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Denmark close to wiping out cancer-causing HPV strains after vaccine roll-out

968 points| slu | 5 months ago |gavi.org

360 comments

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pm90|5 months ago

If you're living in the US: please consider getting the vaccine, ragardless of your age. It was covered by my (rather shitty) health insurance. It consists of just 2 (EDIT: 3 for adults!) doses. It is recommended for both Males and Females.

arjie|5 months ago

It is actually not straightforward to do. Safeway Pharmacy refused to actually give me the vaccine when I showed up saying I'm not in a group that's eligible. One Medical told me that it would be a $400/shot 3-shot regimen. I'll probably just travel to India some time to visit family and get Cervavac there instead of Gardasil here. It's about $20/shot.

xkbarkar|5 months ago

In Denmark its not recommended for women over a certain age.

So please don’t get it regardless of age. Its not really considered effective for women who have been sexually active for some time.

Which is why its only recommended for girls, not women.

https://www.ssi.dk/vaccinationer/boernevaccination/vaccinati....

Tldr; Dont rush to get a vaccine that is probably not effective for you. Make an appointment with your doctor and discuss it with her first.

rtaylorgarlock|5 months ago

And note i believe they just increased the recommended age of administration up to ~40yo? Throat cancer sucks. Get the vax.

yieldcrv|5 months ago

I'm male and read about this exposure vector back in 2012 when it was only rolled out to 12 year old girls, with a further guideline that nobody over 26 should take it.

this was pre- antivaxxer anxiety, and just run of the mill 'is the government condoning sex' anxiety, and it was controversial for that reason alone

the issue was that if you've been exposed already then the vaccine doesn't work. they had a test for women that can prove they've been exposed or not, and most adults have. they don't have a test for men that can prove they've been exposed or not, and most adults have. At the time, they had also only considered males to be carriers, with no cancers themselves.

so for the US government to recommend a limited stock and get insurers on board, it was all based on probabilities of exposure and utility.

I was younger at the time, naturally, I paid $600 out of pocket to get it across 3 doses because I figured it was worse than that, or I could get some 'male ally' brownie points from women. I wasn't wealthy then but figured this experience couldn't be taken from me even if I went bankrupt.

Since then, they've further linked it to throat cancers in males, because of our mouth's contact with genitals, and insurers are told to cover it across all genders and up to mid 40s. that's not really much of a difference now though, since the checkpoint is basically the same group of people, 13 years later.

They're still assuming older people are not worth bothering with, due to likely exposure.

There is an amusing side of this if you are male and not vaccinated yet, since nobody can tell if you've been exposed still: keep your sexual relationships with younger women. lol. in case you needed an excuse - higher probability they're vaccinated.

LorenPechtel|5 months ago

It's not approved for those over 45. (AFIAK, simply because so few people in that age group would have risk without having had prior exposure. Basically only those who had divorced or lost their long time partner.)

comrade1234|5 months ago

Any way to test for previous exposure? I'd be pretty surprised if I didn't already have antibodies. I suppose it doesn't matter though.

rogerrogerr|5 months ago

If you’re not sexually active, is it still worth doing?

justin66|5 months ago

> It consists of just 2 doses.

Wasn't it 3 doses before?

hedora|5 months ago

I went to my local megacorp pharmacy out here in California, and asked about the COVID vaccine that’s no longer recommended by our anti-vaxxer overlords.

Apparently, it’s about as easy to get as an old-school medical marijuana card.

Results vary by state though. No need to travel to Canada or Mexico (yet).

DaSHacka|5 months ago

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p1dda|5 months ago

That is a truly naïve way of thinking about a pharmaceutical product. Would you say the same about any other drug? What about blood pressure medicines, should everyone "consider getting it"? Completely ignorant, you have to consider multiple factors for the individual before taking any pharmaceutical drug and then you have to consider the risk from the drug, yes, low and behold, even vaccines can give side effects! The level of ignorance of the comments is staggering!

pyuser583|5 months ago

I've been through this with medical providers, and they say it's not recommended for me.

I don't take medical advice from internet strangers, especially when it contradicts my doctors'.

I'm not particularly interested in discussing the how's and why's. My doctor said he doesn't recommend I get it, so I don't.

shirro|5 months ago

Good stuff. Australia has a target for eliminating cervical cancer by 2035 and ofcourse HPV is responsible for a large proportion of penile, mouth, throat and anal cancers as well. All my kids got free vaccinations at school.

