Every year, the same situation is discussed in parents' WhatsApp groups: a teacher notifies about the upcoming vaccination of girls against the human papillomavirus (HPV), after which an active discussion begins. Many mothers express distrust towards the vaccine, believing it to be a "product of the West."
To clarify the situation and understand the sources of parental concerns, we reached out for comments from gynecologist and endocrinologist Cholpon Abdilova.
— What is the human papillomavirus and how dangerous is it?
— HPV is transmitted through contact (skin) and during sexual intercourse. According to the World Health Organization, most people encounter it during their lifetime. In 90% of cases, the body manages to cope with the virus on its own within one to two years. However, in the remaining 10%, it can cause changes in cells, which over time may lead to dysplasia or cervical cancer. Unfortunately, this disease often proceeds asymptomatically, and a person may be unaware of its presence. There are various types of HPV, among which oncogenic types pose the greatest danger.
— Why has vaccination against this virus only started recently?
— In the past, doctors did not realize that HPV is the main cause of cervical cancer and other serious diseases. Research on the link between HPV and oncology only began in the 1980s-1990s. Mass vaccination started later, as only in recent years have safe and effective vaccines been developed that can protect against the most dangerous types of the virus.
Moreover, the process of implementing the vaccine takes time: it is necessary to obtain approvals, include the vaccine in national programs, organize supplies, and conduct public awareness campaigns.
— What scares parents the most — side effects or future consequences?
— Parents are most concerned not even about the vaccine itself, but about the topic it relates to. Many immediately think about morality, teenage behavior, and upbringing. It is important to understand that the vaccine acts on a different level — it prevents a disease that may develop over many years and manifest only in adulthood. Parents' fears are related to the fact that the virus is transmitted sexually: they fear that the vaccine may encourage early sexual activity. We explain that the vaccination is done now, and the protection is formed for the future and can be effective even after 20 years.
— What reasons do parents most often cite when refusing vaccination?
— The main reasons are low awareness, fears, and prejudices. The position "I am against vaccinations in general" is often heard, as well as refusals based on religious beliefs. Some parents want to postpone vaccination until the age of 18, not realizing that the greatest effectiveness of the vaccine is achieved at a younger age.
— Do you think parents' attitudes would change if the vaccine were called "cervical cancer vaccine" instead of "HPV vaccine"?
— Possibly. The word "cancer" evokes a sense of responsibility, unlike "HPV," which is associated with shame. Paradoxically, the papillomavirus is one of the main causes of cervical cancer, and due to the name and the associations it carries, parents postpone vaccination, depriving their children of protection. My daughter is vaccinated against HPV, as are the daughters of my relatives and close ones who received complete and reliable information.
— How often do you encounter the consequences of HPV in your practice?
— Almost daily. Recently, a 35-year-old woman came for a consultation, whose tests revealed severe dysplasia and a high-risk oncogenic virus. In another case, a 43-year-old patient had not visited a gynecologist for several years, believing that if there was no pain, there were no problems. When she experienced bloody discharge, examinations showed serious changes in the cervix. Most oncological processes develop silently, without pain, so cervical cancer often goes unnoticed.
— Why is vaccination recommended at ages 9 to 14?
— At this age, the immune response is strongest. The vaccine creates a protective barrier before the first encounter with the virus. This is the principle of prevention: first protection, then risk. Additionally, children at this age require only two doses of the vaccine with an interval of six months, while adults need three.
Many countries around the world have included HPV vaccination in their national programs.
For example, Australia was one of the first countries to begin mass vaccination of adolescents, which has already led to a decrease in cases of dysplasia and precancerous changes among young women.
It is important to note that vaccination is recommended not only for girls but also for boys, as HPV is also dangerous for men: it can cause anal canal cancer, penile cancer, and the appearance of anogenital warts. Men can be not only infected but also carriers of the virus.
— If a girl has already reached 16 years old and did not participate in the free program, is it possible to get the vaccine for a fee?
— Yes, vaccination can be performed at any age, preferably before the onset of sexual activity. In private clinics, the cost starts from 250–300 dollars per dose. There are various types of vaccines that differ in the number of virus types they protect against.
For example, "Gardasil-4" protects against four types of HPV, including 6 and 11 (low-risk, causing warts and condylomas) and 16 and 18 (high-risk, causing cancer and precancerous conditions). Its cost is about 17,000 soms per dose.
"Gardasil-9" protects against nine types of the virus, including five additional high-oncogenic types, and costs about 25,000 soms per dose. There are also other types of HPV (1, 2, 3, 4, 5) that cause skin growths but do not lead to tumors.
— Are there any side effects of the vaccine?
— The vaccine is well-studied and recognized as safe. Side effects are more often related not to the drug itself but to the injection: possible pain at the injection site, redness, weakness, headache, and sometimes a slight increase in temperature.
— How to communicate effectively with parents who doubt the necessity of vaccination?
— First of all, it is necessary to provide reliable information. Fear is a natural reaction when it comes to a child's health. It is important to understand that HPV vaccination is not about early sexual behavior, but about prevention, and at this moment, it is the most effective method.
It should be remembered that many countries have been using the vaccine for many years, its safety is confirmed by large studies and the experience of millions of vaccinated adolescents.
Cholpon Abdilova
It is also important to note that it is impossible to fully control the future circumstances of a child's life. Even confidence in upbringing and values does not guarantee who a person will encounter in adulthood. HPV can be transmitted even within marriage, and the presence of the virus has no relation to a person's moral qualities.
When vaccination begins, many parents come to me for consultation. I ask them not to be afraid, to trust medicine and doctors, and emphasize that the vaccine is a great investment in their daughters' health.
