After reading a letter in Stabroek News on Friday, November 3rd 2017 entitled:- `Gov’t should halt HPV vaccination programme, there are better options’, I am obliged to reply to the authors in their own interest and in the interest of the public.
The human papilloma virus (HPV) causes most cervical cancers, as well as some cancers of the vagina, vulva, penis, anus, rectum, tongue and throat. There are over 170 types of human papilloma virus, most cause no symptoms and resolve spontaneously. In some cases and in conditions and situations which may impair the cell-mediated immune response the virus is not cleared and progression to malignancy is not suppressed. These lesions then progress to cancer. HPV genital infection is extremely common but in the overwhelming number of cases is asymptomatic, self limited and will not lead to cervical malignancy. Progression from genital infection to malignancy depends on the host’s ability to clear the virus. HPV infection is the essential prerequisite for the development of cervical cancer. Its prevalence in cervical cancer is 99.7%.
Vaccinating young girls aims to prevent HPV infection and the subsequent risk of cervical cancer when they are adults.
The duration of protection, the acceptability by societies of the vaccine and the need to protect against many HPV types are difficult issues.
Gardasil (MERCK, HPV quadrivalent recombinant vaccine) with protection against HPV types 6,11,16,18 was 100% effective in clinical trials in preventing type-specific, high grade cervical pre-malignancy disease. There is also evidence of protection against other risk types (31 and 45). This vaccine use among young women can prevent HPV type-related cervical cancer, vaginal and vulval cancer precursors and anogenital warts.
This vaccine has been in use for over eight years in over 130 countries and more than 150 million doses have been distributed globally. It has been found to be both safe and effective in reducing pre-cancers and the high risk of HPV lesions that lead to cancer affecting both men and women.
FIGO: – The International Federation of Gynaecologists and Obstetricians had this to say about the HPV vaccine:- “All randomized clinical trials of both the bivalent and quadrivalent vaccines provide evidence of an excellent safety profile. The most common complaint was pain at the injection site which was largely self-limiting and resolved spontaneously. The side effects do not appear to be more common than that reported with other types of vaccination”.
The vaccine has been approved by the Global Advisory Committee on vaccine safety of the WHO. It is safe and vaccination remains one of the recommended actions of prevention of cervical cancer and other HPV associated diseases. Gardasil HPV vaccine has been thoroughly tested and many clinical trials and studies conducted, all of which concluded that it is safe internationally.
The authors did mention the need for regular health checks and cancer screening such as Pap smears and VIA (Visual Inspection with Acetic acid) .While the Pap smear is the best screening test, it is not available at public institutions in Guyana and is very costly if done privately. This results in not many women having Pap smears. The VIA test is available at public Institutions free of cost. All these screening tests are good measures that lead to early detection and treatment of cervical cancer. I fully agree with the authors that they should be implemented and made easily available.
However, I would like to stress to the authors that these tests should not eliminate the need for vaccinations as a preventative measure. Preventative measures by immunization is the main focus in the prevention of diseases. Most people in Guyana are immunized against measles, mumps, rubella, hepatitis B and tetanus. Conditions which were very prevalent before the advent of vaccines. The authors should remember the outbreak of polio in the 1950’s when people died and many became disabled from it. Thanks to the discovery of the polio vaccine polio is now under control and thanks to Rotary International and the Bill and Melinda Gates Foundation polio is almost eradicated from the world. At present only two countries have had a few cases of polio, Pakistan and Afghanistan. In the near future the world will be free of polio. Thanks to worldwide vaccination programmes. Remember “vaccines prevent diseases and prevention is better than cure”.
Now as to the safety of the HPV vaccine: The WHO, The Inter-national Federation of Gynaecologists and Obstetricians, the USA, England, Ireland, Scotland, the European Union, Australia, New Zealand and over 130 countries have been using the vaccines with good results, and these countries have very good and effective screening programmes for the early detection and management of cervical cancer.
The authors claim knowledge about the Gardasil vaccine and include a public health professional. I am totally disappointed with their views on the subject. Denying our young women protection from a deadly cancer by withholding vaccination is a retrograde step and must be aggressively condemned.
I would like to thank the Ministry of Public Heath for making this vaccine available to our young girls and boys too (if more can be sourced) in order to eliminate not only cervical cancer but also cancers of other parts of the body.
Dr Narine D. Sooknanan
Fellow of the Royal College of