Analysis Sexual Health

Despite Dangers of Cervical Cancer, Many Parents Still Don’t Vaccinate Their Kids Against HPV

Martha Kempner

When it comes to HPV, somehow many parents still have it backwards—in reality, the HPV vaccine is safe, but cervical cancer is both dangerous and all too common.

Human papillomavirus (HPV) is the most common sexually transmitted infection (STI) in the United States, infecting millions of individuals each year. Moreover, thousands of people die each year from cervical cancer caused by HPV. But HPV is entirely preventable. With all that’s at stake, you’d think that parents would be tripping over themselves to get their daughters to the pediatrician’s office for the HPV vaccine as soon as possible. Unfortunately, that’s not what we’ve seen in the six years since HPV vaccines were released. Instead, parents have seemed reluctant to start the series and unmotivated to finish it.

Approximately 79 million Americans are currently infected with HPV. About 14 million people become newly infected each year. HPV is so common that nearly all sexually-active men and women will get at least one type of HPV at some point in their lives. Most people who have HPV will have no symptoms or health problems and may never even know they have it. Some people will get genital warts, which may go away on their own or may need to be removed by a health-care provider. However, certain strains of the virus, if left untreated, can lead to cervical cancer. Approximately 12,000 women in the United States are diagnosed with cervical cancer each year, and about 4,000 die. HPV can also cause cancer of the penis and anus, and is responsible for a recent increase in cases of head and neck cancers.  

HPV is easily spread from infected skin to uninfected skin. Transmission of HPV can be prevented by condoms, but only if the infected skin is in an area covered by the condom. If it is on an area such as a man’s scrotum, condoms cannot help reduce transmission. 

The good news is that HPV is one of the few STIs for which there is a vaccine. Actually, there are two: Gardasil and Cervarix. Gardasil was approved by the Food and Drug Administration (FDA) in 2007 and has been proven to protect women from four strains of HPV, including two that account for 70 percent of cervical cancers and two that account for 90 percent of genital warts. Cervarix was approved in 2009 and also protects against the two strains that cause most cervical cancers.

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The vaccine is given as a series of three shots and is approved for young people—both men and women—between the ages of nine and 26. In order to ensure that it works, health-care professionals prefer to administer all three shots before a young person becomes sexually active, which is why the Centers for Disease Control and Prevention (CDC) recommends that HPV vaccines become part of the routine vaccinations for girls who are 11 or 12 years old.

HPV vaccines are considered a huge breakthrough for public health. They represent the first vaccines that can prevent cancer. (I always feel like I have to say that twice, and loudly: They prevent cancer!) The National Cancer Institute notes that if all women were to get the vaccines, the benefits would be long-term: “Widespread vaccination has the potential to reduce cervical cancer deaths around the world by as much as two-thirds.” Widespread vaccination would also reduce the health-care costs, physical costs, and anxieties that are associated with abnormal Pap test results. (A Pap test screens for cervical cancer and can detect precancerous changes to the cervix.)

Many Parents Do Not Vaccinate Their Children

So then why aren’t parents jumping on the HPV vaccine bandwagon? A new study in the April issue of Pediatrics aims to answer that question; it also looks at two other new vaccines suggested for adolescents. The study compares the parents’ responses to determine if they think about HPV differently because of its relationship to sexual activity.

Researchers used data from the federal government’s 2008-2010 National Immunization Survey of Teens to determine the percentage of teens who were and were not up-to-date on three vaccinations: HPV, Tdap/Td (which protects against tetanus, diphtheria, and pertussis), and MCV4 (which protects against a form of meningitis).  Parents whose teens were not up-to-date on Tdap/Td and MCV4 were asked why they hadn’t vaccinated their child. When it came to HPV, the question was asked a little differently; parents were first asked if they planned to immunize their teen in the next year, and only those who said they did not plan to do so were asked why. 

Overall, vaccination rates for teenagers between the ages of 13 and 17 are improving, though they remain below the 90 percent goal set by the government. The percent of teenagers who had received the Tdap/Td vaccine rose from 72 percent in 2008 to 81 percent in 2010. MCV4 rates rose from 42 percent in 2008 to 63 percent in 2010. HPV vaccine rates rose as well, but they remain significantly lower than for the other vaccines; just 19 percent of teen girls had been vaccinated in 2008 and 32 percent in 2011. Moreover, the percentage of parents who said they did not intend to vaccinate their daughters against HPV in the next 12 months actually grew, from 40 percent in 2008 to 44 percent in 2010.

