost of about $100,000, by a team of scientists without specialist knowledge. This makes the retention controversy moot since the virus can be easily recreated even if all samples are destroyed. //
It does sound too good to be true. But in this case, it is true.
HPV is probably the best example that exists of an infection being linked practically 1:1 to a cancer. See more information here[1].
If you have knowledge of any other significant sources of cervical cancer, please share them.
1. https://www.cancer.org/cancer/cervical-cancer.html
HPV is probably the best example that exists of an infection being linked practically 1:1 to a cancer. See more information here[1].
If you have knowledge of any other significant sources of cervical cancer, please share them.
1. https://www.cancer.org/cancer/cervical-cancer.html
They're talking about eradicating all reservoirs of HPV, akin to what several countries have successfully done with rabies. The headline is perfectly accurate.
As of the time of writing, the headline was,
"Australia could become first country to eradicate cervical cancer"
not, "... eradicate HPV". I'm skeptical a form of cancer can ever really be "eradicated".
You’re right. It could have been more nuanced about the HPV eradication. Still, if only 1/1000 cervical cancers have other etiologies, that does take them out of the most common cancers and make them rare. As a broad public health concern, it will be pretty close to eradicated.
And yes, no cancer can be eradicated, ever. Life finds a way.
And yes, no cancer can be eradicated, ever. Life finds a way.
0.1% is pretty good as far as headline exaggerations go.
HPV can actually cause other cancers besides just cervical.
https://www.cdc.gov/hpv/parents/cancer.html
>HPV cancers include cancer of the cervix, vulva, vagina, penis, or anus. HPV infection can also cause cancer in the back of the throat, including the base of the tongue and tonsils (called oropharyngeal cancer).
https://www.cdc.gov/hpv/parents/cancer.html
>HPV cancers include cancer of the cervix, vulva, vagina, penis, or anus. HPV infection can also cause cancer in the back of the throat, including the base of the tongue and tonsils (called oropharyngeal cancer).
Because we tend to classify cancers by which organ was affected, _technically_ eradicating cervical cancer isn't possible without getting rid of the cervix (which you can technically do, but it's major surgery).
However, practically all cervical cancer is caused by HPV. Without HPV cervical cancer would be extremely rare, because it's going to need several quite uncommon random events to coincide, the virus is "deliberately" meddling with the copying mechanics inside cells, that's how a virus propagates, without a virus those changes have to happen entirely by accident, maybe a series of cosmic rays.
So it's not _that_ hyperbolic to say this eradicates the cancer itself.
However, practically all cervical cancer is caused by HPV. Without HPV cervical cancer would be extremely rare, because it's going to need several quite uncommon random events to coincide, the virus is "deliberately" meddling with the copying mechanics inside cells, that's how a virus propagates, without a virus those changes have to happen entirely by accident, maybe a series of cosmic rays.
So it's not _that_ hyperbolic to say this eradicates the cancer itself.
Malthus made a big deal how people should have fewer children and the population still grew. With the invention of safe, effective, convenient birth control, world population levels are stabilizing, and even starting to shrink in developed countries.
We need more "fire and forget" solutions. If we want to save our environment and slow down global warming, we need solutions that at most require people to do something relatively painless 1 time. Anything that relies of persuading humans to change their long term behavior is doomed to failure.