As America’s government remains in a shutdown standoff over nationwide healthcare, Israel’s Ministry of Health announced that all girls completing, or in the middle of, eighth grade this year can receive free human papillomavirus (HPV) vaccines. The vaccine is said to prevent nonfatal cases of genital warts as well as pre-cancerous growths, but the news doesn’t come without dissenters, and a hint of caution.
Before approving the vaccine, Health Ministry Director General Prof. Ronni Gamzu considered the evidence for several weeks and even held a conference of 40 leading experts on gynecology, oncology, women’s health, vaccines and other specialties who discussed the pros and cons of the HPV vaccine. The Jerusalem Post noted that many approved of the vaccine, but the leading voice of caution came from Shaare Zedek Medical Center’s obstetrics/gynecology chief Prof. Uzi Beller:
HPV is different from all other vaccines. It is not a vaccination against cervical cancer but against a virus that in some cases causes a premalignant condition, and in a small number of cases, a malignancy. In a year in Israel, there are 180 cases of cervical cancer, and half [of those with the disease] die of it. [This] is a rate of five per 100,000 residents – the lowest rate of cervical cancer in the world. One would have thus have to vaccinate 20,000 girls to prevent one case. If the vaccine prevented cervical cancer, I would be in favor. The vaccine [was hailed] in 2003 as being ‘the beginning of the end for cervical cancer,’ but it was exaggerated. What is known does not yet justify widespread vaccination of healthy girls.
Dr. Diane Flescher, internal medicine specialist and medical director of Jerusalem’s Bishvilaych Women’s Well-Health Center, thought of more productive ways to spend the health budget. “Don’t invest in a vaccine that has not yet saved even one case of cervical cancer; invest the money instead in public service campaigns,” she said during the conference. “How many young women today know that smoking increases the risk of cervical cancer, or that condoms decrease the risk of contracting the HPV virus that may be associated with this? The radio ads, instead of pushing mothers to vaccinate their daughters, need to encourage women to get Pap smears,” said Flescher. For emphasis, she added, “Jerusalem doesn’t have a single sexually transmitted disease clinic. I have to send my patients to Tel Aviv.”
Others support the mandate, but warn that Israel must proceed with caution. Israel’s Cancer Association director-general Miri Ziv took a more moderate view. “We are for saving lives. Chemotherapy is for sick people. Vaccine is for healthy people. If you give something to healthy young people, you have to make sure that it causes no harm and that it doesn’t cause harmful side effects.” Ziv said she wouldn’t oppose a mandate if the government can pay for it, “but it has to be done very carefully, with serious monitoring and a major public health campaign.”
Parents will be given an explanation of the vaccine and can opt out, but with government support behind it, it seems unlikely that many will. The Post predicts that since HPV is a sexually transmitted virus, Haredi families might opt out just to avoid explaining to their daughters the reasons behind it.
For context, although many American doctors recommend the vaccine, according to the National Conference of State Legislatures, a mandatory HPV vaccine has been proposed in at least 24 states and only two—D.C and Virginia—succeeded. Is this a cause for concern for America or Israel? The trouble with medicine is that we might just have to wait to find out.
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