It is important to note that while the numbers for the other two vaccines include both boys and girls, the numbers for the HPV vaccine only include girls who received all three shots. Though the CDC does recommend that boys receive the shots, in part to reduce overall HPV rates, it is often still thought of as a bigger issue for girls because only they can get cervical cancer. It is not yet known if vaccinating boys will protect them for the other types of cancers caused by HPV.

Reasons for Not Vaccinating

The most common reason parents cited for not vaccinating against Tdap/Td or MCV4 was that it was “not recommended” by their health-care provider. Parents also said they thought it was “not needed or not necessary,” admitted they had a “lack of knowledge” about the vaccine(s), or said they “didn’t know” why they had not vaccinated. 

These were all also cited as reasons why parents didn’t vaccinate against HPV, but there were additional reasons as well. For instance, parents said they didn’t seek the vaccine because their child was “not sexually active,” their daughter was not the “appropriate age,” or they had “safety concerns/side effects.” While “lack of knowledge” was the primary reason cited in 2008 and 2009, in 2010 more parents (17 percent) said the vaccine was not necessary and 16 percent said they had safety concerns. In fact, the number of parents with safety concerns has increased dramatically, from 5 percent in 2008 to 16 percent in 2010. 

The findings of this study suggest that while parents may think they have more knowledge about the HPV vaccines, there is still a great deal of misinformation out there. 

Safety Concerns Unfounded

It is unclear where the increasing fears about the safety of HPV vaccines are coming from, though fears about vaccines in general have been on the rise over the past two decades. Much of this has been traced back to a report in the early 1990s linking some childhood vaccinations to autism. It turned out that this initial report (the results of which were never replicated) was completely fabricated by an unethical researcher with profit motives. Although this lie has now been made public, a general distrust in vaccines remains. A quick Google search will still pull up numerous anti-vaccine websites, many of which dedicate pages to the HPV vaccine. Still, these websites have been around for years, so it is hard to tell whether they are behind the disturbing results of this current study.   

Regardless of what’s behind the safety fears, they are unfounded. Before any vaccine is put on the market, the FDA ensures that it is both safe and effective. Both Gardasil and Cervarix were carefully tested before getting FDA approval. Once on the market, the CDC tracks the safety of vaccines through three reporting systems: the Vaccine Adverse Event Reporting System (VAERS), the Vaccine Safety Datalink (VSD), and the Clinical Immunization Safety Assessment (CISA) network. 

A 2009 report co-written by the CDC and the FDA combed through VAERS reports regarding Gardasil and found that 23 million doses had been administered in the United States between June 2006 and December 2008. In total, there had been 12,424 reports of adverse events following HPV vaccination. The vast majority of these cases (94 percent) were not serious and including fainting (which is common after needle shots, especially in teens and pre-teens), pain and redness at the site of the injection, dizziness, nausea, and headache. Though the more serious cases included blood clots, neurological symptoms, and death, the report was unable to find any evidence suggesting that the vaccine itself was the cause of these problems. In fact, in all of the cases of death, autopsies confirmed other causes. The report also concluded that although incidences of fainting and blood clots after Gardasil were higher than after other vaccines given to females of the same age, 90 percent of those who had blood clots had other “known risk factor for them, such as smoking, obesity or taking oral contraceptives (birth control pills).”

In 2011, the CDC looked at specific adverse events reported in the VSD following more than 600,000 doses of Gardasil, such as Guillain–Barré Syndrome (GBS), stroke, blood clots, appendicitis, seizures, fainting, allergic reactions, and anaphylaxis. No statistically significant increased risk for any of these adverse events was detected after vaccination.

Ultimately, the CDC concluded that “[c]linical trials and post-licensure monitoring data show that both vaccines are safe.”

HPV Vaccine Timing Is Misunderstood

The results also indicate that parents do not understand when their teens should be given the HPV vaccine. Over the three years of the survey, 11 to 14 percent of parents consistently suggested that they had not vaccinated their teen because she was not sexually active. Others felt their daughter was not the appropriate age for the vaccine.

