Why do Iranian health authorities deny an HPV crisis?

Iran's health ministry has come under fire for denial of a crisis requiring general vaccination against the Human Papillomavirus (HPV) to please the religious establishment and political hardliners.

Experts, the media, and social media activists have been warning about the alarming spread of sexually transmitted HPV. However, the ministry has so far resisted adding the HPV vaccine to its general vaccination program.

There are no official figures on the spread of HPV, however, and the ministry insists that there is no need to start a vaccination program. Currently, the HPV vaccine can only be procured privately at a very high cost.

Around a dozen variations of the Human Papillomavirus can cause genital warts and different types of cancer in both sexes. HPV16 and HPV18 both of which are transmitted through sexual activity are believed to be responsible for around 70 percent of cervical cancer cases in women. The lesions and warts caused by the virus may be removed with topical preparation or various surgical methods but there is no permanent cure for HPV.

The Islamic Republic’s influential religious establishment and political hardliners oppose general vaccination against HPV on moral grounds, arguing that general vaccination will encourage immorality and promiscuity.

Religious hardliners on social media, particularly domestically developed social media platforms such as Eitaa, have been campaigning against the health system’s adoption of the HPV vaccine in its general vaccination program, calling it “the prostitution vaccine”.

“Sexually transmitted diseases will exist as long as there is prostitution and promiscuity. You can’t escape punishment for these with any vaccines or medication. The lasting solution is chastity,” a recent X post against vaccination exhorted.

“The propaganda over [the necessity] of vaccination against HPV on social media is a kind of fraud and the ministry does not approve of it,” Deputy Health Minister Alireza Raisi told the semi-official Mehr News Agency earlier this month, adding that the introduction of a vaccination program required further studies on its effectivity against cervical cancer.

Two types of HPV vaccine are currently available in Iran including Gardasil, developed by Merck & Co., an American multinational pharmaceutical company. Gardasil is imported through intermediary companies and sold in some pharmacies, but it must often be procured from the underground networks that smuggle pharmaceutical products from neighboring countries.

The American vaccine which offers protection against nine types of the HPV virus is completely unaffordable to most Iranians whose monthly income is around $200. According to Iranian media, three doses currently cost around 350 million rials (roughly around $500).

An Iranian version named Papilloguard, developed by Nivad Pharmed Salamat, is more readily available and costs less, around 40 million rials (roughly $60). It only offers protection against the two most high-risk types of the HPV virus.

In a tweet Wednesday, Alireza Vahabzadeh, a health ministry adviser under Hassan Rouhani, warned those opposed to general HPV vaccination and public education that the crisis was going to hit them in the face, like the HIV crisis that broke out in Iranian prisons in the 1990s, if they refused to acknowledge it.

During the second term of the reformist Mohammad Khatami’s presidency (2001-2005), authorities had to introduce a comprehensive harm reduction program which included methadone maintenance treatment and offering free needles and condoms at prisons and harm reduction centers) to contain the epidemic.

The program, authorities said, was very successful in controlling the spread of HIV/AIDS. Distribution of condoms, however, stopped during hardliner Mahmoud Ahmadinejad’s presidency, and the whole harm reduction program was abandoned a few years ago.

In 2021, vaccination against non-sexually transmitted Covid-19 also became a huge political issue when hardliners spread various conspiracy theories and opposed vaccination with Western-made vaccines, the only ones available at the time.

Supreme Leader Ali Khamenei eventually banned importing American and British-developed vaccines and insisted that Iran had to develop its own vaccines or procure them from more reliable sources. The ban allegedly led to tens of thousands of extra deaths when a severe wave of infections hit the country from June to August 2021.

In the US and UK, vaccination against HPV is recommended around the age of 12 as a preventive treatment against the likes of cervical cancer. Research from the National Institutes of Health found that in the US, 40 percent of the population aged 15 to 59 had contracted HPV.