It is shocking that there are still places in the world where this is controversial. You can tell a lot about the qualities of a society by the way they care for their own.

illiac786|5 months ago

You should think about how you would react to “you can tell a lot about the qualities of a society by the way they [detain people on Nauru | reject asyl seekers | don’t care for indigenous populations]”.

I feel your comment is a generalisation and could be construed as provocation/trolling. Probably not your intention, but just so you are aware how this is coming over.

Better maybe: “societies that have good health care thrive” or something like this. Sounds less judgmental and it doesn’t put all US Americans in one basket.

I fully agree on the content though, only criticising the form here.

Animats|5 months ago

Good to hear what's happening in the more advanced countries.

dmix|5 months ago

RFK Jr may be a bit biased, his opposition has been profitable

> Kennedy for years has earned referral fees from Wisner Baum, a Los Angeles personal injury law firm that is currently suing Merck, alleging the pharmaceutical giant failed to properly warn the public about risks from its vaccine against human papillomavirus (HPV), Gardasil, according to financial disclosure documents filed by Kennedy with the Office of Government Ethics.

https://www.cbsnews.com/news/rfk-jr-confirmation-robert-f-ke...

stared|5 months ago

There is recent research showing that it can (slightly) help even during HPV infection, see "Effect of HPV Vaccination on Virus Disappearance in Cervical Samples of a Cohort of HPV-Positive Polish Patients", J Clin Med (2023) https://pubmed.ncbi.nlm.nih.gov/38137661/.

Also, the eligibility criterion of not vaccinating people above certain age is NOT valid. I mean, sooner better. But if you are adult and there is any chance that you ever get a new sexual parter, get a vaccine.

90% people with get at least one HPV strain in their life. 10-30% people have at least one HPV strain right now.

(I recommend doing PCR test with strains genotyping. I do it periodically.)

Sure, our organism usually gets rid of such on 1-3 years, with no consequences. Yet, vaccine boosts your immunity.

Also, over 50% of cases of throat cancer are HPV-lead. So if you have male body, also vaccinate - both to protect others and yourself. Ideally for 9 strains, but HPV 16 and HPV 18 are by far the most important.

A few more links: https://pinboard.in/u:pmigdal/t:hpv

vidarh|5 months ago

> Also, the eligibility criterion of not vaccinating people above certain age is NOT valid. I mean, sooner better. But if you are adult and there is any chance that you ever get a new sexual parter, get a vaccine.

The eligibility criterion has primary been about controlling cost to focus about the groups where the societal effect is greatest.

I expect it may gradually get broadened, but most places you can also get it privately even if you fall outside those ages.

E.g. in the UK, most private providers will vaccinate you up to 45, and at least some private providers will give you the vaccine with no upper age limit (and a lower age limit of 9) at a relatively reasonable cost (~180 pounds per dose - 2 to 3 doses)

tecleandor|5 months ago

Thanks! I wanted to talk about the effect on already infected individuals in my comment, but I couldn't find the study so I didn't say anything just in case I was misremembering it...

blindriver|5 months ago

The goal wasn't to eliminate the HPV strains, it was to decrease cervical cancer. Has Denmark encountered a drop in cervical cancer? If so, that's a great outcome!

LorenPechtel|5 months ago

The lead time from infection to cancer is very long, we would not expect to see too much of a drop *yet*. But testing for those strains seems to be as useful for screening as a pap smear.

justin66|5 months ago

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olivia-banks|5 months ago

Cervical cancer really doesn't need to be a thing anymore, the vast majority of cases are oncoviral, and we know how to prevent HPV.

syntaxing|5 months ago

Wasn’t this also the same conclusion for Australia? Cervical cancer plummeted to record rates. Men should still get it so they don’t effect their partners and HPV causes all sort of cancer too.

epistasis|5 months ago

Yes, Michael Douglas had a throat cancer he said was from "oral sex" meaning HPV infection, and I remember social media berating him for saying that as if it were impossible, but it really is.

Random anecdote: with whole genome sequencing, which is fairly common among the rich with cancer, you can sometimes find the exact cancer driving genes that the HPV has amplified. I remember looking at one case where the HER2 gene was amplified with many copies, and you could see it attached to chunks of HPV genome. Fortunately there's now many drugs that specifically target amplified HER2, originally developed only for breast cancer, where there are diagnostic test to find the subset of breast cancers with the amplification.