It’s understandable that some parents would balk at the idea of preventing an STI in an 11-year-old. Though today’s tweens may look and sound a lot like teenagers, they are still very much kids and clearly not ready for sexual activity. This may make it seem like they are also not ready for the HPV vaccine, but just the opposite is true.  

The CDC specifically recommends that young people be given the vaccine before they become sexually active so as they avoid exposure to HPV. If a teen waits until she has already had sex to get vaccinated, she may have already been exposed. Though the average age when individuals first have sex is around 17, some have sex earlier, and given that the vaccine is safe for individuals as young as nine, it makes sense to start it early. (The skeptic in me also has to wonder how many of the parents who think their teens aren’t sexually active are flat-out wrong.)

Though the aforementioned study did not conclude that parents fear the vaccine might encourage sexual activity, this has often been stated as a concern, and I wonder if it is consciously or unconsciously one of the reasons parents declare that their daughters are not the “appropriate age.” The good news is that research has found that access to the vaccine does not increase sexuality activity. One study reviewed medical records and found no differences between girls who got HPV vaccines and girls who did not when it came to pregnancy tests, STI diagnoses, or contraceptive counseling (all markers that would indicate sexual activity). Another followed girls between the ages of 15 and 24 and found that young women who are vaccinated against HPV are no more likely to be sexually active or to have more partners than un-vaccinated girls. 

Even better, that same study found that girls who are vaccinated are “more likely to report always using a condom in the four weeks prior to the study than sexually active young women who had not received the vaccine.”  

Changing Public Opinion

Over the past few years, public health professionals have concentrated on increasing the number of physicians who recommend the vaccine, as this had been one of the main reasons parents cited for not vaccinating. It seems as if these efforts have paid off, as fewer parents cited this issue in 2010. In fact, the percent of parents who did vaccinate their teen against HPV and who reported that their physician recommended it went from 40 percent in 2008 to 45 percent in 2009, dropping just a bit, to 44 percent, in 2010. 

But the researchers suggest that physician recommendations may not be enough, and we need to explore other interventions. Merck, the company that makes Gardasil, launched an ad campaign called “One Less” when the vaccine went on the market, and it continues to build on that campaign today. The authors of the current study suggest that it might be time for state and federal agencies to develop social marketing campaigns to encourage the vaccine as well. 

Perhaps they could take a lesson from the commercial promoting the MCV4 vaccine for meningitis. The ad shows happy, healthy teenagers at school, eating lunch, laughing, sharing a drink, running on the beach, and partaking in a chaste kiss on the lips. The voice-over says, “This is what meningococcal meningitis can look like just 24 hours before it claims the life of a child.” I mentioned this to my pediatrician the very next time I saw her and was disappointed to learn that my daughter was 10 years too young for the vaccine at the time.

 

It’s not right to scare adolescents out of having sex, but scare tactics could be an effective way to get parents on the right vaccination path. The recent, ill-founded distrust of vaccines has meant that there are outbreaks of measles and mumps, diseases my generation never saw, and that kids are dying of things as seemingly innocuous as the flu.

 

When it comes to HPV, somehow parents still have it backwards—in reality, the HPV vaccine is safe, but cervical cancer is dangerous. HPV is everywhere, and cervical cancer is a real and totally preventable threat. Maybe a dose of fear-based advertising is just what the doctor ordered.

Roundups Sexual Health

This Week in Sex: The Sexually Transmitted Infections Edition

Martha Kempner

A new Zika case suggests the virus can be transmitted from an infected woman to a male partner. And, in other news, HPV-related cancers are on the rise, and an experimental chlamydia vaccine shows signs of promise.

This Week in Sex is a weekly summary of news and research related to sexual behavior, sexuality education, contraception, STIs, and more.

Zika May Have Been Sexually Transmitted From a Woman to Her Male Partner

A new case suggests that males may be infected with the Zika virus through unprotected sex with female partners. Researchers have known for a while that men can infect their partners through penetrative sexual intercourse, but this is the first suspected case of sexual transmission from a woman.

