Editor's Note: We at POPSUGAR recognize that people of many genders and identities, including but not limited to women, may or may not have female sex organs, such as a cervix or vagina. This particular story includes language from experts, government agencies, and studies that generally refer to people with female sex organs as women.
It's been roughly two decades since the US launched a nationwide vaccination effort against the human papillomavirus (HPV), a sexually transmitted virus that increases the likelihood of developing certain cancers. While the campaign is widely viewed as a success, it has led only to a stagnant reduction in infection rates in the Black and Latinx communities — and not just because, historically, these communities have been more likely to express vaccine hesitancy. The first two vaccines created to slow HPV transmission did not address the strains of the virus that are most common in women who researchers identify as Black or Hispanic, the demographic that is also most likely to be diagnosed with HPV-associated diseases, including cervical cancer.
Young millennials like myself and older members of Gen Z may recall getting Gardasil-4 or Cervarix-2, the first vaccines that were developed to curb the spread of HPV. Gardasil-4 and Cervarix-2 were administered to young people and children as young as 9 years old, and required a two- or three-dose regimen, depending on the person's age at the time of their first dose. However, despite the success of these vaccines following their rollout in 2006, the Black and Latinx communities have continued to experience disproportionate levels of HPV-associated cancers. Thus, the creation of the Gardasil-9 vaccine — the latest HPV vaccine that expands protection against multiple strains of high-risk HPV — is essential in addressing this disparity.
Gardasil-9 is now the primary HPV vaccine in the US and has proven to be nearly 100 percent effective at preventing HPV-associated diseases, especially when administered early in life. But what does this mean for those who were already vaccinated, or are perhaps considering it for the first time? Here's what you need to know to protect yourself and those you care about most.
How Is Gardasil-9 Different From Previous HPV Vaccines?
First, let's talk about the basics. Though most HPV infections resolve on their own within two years of transmission, nearly 80 million Americans are currently living with the virus, with 14 million HPV infections occurring annually. The 37 known strains of HPV are divided into "high-risk" and "low-risk" categories. Low-risk strains are known to carry a lower risk of a person who contracts HPV later being diagnosed with HPV-associated cancers, and their symptoms are typically milder in nature. In contrast, high-risk strains present the highest risk of causing cervical, oropharyngeal, anal, and other types of cancers. Overall, 14 of the 37 strains of HPV are considered high-risk strains, with strains 16 and 18 causing 70 percent of cervical cancers and precancerous lesions.
Despite the Gardasil-4 and Cervarix-2 vaccines being responsible for massive decreases in HPV and HPV-associated cancers, more recent studies have shown that not all Americans benefited equally. A 2013 study conducted by researchers at Duke University School of Medicine found that white people tend to primarily contract HPV strains 16, 18, 33, 39, and 59, while Black participants in the study carried strains 31, 35, 45, 56, 58, 66, and 68. Moreover, a study published in 2015 by the American Association For Cancer Research found that some of the same strains that affected Black women at higher rates were even more common in Hispanic women living along the Texas-Mexico border.
The original Gardasil, a quadrivalent vaccine, was designed to prevent HPV strains 6, 11, 16, and 18; Cervarix, a bivalent vaccine, only targeted strains 16 and 18. By contrast, Gardasil-9 protects against HPV strains 6, 11, 16, 18, 31, 33, 45, 52, and 58 — widening the net for the communities that are most at risk for HPV-associated cancers.
"I think the original vaccines not covering more high-grade strains is not necessarily a failure of medicine or research. I think it's just a function of how science and discovery go," Ukachi Emeruwa, MD, MPH, an ob-gyn and clinical fellow in maternal-fetal medicine at Columbia University Irving Medical Center in New York, told POPSUGAR. "Medications and vaccinations should change — not because they were unsafe when they came out, but because we make them available as soon as we find something helpful and then change them to make them even better every time we can."
Who Should Get the Gardasil-9 Vaccine?
Gardasil-9 is recommended for young people ages 11 to 26, as well as adults up to age 45 who, after discussing their risk factors with their doctor, decide that they could benefit from being vaccinated. However, Chinedu Nwabuobi, MD, an ob-gyn at a large health system in Columbus, OH, explained that people who have already received the required doses of the Gardasil-4 or Cervarix-2 vaccines are not advised to undergo an additional course with Gardasil-9. I, personally, chose to get the Gardasil-9 vaccine recently at 28 years old, because I never completed my third dose of the HPV vaccine after receiving my first at age 11. I was informed by my own doctor that there's no specific amount of time that needs to pass before you begin your course of Gardasil-9 should you choose to do so.
If you're unvaccinated and still skeptical or hesitant to add the vaccine to your to-do list, know that there are benefits beyond cancer prevention (which is a massive one). "HPV is also associated with genital warts," Dr. Nwabuobi told POPSUGAR. "In addition, management of abnormal pap smears — which may be attributed to high-risk HPV — may include a procedure called a cone biopsy. During this procedure, a portion of your cervix that contains abnormal cells is removed surgically," which may increase your risk for premature delivery if you decide to have a baby later on. "As a maternal-fetal medicine doctor, I deal with preterm birth issues frequently, and prevention of this condition is very paramount whenever possible," Dr. Nwabuobi explained.
How Else Can These Racial Disparities Be Addressed?
Experts generally agree that more work needs to be done to ensure equitable healthcare and public health education for those who are most affected by HPV. The fact that such disparities exist suggests that preventive strategies — including identification of and treatment for precancerous lesions — aren't reaching the Black and Latinx communities the way they should, Dr. Emeruwa explained. "Until we can get to a point in which the way we share knowledge, build trust, and distribute interventions is equitable, I don't see us making a dent in that disparity."
As we've seen during the COVID-19 pandemic, vaccination efforts are futile when a population isn't properly informed about the vaccine and granted equitable access to it. "Ultimately, I think the first step in closing the gaps is for healthcare providers to engage women of color through education and unbiased counseling," Dr. Nwabuobi said, adding that the government can also address these disparities by engaging communities of color with awareness campaigns focused on cervical cancer and by expanding healthcare coverage. It's well-documented within public health research that Black and Latina women are least likely to have health insurance coverage and access to healthcare — and by extension, preventative treatments — due to issues like poverty and systemic and medical racism.
"I think the future of women's health is understanding and respecting that medicine and health do not operate in a vacuum," Dr. Emeruwa explained. "Access to care and infrastructure that promotes healthy behavior, policy, financial resources, discrimination, racism, cultural competency, historical context — all of these and more directly impact any intervention or treatment that we develop. It's not all genetics and biology the way we used to or would want to believe." She continued: "If we want to mend and close the gaps in healthcare, our research and care have to start to investigate women's health through this more holistic lens."
Though a major overhaul is needed within the medical and public health communities, the development of the Gardasil-9 vaccine to specifically address the HPV strains that are most prevalent in Black and Latina women is indicative of an era of healthcare dedicated to addressing both bodily and societal ills.
While that work continues, you should do everything you can to reduce your risk. "Other than getting the HPV vaccine, the best way to lower your chance of getting HPV is to use latex condoms and dental dams the right way every time you have sex," Dr. Nwabuobi said, noting that you should also get routine cervical cancer screenings, starting at age 21. In the battle against HPV, it's important to arm yourself with every resource available.