To the editor:
Cancer is a complex set of diseases with many different causes. Some cancers are caused by viruses such as hepatitis and human papillomavirus (HPV). One of the most common cancers in women throughout the world is cervical cancer, in which HPV plays an essential causal role. The development of a vaccine that prevents most cervical cancers, anal cancers, and genital warts is a remarkable achievement we all should embrace. As shown in several countries and in some U.S. communities, HPV-related infections and diseases, such as pre-cervical cancer lesions and genital warts, have decreased as a result of strong goals and vaccination policies.
As HPV and cancer researchers, we write to bring evidence based public health and policy considerations to the immunization debate in the Indiana legislature. Two bills in this session called for important changes to immunization legislation. Even though one (HB1359) was defeated, it had been unanimously passed in the House Public Health Committee and, ultimately, 44 legislators from both parties supported the defeated bill and agreed that Indiana can do better to protect the health of our children. The surviving bill (Senate Bill 461) is in need of strengthening if we are to beat HPV-related cancers among Hoosiers.
Although we knew the value of HPV vaccination when it was first approved in 2006, the evidence of effectiveness has greatly increased in the last 8 years. For example, the vaccine protects both boys and girls from HPV-related cancers. Men and women both are susceptible to anal and head and neck cancers caused by HPV, which are emotionally devastating to families and financially costly to our state and country. HPV vaccines, like other vaccines, have been shown to be safe and effective. There is no evidence-based credible debate about this. With the recent Measles outbreak, the public has been reminded that false concerns about vaccine safety can have great health and economic consequences.
Our studies confirm that parents and clinicians need help talking about HPV vaccination. Parents depend on their children’s doctors to initiate the discussion and it is important that parents have accurate information. Our role in the public health sector is to facilitate this conversation, through information sharing such as sending home brochures through the school system to parents. But this is clearly not enough; Indiana is 32nd in the country for HPV vaccine initiation in girls and 46th for boys.
House Bill 1359 expanded access to vaccination education to all parents of 6th graders so that parents of boys could consider HPV vaccination; and it called on the state to improve our vaccination rate so that more Hoosier boys and girls would be protected against HPV-related cancers. This bill in no way mandated HPV vaccination, yet it failed to pass the Indiana House because of fear that setting goals in our fight against cancer would result in mandates, and because of incorrect claims about HPV vaccination. Ignoring the benefits of preventive care and health education puts our next generation at risk for HPV-related cancers. Our children depend upon our vision and informed leadership.
A similar bill survives (SB 461 which moves to the House now), but it includes no cancer fighting goals for Indiana. There is still time to set goals in the fight against cancer. Working towards HPV vaccination goals does not have to burden Hoosier citizens financially. Our state health department can lead the way by drawing down available federal funding to strengthen programs in our state. Indiana has been consistently ranked among the last of states in per capita funding from the Centers for Disease Control and Prevention (CDC), the agency that provides important public health resources to all communities. We already pay for these resources through our federal taxes and have not taken advantage of them. We strongly support amending SB 461 so that it includes the setting of HPV vaccination goals.
Indiana University Melvin and Bren Simon Cancer Center
Patrick J. Loehrer, Sr., MD,
Director, Indiana University Melvin and Bren Simon Cancer Center
Victoria L. Champion, PhD, RN
Associate Director for Population Science Research, Indiana University Melvin and Bren Simon
Center for HPV Research, Indiana University-Purdue University Indianapolis
Gregory Zimet, PhD, IU School of Medicine
Co-Director, Center for HPV Research
J. Dennis Fortenberry, MD, MS, IU School of Medicine
Co-Director, Center for HPV Research
Elliot Androphy, MD, IU School of Medicine & Chair, Department of Dermatology
Asok Antony, MD, IU School of Medicine
Darron Brown, MD, MPH, IU School of Medicine
Anthony Cox, PhD, IU Kelley School of Business
Dena Cox, PhD, IU Kelley School of Business
William Crabtree, PhD, IU School of Medicine
Aaron Ermel, MD, IU School of Medicine
Kenneth Fife, MD, PhD, IU School of Medicine
Barbara Frain, MS, IU School of Medicine
Michael Moore, MD, IU School of Medicine & Indiana State Chair for the Commission on Cancer
Vaughn Rickert, PsyD, IU School of Medicine
Marcia Shew, MD, MPH, IU School of Medicine
Sharon Stack, PhD, University of Notre Dame & Director, Harper Cancer Research Institute
Nathan Stupiansky, PhD, IU School of Medicine
Lynne Sturm, PhD, IU School of Medicine
Kara Wools-Kaloustian, MD, IU School of Medicine & Director, Division of Infectious Diseases
Rural Center for AIDS/STD Prevention
A Joint Project of Indiana University, University of Kentucky and University of Arizona
William L. Yarber, H.S.D., Indiana University School of Public Health-Bloomington & Senior Director of the Rural Center for AIDS/STD Prevention
Anne M. Bowen, PhD, University of Arizona College of Science & Co-Director of the Rural Center for AIDS/STD Prevention
Richard A. Crosby, PhD, Chair of Health Behavior, University of Kentucky College of Public Health & Co-Director of the Rural Center for AIDS/STD Prevention
Beth Meyerson, MDiv., PhD., Indiana University School of Public Health-Bloomington & Co-Director of the Rural Center for AIDS/STD Prevention