The case involves a New York City woman who is in her early 20s and traveled to a country with high rates of the mosquito-borne virus (her name and the specific country where she traveled have not been released). The woman, who experienced stomach cramps and a headache while waiting for her flight back to New York, reported one act of sexual intercourse without a condom the day she returned from her trip. The following day, her symptoms became worse and included fever, fatigue, a rash, and tingling in her hands and feet. Two days later, she visited her primary-care provider and tests confirmed she had the Zika virus.

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A few days after that (seven days after intercourse), her male partner, also in his 20s, began feeling similar symptoms. He had a rash, a fever, and also conjunctivitis (pink eye). He, too, was diagnosed with Zika. After meeting with him, public health officials in the New York City confirmed that he had not traveled out of the country nor had he been recently bit by a mosquito. This leaves sexual transmission from his partner as the most likely cause of his infection, though further tests are being done.

The Centers for Disease Control and Prevention (CDC)’s recommendations for preventing Zika have been based on the assumption that virus was spread from a male to a receptive partner. Therefore the recommendations had been that pregnant women whose male partners had traveled or lived in a place where Zika virus is spreading use condoms or abstain from sex during the pregnancy. For those couples for whom pregnancy is not an issue, the CDC recommended that men who had traveled to countries with Zika outbreaks and had symptoms of the virus, use condoms or abstain from sex for six months after their trip. It also suggested that men who traveled but don’t have symptoms use condoms for at least eight weeks.

Based on this case—the first to suggest female-to-male transmission—the CDC may extend these recommendations to couples in which a female traveled to a country with an outbreak.

More Signs of Gonorrhea’s Growing Antibiotic Resistance

Last week, the CDC released new data on gonorrhea and warned once again that the bacteria that causes this common sexually transmitted infection (STI) is becoming resistant to the antibiotics used to treat it.

There are about 350,000 cases of gonorrhea reported each year, but it is estimated that 800,000 cases really occur with many going undiagnosed and untreated. Once easily treatable with antibiotics, the bacteria Neisseria gonorrhoeae has steadily gained resistance to whole classes of antibiotics over the decades. By the 1980s, penicillin no longer worked to treat it, and in 2007 the CDC stopped recommending the use of fluoroquinolones. Now, cephalosporins are the only class of drugs that work. The recommended treatment involves a combination of ceftriaxone (an injectable cephalosporin) and azithromycin (an oral antibiotic).

Unfortunately, the data released last week—which comes from analysis of more than 5,000 samples of gonorrhea (called isolates) collected from STI clinics across the country—shows that the bacteria is developing resistance to these drugs as well. In fact, the percentage of gonorrhea isolates with decreased susceptibility to azithromycin increased more than 300 percent between 2013 and 2014 (from 0.6 percent to 2.5 percent).

Though no cases of treatment failure has been reported in the United States, this is a troubling sign of what may be coming. Dr. Gail Bolan, director of CDC’s Division of STD Prevention, said in a press release: “It is unclear how long the combination therapy of azithromycin and ceftriaxone will be effective if the increases in resistance persists. We need to push forward on multiple fronts to ensure we can continue offering successful treatment to those who need it.”

HPV-Related Cancers Up Despite Vaccine 

The CDC also released new data this month showing an increase in HPV-associated cancers between 2008 and 2012 compared with the previous five-year period. HPV or human papillomavirus is an extremely common sexually transmitted infection. In fact, HPV is so common that the CDC believes most sexually active adults will get it at some point in their lives. Many cases of HPV clear spontaneously with no medical intervention, but certain types of the virus cause cancer of the cervix, vulva, penis, anus, mouth, and neck.

The CDC’s new data suggests that an average of 38,793 HPV-associated cancers were diagnosed each year between 2008 and 2012. This is a 17 percent increase from about 33,000 each year between 2004 and 2008. This is a particularly unfortunate trend given that the newest available vaccine—Gardasil 9—can prevent the types of HPV most often linked to cancer. In fact, researchers estimated that the majority of cancers found in the recent data (about 28,000 each year) were caused by types of the virus that could be prevented by the vaccine.

Unfortunately, as Rewire has reported, the vaccine is often mired in controversy and far fewer young people have received it than get most other recommended vaccines. In 2014, only 40 percent of girls and 22 percent of boys ages 13 to 17 had received all three recommended doses of the vaccine. In comparison, nearly 80 percent of young people in this age group had received the vaccine that protects against meningitis.

