This text is the English translation of the article “HPV: Katil Aşk Değil Bizi 9 Yaşında Aşılamayanlar“, by Cem Kılınç, published on areteportal on 21 July 2022. The text has been translated into English by Tayfun Tatar.
HPV: Human Papilloma Virus.
A public health issue that we frequently come accross in the last year with the struggle for its free vaccine and the solidarity with which citizens get vaccinated. The one that made institutions move into action and created awareness widespread enough to encourage deputies to propose laws repeatedly and political parties to generate election promises based on itself… The one that causes several types of cancers, mainly cervix cancer, and in the act of prevention, the vaccination for which has been included in free vaccination calenders in over 100 countries but Turkey, where the three doses of the vaccination can only be purchased for 3000 TL as a result of the obscurantist healthcare policies.
HPV is a virus with over 200 variants, 40 of which target genital area. It is the most prominent factor with known connection with cancer. It causes 5% of all the cancer cases worldwide and 10% of all cancer cases in women. While some types (type 6 and type 11) cause genital warts, some other tips lead to cancer and pre-cancerous diseases (type 16 and type 18 are responsible for 70% of all cervix cancer cases). This virus dominantly infects people through sexual ways and it is highly widespread in unvaccinated societies. It is known that 80% of all women are infected with HPV at least one time during their lifespan, while the situation is not any better in men. The cumulative risk that a woman is infected with HPV during his first sexual intercourse is 46%, which corresponds roughly to 1 in every 2 women. According to records (which in fact underestimate the real numbers), 600 thousand women are diagnosed with HPV-caused cancers, among which 350 thousand of which result in death. Unlike the common belief, men are not only carriers. Even though the numbers are not such striking as in women, 40 thousand men are globally diagnosed with cancer caused by HPV.1 While these are saddening statistical data, there is a certain way to get rid of the problem: Vaccinating people at early age in the scope of national vaccination calender.
Because these facts are clear: In a country that conducted vaccination program for 10 years as a part of national vaccination calender, a decrease of 90% in genital wars and 85% in high-grade cancer precursor lesions (CIN2-CIN3) were detected according to real life data. 10 years is a pretty short time compared to human history and these effects are utterly strong.1
Whereas HPV vaccination is already included in the national vaccination calender in over 100 countries to vaccinate citizens at early age, no such practice is present in Turkey. In order to judge where Turkey stands, these bullet points would suffice: Both boys and girls are vaccinated freely in Turkmenistan since 2016. It was stated earlier that the vaccine would take its part in the national calender in 2023, even though with Taliban coming to power this will most probably be (or have already been) canceled. Whatever is causing this, it is the same reason in Turkey: Obscurantism.
In United Arab Emirates, HPV vaccination is a must for school children. In countries including Mozambique, Zimbabwe, and Haiti, on the other hand is currently a pilot scheme.2 In Turkey, however, the vaccination rate is only 0.9%, as stated by the experts.This implies that 99.1% of Turkey population is forced to experience their sexuality under the shadow of the aforementioned health threats. In the meantime, it is known that this vaccine is a cost-effective one. Yet, we know that when the “Vaccine Scholarship Solidarity” started to make a sound and journalists asked the members of parliamentary health commission from the ruling party for their opinions, they replied fudging that its cost must be investigated first. However, the reports of the 3rd Health Workshop organized by the Ministry of Health in 2018 state that HPV vaccine is cost-effective. We estimate that on the cost of the “dinasaur park” constructed by former Ankara metropolitan mayor Melih Gökçek, 26 million kids would receive 2 doses of vaccination each. The choice is whether to spend the taxes on publich health or on rant. This is why we believe the issue is not the cost but obscurantism. Once this vaccine is applied within the scope of national vaccination calendar, it is known to positively affect the state budget by mitigating the treatment costs of cancer as well as precancerous diseases.4
The initative “Boyun Eğmeyen İlaç Emekçileri (Non-Surrendering Pharmaceutical Workers)” formed of pharmacists that do not bow down and prioritize public health and that I am a part of carries out a “Vaccination Scholarship Solidarity”. This collective struggle brought public awareness to the HPV vaccination issue and lead it to be discussed with unprecedented prespectives. While this destroyed many misbeliefs on the issue, the cases prosecuted in the name of vaccinated people by The First Women and Children Association (Önce Kadınlar ve Çocuklar Derneği) started to result in victory, which provided a socialist perspective for public health rights.5
The HPV vaccine first came to question in Turkey in 2006. Former president of Cancer Department of Ministry of Health expressed that they would conduct a study to investigate the prevalence and types of cervix cancer cases in Turkey. One year later, the same person unfortunately stated that its his own choice to not let his children to get HPV vaccine, which is the licenced prevention method against the most influential factor of cervix cancer. Unfortunately, cancer prevention vaccines were politicized, through the government institution responsible for keeping us safe against cancer.
The HPV vaccination matter was mainly discussed through the social pressure on women. In Turkey, as in every country, the block against the vaccination is formed by religious organizations together with drug monopolies which will face with the risk of shrinking market as the result of vaccination affects. HPV, with an unscientific manner aiming at the rights of living and health, were always framed with polygamy perspectives. As stated above, scientific data reveals that even in the fisrt sexual experience, the cumulative risk of women getting infected with HPV is 46%. Even though change of partners increases this risk to some certain extent, addressing this matter through women is, in my opinion, a conscious choice. To address a public health issue from a perspective concerning an individual’s personal choices while that issue can be resolved easily through vaccination at early age is clearly exploited to consciously mislead public awareness and get rid of official responsibilities. As indivuduals believing that sexuality which is desired by billions of people for experiencing most human feelings should be broken free from this fear and that the issue cannot be discussed from this angle, we emphasized repeatedly that this concerns health rights. This is why we stated over and over that the murderer is not love but those who did not vaccinate us when we were 9.
According to the studies conducted with HPV-positive subjects, serious problems such as depression, anxiety, lose of self-respect, social isolation, disaffection against sexuality, fear of cancer, which worsen the overall well-being, are observed.1 In the one year period during which I get to know many HPV-positive people, I had to chance to self-observe and verify these claims from the literature. These people were forced to blame themselves, their partners or the sexuality between them in this emotional darkness regardless of how secular they are. However, we tried to revive them from this sick mood by reassuring them that 8 out of 10 people experience this once in their lifetime and they should be angry with those that did not provide their public with the health rights. The angry which once was pointed to a wrong direction, now became a struggle.
As Boyun Eğmeyen İlaç Emekçileri, we defend that HPV vaccination should be free and be included in the national vaccination calender in order to protect public health, fight against cancer, prevent mental disorders in especially women, and to line up with the congenital rights of life and health.
We further claim that this is a class-related matter. While people with financial strength have access to HPV vaccine, the minimum wage-workers and students living on scholarships insufficient even for accommodation cannot procure it despite their increasing awareness. The inequality in the health right should be dismissed. A majority of Turkey’s population either work for wages below hunger limit or convicted to unemployment. Therefore, there is a class barrier between these people and HPV vaccine. We have been speaking mostly on their behalf and giving their fight.