YeahThisIsMe|5 months ago

And I can't get the shot in Germany because I'm "too old" and just assumed to be infected with it already, anyway.

What a great system.

perlgeek|5 months ago

Many doctors in Germany stick very closely to the recommendations of the Stiko (standing committee on vaccinations) and take a lot of convincing to vaccinate more, or they outright refuse. It's really annoying.

My health insure only covers HPV vaccines for 26 year olds and younger: https://www.sbk.org/beratung-leistungen/vorsorge-und-praeven...

odiroot|5 months ago

Sort of similar in most EU countries. I could get it in Austria but it's prohibitively expensive.

n1b0m|5 months ago

Can you pay for it?

m101|5 months ago

I think the history of this is something like:

- it was an expensive vaccine

- it was therefore initially introduced to women as a cervical cancer thing

- HPV however hits men at around half the cancer rate of women but through throat cancer

Or something like that. So actually the benefit to men is of a similar order of magnitude as that to women but it was just given to women to save money. Every child should be given it.

Edit: Total Rate (of HPV caused cancers) in Women: Approximately 15.9 cases per 100,000 females per year.

Total Rate in Men: Approximately 9.3 cases per 100,000 males per year.

Edit 2: Severity-Adjusted HPV Cancer Burden:

When adjusted for the severity and impact on life, the relative burden of HPV-related cancers shifts. Cancers with higher mortality rates and more debilitating treatments, like oropharyngeal cancer, carry a heavier weight.

Total Burden in Men: Approximately 135 DALYs per 100,000 males per year.

Total Burden in Women: Approximately 125 DALYs per 100,000 females per year.

holm|5 months ago

The HPV vaccine became part of the government vaccination program for boys/men 6 years ago (almost to the date) precisely for the reasons you mention. Personally really happy to see this as there was some initial fear mongering related to the HPV vaccine some years ago.

everdrive|5 months ago

Does the vaccine benefit you if you've already been infected?

Fomite|5 months ago

Potentially, yes. HPV infections are cleared over time, and there are many strains of HPV.

giantg2|5 months ago

I've heard of it being administered post exposure as a way to help the body fight the existing infection. Seemed a little odd when I first heard it as HPV should clear on it's own.

tialaramex|5 months ago

In a sense no, hence the choice to vaccinate younger children who will mostly not be sexually active yet.

But because the modern versions of these vaccines cover many strains (initial vaccines were two, Denmark chose a 4 way vaccine, now a nine way) it's very possible that you get a meaningful benefit by being protected from say six strains your body has never seen, even though the three it has already seen wouldn't be prevented.

deadbabe|5 months ago

It’s insane to think that someday humanity will finally find a cure for cancer, and then after all this money and research and struggle people will just… choose not to use it.

somenameforme|5 months ago

A cure is a treatment, a vaccine is a prophylactic. The most dangerous, by far, cancer that this would help mitigate is cervical cancer which makes up about 0.7% of cancer deaths in the US, exclusively amongst women. The overwhelming majority of cervical cancers occur in Africa due to the fact that HIV/AIDS dramatically increases your susceptibility to developing it.

thfuran|5 months ago

There will never be a single cure to all cancers. Different cancers have different underlying mechanisms and affect different tissues.

perihelions|5 months ago

By way of contrast, America's current top "doctor" organized a class-action lawsuit against the HPV vaccine.

https://www.reuters.com/business/healthcare-pharmaceuticals/... ("Kennedy played key role in Gardasil vaccine case against Merck")

> "Details of the Gardasil litigation show how Kennedy took action beyond sowing doubt about the safety and efficacy of vaccines in the court of public opinion and helped build a case against the pharmaceutical industry before judges and juries."

> "Kennedy, a longtime plaintiffs' lawyer, became involved in the Gardasil litigation in 2018 in collaboration with Robert Krakow, an attorney specializing in vaccine injury cases, Krakow said"

unethical_ban|5 months ago

I remember this being a big controversy in Texas in the 2000s. Our Republican governor, forcing girls to get the vaccine! What does he think Texan girls are, lusty?

Not like disease prevention is a universally good thing and some people tend to have sex.

At the end of the day, religious radicals like STDs because it enforces their worldview that having multiple sexual partners in a lifetime is a sin.

api|5 months ago

It's okay, he'll have us treat cervical cancer with a juice cleanse and vibes.

etchalon|5 months ago

We have the first leaders.

killjoywashere|5 months ago

Denmark is in a chronic baby shortage [1] and people in Western democracies are having less sex generally [2]. So, yay, less HPV. Go get vaccinated [3]. Unfortunately, there are some pretty significant (and sad, yes, sad) confounders.