In response to the newest data, Dr. Electra Paskett, co-director of the Cancer Control Research Program at the Ohio State University Comprehensive Cancer Center, told HealthDay:

In order to increase HPV vaccination rates, we must change the perception of the HPV vaccine from something that prevents a sexually transmitted disease to a vaccine that prevents cancer. Every parent should ask the question: If there was a vaccine I could give my child that would prevent them from developing six different cancers, would I give it to them? The answer would be a resounding yes—and we would have a dramatic decrease in HPV-related cancers across the globe.

Making Inroads Toward a Chlamydia Vaccine

An article published in the journal Vaccine shows that researchers have made progress with a new vaccine to prevent chlamydia. According to lead researcher David Bulir of the M. G. DeGroote Institute for Infectious Disease Research at Canada’s McMaster University, efforts to create a vaccine have been underway for decades, but this is the first formulation to show success.

In 2014, there were 1.4 million reported cases of chlamydia in the United States. While this bacterial infection can be easily treated with antibiotics, it often goes undiagnosed because many people show no symptoms. Untreated chlamydia can lead to pelvic inflammatory disease, which can leave scar tissue in the fallopian tubes or uterus and ultimately result in infertility.

The experimental vaccine was created by Canadian researchers who used pieces of the bacteria that causes chlamydia to form an antigen they called BD584. The hope was that the antigen could prompt the body’s immune system to fight the chlamydia bacteria if exposed to it.

Researchers gave BD584 to mice using a nasal spray, and then exposed them to chlamydia. The results were very promising. The mice who received the spray cleared the infection faster than the mice who did not. Moreover, the mice given the nasal spray were less likely to show symptoms of infection, such as bacterial shedding from the vagina or fluid blockages of the fallopian tubes.

There are many steps to go before this vaccine could become available. The researchers need to test it on other strains of the bacteria and in other animals before testing it in humans. And, of course, experience with the HPV vaccine shows that there’s work to be done to make sure people get vaccines that prevent STIs even after they’re invented. Nonetheless, a vaccine to prevent chlamydia would be a great victory in our ongoing fight against STIs and their health consequences, and we here at This Week in Sex are happy to end on a bit of a positive note.

Commentary Science

Robert De Niro’s Move on Anti-Vaccine Propaganda Film Is a Win for the Science Side

Martha Kempner

The events surrounding the Tribeca Film Festival and a documentary called Vaxxed: From Cover-Up to Catastrophe may provide a glimmer of hope that facts and science can still win.

Recently, some political pundits have begun to suggest that we are living in a post-truth world. It doesn’t matter, they say, that candidates spread blatant falsehoods, or contradict themselves within moments, because the American public no longer cares about what is true; they only care about what they believe to be true. This is a terrifying thought, one perhaps unrealistically heightened by the drama of the current campaign cycle. Regardless, the events of this weekend surrounding the Tribeca Film Festival and a documentary called Vaxxed: From Cover-Up to Catastrophe may provide a glimmer of hope that facts and science can still win.

The festival, co-founded by legendary actor Robert De Niro, came under fire when it revealed last week that it would be screening Vaxxed in April. The documentary, directed by discredited ex-medical researcher Andrew Wakefield, claims to be a whistle-blowing piece; it accuses the Centers for Disease Control and Prevention (CDC) of knowing about a link between autism and the measles, mumps, and rubella (MMR) vaccine, and engaging in a conspiracy to cover it up. Though De Niro initially stood behind the choice to show the film as a way to encourage “further conversation” around autism, just one day later, the festival’s organizers announced the film would no longer be on the schedule. Scientists, filmmakers, researchers, and members of the public breathed a sigh of relief.

I think we can look at De Niro’s ultimate decision as a victory for facts—because when it comes to vaccines and autism, the history is complicated, but the science is very, very clear.

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The Study That Changed the World for the Worse

In 1998, a British researcher named Andrew Wakefield published a study in which he claimed to have followed 12 children who had developed normally until being exposed to the MMR vaccine. The study, which was published in the esteemed medical journal the Lancet, argued that the vaccine had led to intestinal problems, which had, in turn, led to autism. Though the study acknowledged that “we did not prove a connection between the measles, mumps, and rubella vaccine and the syndrome described,” this is how it was interpreted and reported by many.

