Is The New HPV Vaccine Doing Enough For Women?

The new and improved HPV vaccine that's just gotten approval for mass production on the U.S. market is getting a lot of attention. Mostly, people are celebrating the fact that it finally covers a larger number of HPV strains — nine, to be exact, up from the last vaccine's two. Which is, any way you slice it, amazing news.

HPV, or the human papillomavirus, is a sexually transmitted disease that's estimated, according to a landmark study in 2008, to be linked to a huge swath of cancers: up to 40 percent of vulvar, 60 percent of vaginal, and 80 percent of anal cancers can be traced back to it, plus most of the incidences of genital warts. So a nine-strain vaccine must be very, very good for everybody. Right?

Unfortunately, not so much for black American women, who've already been let down massively by the vaccines currently on the local market. So what's really going on — and will the new vaccine provide genuine change for those who were left behind before?

Duke University did a now-famous study laying this disparity out back in 2013, and pointed out a pretty enormous problem: the then-current HPV vaccines, Gardasil and Cervarix, only targeted subtypes 16 and 18. Yep: the vaccines weren’t targeting any of the subtypes common in black American women. They were being left incredibly vulnerable.

Let's break one thing down first: the human papillomavirus isn't actually a single virus at all. It has up to 100 different strains or types. They're all handily numbered, for our convenience, and are sorted into "high grade" and "low grade." High grade HPV means that HPV cells carry a high risk of developing into cancer, while low grade cells may just go back to normal on their own. If you've ever had a Pap smear with abnormal results, somebody has (hopefully) explained this to you.

But there's another aspect to HPV subtypes, as the strains are called: who gets what seems partially determined by racial background. Research in the past few years has shown that, in the American population, women most often get HPV subtypes 16, 18, 56, 39, and 66, while black women most often contract HPV subtypes 33, 35, 58, and 68. See a lot of crossover there? Neither do we.

As of yet, we don't know why black American women (and other non-Caucasians) develop different HPV strains to white women. But it seriously affects treatment — particularly because the vaccines currently on the US market only vaccinate girls against two subtypes.

Duke University did a now-famous study laying this disparity out back in 2013, and pointed out a pretty enormous problem: the then-current HPV vaccines, Gardasil and Cervarix, only targeted subtypes 16 and 18. Yep: the vaccines weren't targeting any of the subtypes common in black American women. They were being left incredibly vulnerable.

"I endured the three painful shots — and thought it was a form of punishment for not using condoms — never knowing that Gardasil may not have been the correct option for me," Evette Dione wrote for Bustle when she discovered her own HPV-positive status. "Had there been funding for a vaccine specifically designed for my black, female body, a shot that protects my body as well as it does white women, I might very well be HPV-free today."

This is a hideous situation — but it's one which the new HPV vaccine is trying to (partially) improve. The new shot is designed to target HPV types 31, 33, 45, 52, 58, 6, 11, 16 and 18. Two of these are on the list of types most commonly found in black American women: 33 and 58. Both are "high grade" HPV subtypes, likely to lead to cancer (58 has been found in a high proportion of Chinese sufferers of cervical cancer, too). So: dancing in the streets. Right? Not so fast.

Targeting vaccines to particular races is a sticky issue. A TIME magazine article in 2013 pointed out that scientists are often reluctant to factor race into medical discussions, mostly because it’s insanely complicated: race-based medicine, as it’s called, is based on genetic factors far more complicated than just skin color.

Hopefully, with this first nine-strain vaccine approved by the Centre For Disease Control this month, black American women will begin to be (at least partially protected) by their HPV vaccinations. But there continues to be resistance to tailoring vaccine study to particular races, and a blame game has started that goes something like this: that not enough scientists are including different races in their HPV studies, that not enough black women are volunteering for experiments, that studies ignoring "low grade" subtypes as less important, the list goes on.

And, despite both the FDA and CDC's approval, the timeline for when the nine-strain vaccine will become available remains hazy.

But this is urgent. Four of the HPV subtypes that Duke identifies as common in black women are classified as "high grade," and two of them still have no vaccine. Gardasil and Cervarix, which have been on the market since 2008, have failed thousands of black American women; research into vaccines that target high grade subtypes across the entire racial spectrum would go at least some way towards fixing that.

Perhaps understandably, Duke's findings didn't go down well. The developers of Gardasil argued that 16 and 18 are the ones responsible for 70 percent of all HPV-related cancers — which was the conventional wisdom — but Duke's scientists maintained that more subtypes were involved. And while the scientists bickered, more and more black American women were getting a vaccine that, it turned out, wasn't targeted at their most common foes at all. (There have, as of yet, been no studies published of the HPV subtypes typically contracted by women in other parts of the world, and Gardasil and Cervarix remain the global go-tos for HPV vaccines — including in developing countries, where 85 percent of worldwide deaths from cervical cancer occur.)

Targeting vaccines to particular races is a sticky issue. A TIME magazine article in 2013 pointed out that scientists are often reluctant to factor race into medical discussions, mostly because it's insanely complicated: race-based medicine, as it's called, is based on genetic factors far more complicated than just skin color. And it's a seriously touchy subject, politically; claiming that different races require different medical care is seen as a "slippery slope" that might lead to deepened racial divides as medical treatment becomes more segregated, and to people excusing the health affects of social inequality as "just the way that race is."

As of right now, nobody's announced any studies into why American black and non-Caucasian women sustain different HPV subtypes, and it's likely because of this worry; scientists who tried to delve into the area might be unlikely to get funding from squeamish authorities. But without understanding the real roots of the divide, it may be tricky for scientists to develop more targeted vaccines.

Fortunately, there's hope in other areas of medicine even for those whose common strains aren't covered by the latest vaccine. In Mexico, a treatment has been authorized by the government that treats women who already have HPV with a therapeutic vaccine, and it's been a big success in clinical trials: every subject either had their HPV cells massively diminish, or saw them vanish entirely.

If the race card proves too difficult for science to manage, this may be the way the game goes: just let people get HPV, and treat them for it afterwards. But surely an ounce of prevention is still better than a pound of cure — and every woman deserves to be protected.

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