10. HPV Vaccine Uptake in Lebanon: A Vicious Cycle of Misinformation, Stigma, and Prohibitive Costs
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PART III Engaging Sex and Sexuality 137 10 HPV Vaccine Uptake in Lebanon A Vicious Cycle of Misinformation, Stigma, and Prohibitive Costs Faysal El-Kak Human papillomavirus (HPV) is an extremely common virus that is spread through sexual contact. In most cases the virus has no physical manifestation in the body, although some strains can result in visible skin lesions such as warts. Most of these HPV infections resolve on their own with time. However , the warts can develop into precancerous lesions in the vulva, vagina, and cervix, and two of the more than forty strains of the virus account for 70 percent of cervical cancers worldwide (Bosch et al. 2002). Overall, studies have revealed that most (more than 50 percent) of sexually active women have been infected by one or more genital HPV types at some point in time, with very few HPV-infected individuals progressing to invasive cervical lesions (Baseman and Koutsky 2005). In 2006 and 2009, the US Food and Drug Administration (FDA) approved two safe and effective vaccines for HPV that aimed to prevent cervical cancer as well as precancerous lesions and genital warts. The target groups for the vaccines are girls aged eleven and twelve; vaccination is also recommended for women up to age twenty-six who have not previously been vaccinated (Centers for Disease Control and Prevention 2007, 2015). Although men are not at risk for developing cervical cancer as a result of HPV infection, the CDC also recommends vaccinating boys aged eleven and twelve (and older, if they have not been previously vaccinated) because they are vectors for transmission of the virus. Despite mounting global evidence of the benefits of the HPV vaccine— namely that it is 100 percent effective in protecting women against cervical cancer (Harper et al. 2006) and there are no significant adverse reactions (FIGO 2013)—its uptake is still far from universal. Indeed, in much of the world, a confluence of political, regulatory, provider, and information barriers have impeded widespread vaccination. In this chapter, I reflect on the experi- 138   Abortion Pills, Test Tube Babies, and Sex Toys ence of the HPV vaccine in Lebanon. After providing contextual information about international research on the uptake of HPV vaccine, I then provide an overview of the history of the vaccine in Lebanon and ongoing efforts by a coalition of stakeholders to establish national guidelines and increase awareness about the HPV vaccine among both providers and the public. I argue that misinformation, stigma surrounding premarital sex, and the high cost of the vaccine have conspired to inhibit uptake of this lifesaving intervention . I conclude with some reflections on the lessons from our experience in Lebanon that could be applied to other countries in the Middle East and North Africa (MENA) region. Setting the Context Despite the safety and efficacy of the HPV vaccine, a body of research from around the world demonstrates considerable variation in utilization. Since the mid-2000s, the quadrivalent (Gardasil®) and bivalent (Cervarix®) vaccines have been licensed in more than one hundred countries and incorporated into the national vaccine programs of more than three dozen. Wealthy countries in the global North were early adopters; more recently, and as a result of negotiated public sector pricing, the HPV vaccine has been introduced into a plethora of middle and lower income countries. Target population, cost, and systems of provision vary tremendously by country, but acceptability of the vaccine has generally been high (Markowitz et al. 2012). The full course of the vaccination requires three doses over a six month period. In general, national programs that include publicly-financed, schoolbased delivery have achieved higher rates of vaccination. However, research from around the world has demonstrated that concerns about safety often championed by antivaccine campaigners, clinicians’ and parents’ misgivings about providing the vaccine to preteens and young adolescents, discomfort with government interference with parental autonomy, and concern about the cost borne by health systems and individuals have consistently hampered the intention to vaccinate and have impeded uptake (McRee, Gilkey, and Dempsey 2014; Markowitz et al. 2012; Seoud 2012; Barnack et al. 2010; Chow et al. 2010; Krupp et al. 2010; Wong 2009). As a result, for example, by 2008 less than 5 percent of eligible girls and women from Korea, Malaysia, Taiwan, and Thailand had been vaccinated (Chow et al. 2010). By 2013, fourteen countries in the MENA region had licensed at least one of the HPV vaccines (Jumaan et al. 2013). Seoud (2013) describes the prevalence of HPV in the region...


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Subject Headings

  • Human reproductive technology -- Middle East.
  • Human reproductive technology -- Africa, North.
  • Birth control -- Middle East.
  • Birth control -- Africa, North.
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