[1] https://www.sdu.dk/en/nyheder/faldende-fertilitet

[2] https://www.google.com/search?q=western+democracies+decreasi...

[3] https://pmc.ncbi.nlm.nih.gov/articles/PMC10399474/

illiac786|5 months ago

Do you mean there is a causality between less sex and HPV vaccination, when you write “confounder”? I can’t find any study supporting this, hence double checking.

m-p-3|5 months ago

Reminded me that I'm due for my second dose, provided temporarily for free in Quebec for people between 21 to 45 years old who didn't get it when they were young because it wasn't a thing back then.

https://www.quebec.ca/en/health/advice-and-prevention/vaccin...

Now they're offering it to children as part of the standard regimen, which is great.

0xTJ|5 months ago

That's great to hear! Here where I am, Ontario, Canada, I just barely missed out on getting the HPV vaccine for free in high school. At the time, they were only vaccinating girls, but added boys a year or two after me.

hylaride|5 months ago

Check your (or your parent's) drug coverage insurance. You may be covered (mine is under the drug name gardasil).

v3ss0n|5 months ago

Can I still take that vaccine regardless of sexual activity as a 41 years old male? Will it prevent centers that can cause by HPV?

navi0|5 months ago

It could still protect you from one or more strains that you haven’t been exposed to through sexual partners and avoid contracting or passing it along to a future partner. There’s no practical way for a man to be tested for HPV (I asked and the doc said “it’ll be very painful and the result will be the same: get the vax”)

I experienced zero side effects when I got HPV vaxxed at 38yo.

egorfine|5 months ago

No worries. Some developed countries[1] will make sure to preserve these strains.

[1] The list has just a single entry for now.

spwa4|5 months ago

HPV vaccine is certainly not fully rolled out across developed countries.

NooneAtAll3|5 months ago

Cervical cancer (uterus), not skin cancer from a bad papillomas as I thought after looking up what HPV meant

mitb6|5 months ago

Also throat, mouth, tongue, anal and penile cancers.

tialaramex|5 months ago

It turns out a human body has a lot of surfaces facing the "outside" in some sense and we forget about the parts we can't see. Most of this surface is not covered in what we'd conventionally consider skin. It's bit like if you were looking at surfaces in a house and forgot the walls and ceiling.

duffpkg|5 months ago

This article headline is a gross abuse of the conclusions of the actual study which is here: https://www.eurosurveillance.org/content/10.2807/1560-7917.E...

This site is full of people perfectly capable of reading most studies. I would much rather see these links go to studies than endless clickbait articles about studies.

The conclusion of the study show that about 30% of the women in the study from 2017-2014 tested positive for one of several types of HPV infection. This does appear to be a reduction from an earlier 2013 study but the earlier study was by different authors with different methodology so gauging the scale of the reduction is not straightforward. My opinion is that a safe conclusion of the study is that HPV prevalence has not increased.

amluto|5 months ago

That link says:

> What have we learnt from this study?

> Infection with HPV types covered by the vaccine (HPV16/18) has been almost eliminated. Before vaccination, the prevalence of HPV16/18 was between 15–17%, which has decreased in vaccinated women to < 1% by 2021. However, about one-third of women still had HPV infection with non-vaccine high-risk HPV types, and new infections with these types were more frequent in vaccinated than in unvaccinated women.

The conclusion seems to be that the vaccine is extremely effective at preventing infection by the strains included in the vaccine. One might reach a stretch conclusion and infer that the 9-valent vaccine would be even better as it would (probably) dramatically reduce the risk of several of the remaining “high-risk” variants.

pitpatagain|5 months ago

The study is linked early in the article and is fairly dense, the article summarized it well and is a lot more readable.

16/18 are the most carcinogenic strains, they have been close to eradicated in Denmark. "Denmark close to wiping out leading cancer-causing HPV strains after vaccine roll-out" is the full headline and 100% accurate.

Those were the only two high risk strains covered by the vaccine used in the time frame studied. The study covers the first cohort of girls given the 2008 version of the vaccine when they recently reached age to start screening. It is expected to not see other strains affected in this study, even though current vaccines are broader. The total number of high risk HPV cases in the study went down post-vaccination.

