We wish to respond to the claims of Sherlina Nageer and friends who penned a letter titled `Government should halt HPV vaccination programme, there are better options’ to your newspaper dated 03/11/2017.
Before we do, we’d like to acknowledge the importance of the letter’s latter points, with the exception of the call to “stop the HPV vaccines campaign”. Indeed, poor public health and sexual education, as well as dysfunctional facilities, can hinder or stall efforts in delivering quality healthcare to Guyanese people.
However, we would like to clarify the listed concerns put forth by the authors which, intentionally or not, erroneously convey the impression that the vaccine is more dangerous than helpful:
Concern One: “Most HPV infections go away on their own, without treatment, and do not result in cancer. In the United States, where the prevalence of HPV infection is significantly higher than in Guyana, only about 3.4% of all HPV viruses were associated with cervical cancer.”
This is a misleadingly framed statement. Yes, it is true that not all HPV viruses are associated with cervical cancer and that figure may well be 3.4%. According to the World Health Organisation, there are more than 100 known strains or types of HPV infections and most are harmless. However, there is no need for 100% of the viruses to be carcinogenic for it to have a deadly impact. Out of over 100 strains, two, the HPV16 and HPV18, carry the highest risk of cervical cancer and are directly responsible for 66% of reported cases of cervical cancer in the U.S. (‘US Assessment of HPV types of Cancers’—a work corroborated by over 20 expert independent U.S. medical institutions and universities). In Guyana, where cervical cancer claims an estimated 71 lives annually, 62% of all reported cervical cancer cases involve HPV 16 and 18 (ICO HPV Information Centre Human Papillomavirus and Related Diseases Report Guyana July 2017). Fortunately, the HPV vaccine Gardasil is extraordinarily effective at preventing infection against the HPV 16 and 18 strains.
Furthermore, while HPV may be more prevalent in the U.S, according to the Pan-American Health Organization, in 2002, the incidence and mortality rates of cervical cancer in Guyana was 47.3 and 22.2 per 100,000 while the incidence and mortality rates in the US were 7 and 2.3 per 100,000, respectively.
Concern Two: “The World Health Organisation notes that early treatment programmes in developed countries prevent up to 80% of cervical cancers”
The WHO goes on to note that, “In developing countries, limited access to effective screening means that the disease is often not identified until it is further advanced and symptoms develop. In addition, prospects for treatment of such late-stage disease may be poor, resulting in a higher rate of death from cervical cancer in these countries.” And further, that some 270,000 women die each year from cervical cancer — of which 85% of women are from developing countries. (See ‘WHO—Human Papillomavirus and Cervical Cancer’). There is no argument from us that greater access to screening (and treatment) is needed nor that the vaccine alone is the best or even a standalone preventative option. What’s more, even if the vaccine is administered, screening must still occur afterward. However, it hardly needs mentioning that Guyana is far from a developed country and lacks sufficient resources (human, time, financial, not to mention political will) to have as effective a screening infrastructure as, say, the U.S. Better preventative measures demand better access to excellent healthcare services, and Guyana falls short of this. At any rate, the WHO recommends vaccination for girls aged 9-13 years as the most cost-effective public health measure against cervical cancer. Furthermore, WHO advocates for a comprehensive preventative approach to prevent HPV related cases of cervical cancers by “including components from community education, social mobilization, vaccination, screening, treatment and palliative care.”
Concern Three: “Gardasil contains genetically engineered virus-like particles as well as aluminum, which have been proven to negatively affect immune functioning”
Firstly, the virus-like particles (VLPs) are not actual viruses. For vaccines to work as an immunization mechanism, they have to contain the protein subunit of a virus, not the virus itself. When the protein subunit separates from a virus and its DNA, it would then be used as an antigen agent for immunization against that virus. Think of an antigen as containing the signature pattern of a virus-like behaviour. The human body would recognize this antigen and stimulate a protective response. Vaccines act as a means to strengthen the immune system by preparing it for a potential invasion of a harmful or deadly virus. Despite being termed as VLP, there is no part of a virus or otherwise that gets included in a vaccine that is dangerous. That would defeat the purpose of immunization. Millions of people around the world have been immunized by vaccines of all sorts. This information can be accessed from any Biology text book on the topic of vaccination.