In many ways, the study and the way it was reported gave birth to the anti-vaccine movement popular today. Celebrities like Holly Robinson Peete and Jenny McCarthy have claimed that vaccines caused autism in their children, and recommended that other parents reject medical advice and avoid vaccinating their own. And lawmakers around the country have sponsored legislation to let parents opt out of mandatory vaccinations of school-aged children for “personal reasons.”

Not surprisingly, as fear increased, vaccination rates dropped, both in Britain and the United States. Even less surprisingly, as vaccination rates dropped, incidences of diseases thought to be under control, like whooping cough and measles, increased.

Vaccination works not just because it protects an individual from a communicable disease, but because it provides the community with something called herd immunity. Public health experts believe that 90 percent of a given population must be vaccinated to protect the unvaccinated members—such as infants and people with compromised immune systems—from getting sick as well.

So parents who choose not to vaccinate their children are making a decision that affects other people as well. Yet in seven states and the District of Columbia, less than 90 percent of entering kindergarteners have been vaccinated for measles. There are many public health experts, myself included, who believe this is a direct result of Wakefield’s study and puts us all at risk.

Wakefield’s Study, Debunked

Almost immediately after Wakefield’s study was published, other researchers set out to recreate his results and examine the possible connection between vaccines and autism. None of them ever found it. Wakefield himself could not reproduce his results. In 2004, the Institute of Medicine reviewed all of the available research and concluded that no link existed between the MMR vaccine and autism. A 2014 review of all of the studies since Wakefield’s found that researchers have now looked at over 1.2 million children and have not found any link between autism and vaccines.

As others failed to find similar results, scientists began to question Wakefield’s credibility as well. In 2004, it emerged that Wakefield had been paid the equivalent of $674,000 by a law firm intending to sue the manufacturers of vaccines, and he had not revealed this obvious conflict of interest. Upon learning this, his co-authors asked for their names to be removed from the 1998 study. In 2010, the Lancet retracted the study and Britain stripped Wakefield of his medical license. Finally, in 2011, an investigation by the British Medical Journal (BMJ) concluded that Wakefield was guilty of “falsifying medical histories of children and essentially concocting a picture, which was the picture he was contracted to find by lawyers hoping to sue vaccine manufacturers and to create a vaccine scare.”

But Wakefield did not walk away quietly with his tail between his legs. Instead, he portrayed himself as the victim of a medical establishment that had a vested interest in keeping the “truth” a secret. In 2011, when the BMJ investigation was published, he told CNN’s Anderson Cooper that his work was “grossly distorted” and that he was the target of “a ruthless, pragmatic attempt to crush any attempt to investigate valid vaccine safety concerns.” Last month, he was one of the speakers on Conspira-Sea—a cruise for conspiracy theorists. And now, he has released Vaxxed.

According to the New York Times, Vaxxed claims to introduce a CDC insider who says the agency knew about the link between vaccines and autism and deliberately withheld information from the public. The Times also reports that in the promotional material included on the Tribeca Film Festival’s website last week, but has since been taken down, Wakefield’s bio said he authored the Lancet study that “would catapult Wakefield into becoming one of the most controversial figures in the history of medicine.” The bio did not mention that the article had been retracted, or that Wakefield’s medical license had been revoked.

The Film Festival Controversy

The inclusion of the movie on the Tribeca Film Festival’s roster prompted instant criticism from people across many fields who believed it was dangerous to give Wakefield any opportunity to spread his misinformation, let alone a platform as prestigious at this one. A group of scientists, physicians, and autism experts—many organized by the Immunization Action Coalition (IAC)—mobilized almost immediately. Alison Singer, president of the Autism Science Foundation and a member of the IAC listserv, told the Guardian:

Four or five years ago we weren’t as well organized and people didn’t realize the importance of responding quickly and strongly … Today, we know that we have to respond to every incident however large or small, because if you leave any of these discredited theories unchallenged, it allows people to think that there’s something still to be discussed.

Others in the scientific and medical communities weighed in. The science blog Respectful Insolence, which is written by an oncologist, argued that by putting Vaxxed on the schedule, “the organizers of the Tribeca Film Festival have screwed up big time and given antivaccine a big, fat piece of propaganda to scare parents into not vaccinating.”