The notion of numbered strains of HPV is about diverging lineages going back hundreds of thousands of years in a highly conserved, slowly mutating virus. They are not comparable to things like seasonal COVID or flu strains.

atombender|5 months ago

> about 30% of the women in the study from 2017-2014 tested positive for one of several types of HPV infection.

That number was referring to different strains not covered by the vaccine. The study says the rate of infection dropped to less than 1% among those strains the vaccine protects against.

floppiplopp|5 months ago

"Denmark completely autistic." -Unnamed US federal government secretary

born2web|5 months ago

If i have no memory/record of getting this vaccine (but there was a possibility that i could have already gotten the vaccine years ago), is it okay to take it again?

inglor_cz|5 months ago

Good news.

Bad news is that many countries came close to wiping out measles et al. too, but it takes sustained effort to keep things like that.

chris_wot|5 months ago

Amazing how badly the United States is regressing. Literally measles is making a comeback due to idiots like RFK.

giantg2|5 months ago

Unlike the measles, HPV is not a good eradication candidate due to the existence of non-human reservoirs.

boxerab|5 months ago

Here's why we should be wary of the "wonder drug" being touted by GAVI:

RFK Jr.: "Gardasil is probably the single worst mass vaccine that we've ever seen. This vaccine targets millions of preteens and teens for whom the risk of dying from cervical cancer is zero. Nobody in their right mind would ever take this vaccine if they actually read the clinical literature."

"Death rates in the Gardasil trials were 37 times the death rates for cervical cancer. Children who take that vaccine, the Gardasil vaccine, are 37 times more likely to die from the vaccine than they are to die from cervical cancer. The problem with Gardasil, like most vaccines, is it was never tested against a true placebo, an inert placebo."

"And the CDC and HHS say, if you don't test it against a true placebo, it's not science. You have no way of gauging whether the injuries you're seeing from the product are being caused by that product, or whether they're just bad, sad coincidences. The entity that is actually performing the study is, and paying for the study, is Merck."

"Merck got to decide which injuries were being caused by Gardasil and which were just bad coincidences. And because it had that power, it just wrote them all off as bad coincidences."

"You can do that when there's no placebo, because the injuries they were seeing in the control group, where the girls were getting aluminum neurotoxins, were identical to the injuries they were getting in the Gardasil group."

"So they said, well, we don't have to report any of these as vaccine injuries. They were able to license something that is insanely dangerous."

Kalanos|5 months ago

In the US, there is no male test for HPV

uvas_pasas_per|5 months ago

Is there a test to see if you have the virus already? So I know whether I should take the vaccine.

nixosbestos|5 months ago

I remember arguing in favor of Gardasil as a teenager in highschool. And now RFK Jr calling it dangerous. Someday my head might just explode.

gigatexal|5 months ago

[deleted]

toomuchtodo|5 months ago

There are people who will do the right thing, there will be people who you can teach to do the right thing, and there will be people who will ignore you no matter what. Optimize for the first two. "Pick better parents" is unfortunately unactionable advice.

Australia has almost eradicated cervical cancer through HPV vaccination efforts, other countries will get there as a function of uptake and cohort replacement. There is a recently developed blood test that can detect the biomarkers from HPV related cancers years before they would traditionally be diagnosed, but prevention via vaccination remains key.

https://www.who.int/news/item/17-11-2023-global-partners-che...

https://www.thelancet.com/journals/lanpub/article/PIIS2468-2...

https://en.wikipedia.org/wiki/HPV_vaccine

https://academic.oup.com/jnci/advance-article-abstract/doi/1... | https://doi.org/10.1093/jnci/djaf249

boxerab|5 months ago

[deleted]

pitpatagain|5 months ago

That's because other strains weren't covered by the original vaccines: Strains 16 and 18 were the high risk strains covered in the 2008 roll-out, the roll-out to young girls of the broader vaccine covering other high risk strains didn't start until 2017.

“In 2017, one of the first birth cohorts of women in Denmark who were HPV-vaccinated as teenage girls in 2008 reached the screening age of 23 years,” Nonboe explained."

It will take several more years to see the effects on other strains. It seems to have been wildly successful so far.

ekelsen|5 months ago

1. There's still overall fewer infections from high risk HPV types in these women.

2. It needs to be confirmed in ~10 years, but it seems very likely that women given the shots that protect against all high risk HPV types will see almost no infections from them.