Secondly, Gardasil contains aluminum hydroxide (AH), not strictly aluminum. AH can also be found in medication for heartburn, ulcers and antacid products. AH is used in many other vaccines. AH acts as an immune responder in relation to vaccines. There is no causal connection between Gardasil (or AH) and a weakening or dysfunctional immune system. (See Dr. EB Lindblad, ‘Aluminum Compounds for use in Vaccines’ – 2004). The statement is simply unfounded, and bears striking resemblance to a debunked article posted on ‘Washington Times’ dated 13/12/2014 which contains no objective source supporting their claims.
Lastly, since the Gardasil vaccine does not contain any actual HPV virus, it cannot be carcinogenic. (See ‘Review of Gardasil’ – 2010 by US National Library of Health). The authors noted that whether the vaccine may prove cancerous “cannot be known yet though; many years have to pass first.” Many years have passed since the vaccine became available (in 2006) and over 270 million doses of HPV vaccines have been distributed. Safety studies have been conducted over these many years on several million persons, comparing the risks for a wide range of health outcomes. No link to cancer – or any other life threatening diseases – has been found.
Concern Four: “The Japanese Health Ministry stopped recommending Gardasil vaccination for their citizens since 2013 and continues to maintain this position.”
According to Japanese newspaper Asahi, covering the matter, “The Ministry of Health, Labor and Welfare is not suspending the use of the vaccination, but it has instructed local governments not to promote the use of the medicine while studies are conducted on the matter. So far, an estimated 8.9 million people have received the vaccination, out of which, 176 cases of possible side effects, including body pain, have been reported.” Note the sum difference among people who reported possible side effects compared with the total sum of those who received the vaccine. In other words, 0.0019 % of cases reported side effects potentially caused by the vaccine. However, a national expert committee led a clinical review of data related to the 176 cases found no causal connection between the reported side effects and the Gardasil vaccine.
Despite their conclusion, the Japanese Government still refused to resume the campaign. (See Dr. Eiji Yoshioka, ‘HPV Vaccination Crisis in Japan’— 2015).
This is a classic example of correlation not necessarily meaning causation. Furthermore, the WHO notes that “the mortality rate from cervical cancer in Japan, where HPV vaccination is not proactively recommended, increased by 3.4% from 1995 to 2005 and is expected to increase by 5.9% from 2005 to 2015.” In Japan, around 10,000 women die every year from cervical cancer. According to Japanese physicians, this number could likely be reduced if the government chose to restart their vaccination campaign. Worth noting is that the vaccine is still available for purchase in Japan which means the Government does not find the vaccine itself dangerous, but, more likely, just not worth the risk of (as yet unsubstantiated) claims that may serve to besmirch the Government’s image.
While we agree with the authors’ call for greater emphasis on screening for cervical cancer, we strongly encourage them to desist from spreading poorly researched or misleading stories questioning the safety or usefulness of the HPV vaccine. It is hardly an effective method of encouraging the Ministry of Public Health to revisit best cost-effective strategies for reducing the rate of cervical cancer in Guyana. Furthermore, it is irresponsible if it results in parents refusing to have their girls receive a potentially life-saving vaccination given the existing challenges of accessing resources. Finally, it is just dishonest. The copious amounts of scientific and medical studies on millions of people undertaken by international experts which verify the safety and efficacy of the HPV vaccine abound in the public domain. A few anecdotes of adverse reactions, with no conclusive causal link to the vaccine, do not warrant the scaremongering, most especially from persons who say they are committed to the health of women and girls.
We agree with Sherlina and friends regarding the need for the Ministry to improve their public awareness programmes on HPV so that the public can understand the benefits of receiving the vaccine which causes minimum side effects, similar to many common medicines. This outreach is especially needed in indigenous communities in which the rate of cervical cancer is highest in Guyana (American Journal of Obstetrics & Gynecology June 2010).
The HPV vaccine administered by the Ministry is safe, effective and currently plays a very crucial role in Guyana’s fight against cervical cancer. As they say, prevention is better than the cure. The HPV vaccine can prevent up to 70% of cervical cancer cases. This method should not be reserved only for those who can afford it.
Finally, we recommend receivers of the HPV vaccine consult with their doctors immediately should they to experience any abnormal reaction – a very low probability of happening – which could be due to unforeseen allergies or other health complications.
Dr. Tariq Jagnarine
Dr. Stefan Hutson
Dr. Nastassia Rambarran, MPH
Kumar Latchman - Chemist
Navina Paul – Medical Student
Gibran Azeez – Medical Student
Matthew Xavier - Medical
Mahendra Doraisami – Biologist
Meshach Pierre – Biologist
Ria Bisnauth - Biologist
Michael Philander - Biologist