Dr. William Schaffner, a preventive medicine specialist at Vanderbilt University, told the New York Times that the festival’s reputation lent credence to the film that it does not deserve:

All of us are out talking about it reassuring parents, children, anyone who wants to pay attention to this issue that vaccines are safe and effective, and they certainly don’t cause autism, and that Dr. Wakefield was a fraud and had his license removed over this very event.

Similarly, Dr. Mary Anne Jackson, a professor of pediatrics at the University of Missouri-Kansas City, said in an interview with the Times on Friday, “Unless the Tribeca Film Festival plans to definitively unmask Dr. Wakefield, it will be yet another disheartening chapter where a scientific fraud continues to occupy a spotlight.”

Journalists also sounded off. In a piece the LA Times published the day the film festival schedule was released, Michael Specter, a New Yorker writer who has written extensively about vaccines, said of Wakefield, “This is a criminal who is responsible for people dying. This isn’t someone who has a ‘point-of-view.’ It’s comparable to Leni Riefenstahl making a movie about the Third Reich, or Mike Tyson making a movie about violence toward women.”

Michael Hiltzik, a columnist at the LA Times, concluded, “Careless actions such as those of the Tribeca Film Festival don’t contribute to ‘dialogue and discussion,’ as the festival’s PR would have it; they just spread misinformation and pseudoscience and undermine public health.”

And the filmmaking community chimed in as well. In an open letter to the festival’s organizers published on Thursday in Filmmaker Magazine, documentarian Penny Lane wrote:

This film is not some sort of disinterested investigation into the “vaccines cause autism” hoax; this film is directed by the person who perpetuated the hoax.

And this hoax isn’t cute, or fun, or thought-provoking. Very possibly, some people will walk away from your festival having been convinced, in part because of your good name and the excellence and integrity of your documentary programming, not to vaccinate their children. And very possibly people will die as a result.

Still, the initial reaction from the festival’s organizers was to defend their decision. Robert De Niro himself spoke out to support the film on Friday. In a statement he explained that he had asked for the film to be included because he and his wife have an autistic child and felt this conversation was important. He wrote:

We believe it is critical that all of the issues surrounding the causes of autism be openly discussed and examined. In the 15 years since the Tribeca Film Festival was founded, I have never asked for a film to be screened or gotten involved in the programming. However this is very personal to me and my family and I want there to be a discussion, which is why we will be screening VAXXED.

Not surprisingly, this did nothing to assuage others’ outrage. As I have argued in the past, this is not an issue in which there are two sides who have equal credibility and equal right to discuss their opinions. This is settled science, in which research and facts are up against allegations proven to be false. And people said as much to Robert De Niro. More stories were written on Friday, and the comments section on the movie’s page on the festival’s now-defunct website exploded in a debate over vaccine efficacy.

The actor appears to have listened, if not directly to these voices, then to others who expressed similar opinions. In a second statement released Saturday, he wrote, “My intent in screening this film was to provide an opportunity for conversation around an issue that is deeply personal to me and my family. But after reviewing it over the past few days with the Tribeca Film Festival team and others from the scientific community, we do not believe it contributes to or furthers the discussion I had hoped for.”

This Is Not an Entirely Post-Truth World

Hopefully, the positive outcome of the controversy will help us reject the concept of a post-truth world. Granted, this was not a lawmaker being held to the fire for inaccuracies in their debate performance or admitting to inconsistencies in their messages, which they seem reluctant to do thus far on this issue; De Niro’s views on the issue, based on his statements, seem to be less motivated by deeply held beliefs or political strategy and grounded instead, however misguidedly, in “starting a conversation.”

It can also be argued that the free media dedicated to this short-lived controversy was exactly what Wakefield wanted—especially since the outcome gives him even more fodder for his conspiracy theory.

But I choose to look at it as a positive development. Believers in science organized quickly, stood up swiftly, spoke out loudly, and relied heavily on the facts. And those are clear: Vaccines don’t cause autism. Moreover, not vaccinating children leaves our communities open to outbreaks of diseases like measles that we know how to prevent. It took years to recover from Wakefield’s fraud, but it looks like rationality and science may be prevailing on this front—which gives me hope for other topics where the facts are firmly on our side.