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HPV prevents cervical cancer - if it were only that simple.

Thomas Secrest's picture
Inoculation cart: Photo by Thomas Secrest

On June 21, 2013 I wrote a rather positive article about how the HPV vaccine had proved more effective than almost anyone had expected. The CDC had just issued a very upbeat report saying that the prevalence of Human Papilloma virus that causes cervical cancer was down 56%. This was viewed as exciting news with important future implications. The lower prevalence would ultimately translate into many, many fewer cases of cervical cancer in the future; and since about 1/3 of cervical cancers are fetal, it would also translate into many fewer deaths due to cervical cancer.

In the article, I reviewed the serious adverse reactions and tried to put the risk in perspective by comparing the risks of the vaccine to risks that we take every day, but usually ignore.

It would be unethical and dishonest if I failed to present contrary views to the stories I write. If I become aware of something that can alter your decision making, I am very much obliged to try to make you aware of the new information. Little did I know that as I wrote the article the U.S. and Japanese governments were headed in opposite directions regarding the HPV program. That said, I now I need to update you with news from Japan. On June 15, 2013 it was reported that “the Japanese government withdrew its recommendation to use human papillomavirus (HPV) vaccines in girls (), citing concerns from the public about adverse effects, according to news reports.”

The Japanese government is not stopping the vaccination program, they are simply withdrawing the recommendation that girls get the vaccine. The head of the task force looking into the vaccine, Mariko Momoi, stated that “the decision does not mean that the vaccine itself is problematic from the viewpoint of safety.”
The data from Japan is different from the data reported by the CDC. The CDC data involves many more vaccinations (23 million vs. 8.3 million). The CDC data also reports about 4 times fewer serious adverse reactions compared to the Japanese data. The Japanese data indicates about 12.8 serious adverse reactions per 1 million inoculations, while the CDC data indicates about 3 serious adverse reactions per 1 million inoculations. When the Japanese use their data, there are many more serious adverse reactions associated with the HPV vaccine compared to the influenza or polio vaccine; whereas the CDC data is comparable with the influenza and polio vaccines.

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How to interpret the data?

In my experience, when something is politicized it becomes very difficult to sort fact from fiction. Vaccines are soft targets for politicians and, as a rule, they don’t hesitate to exploit a soft target. Statements from the Japanese government indicated that the vaccine is safe, since they are not suspending the vaccine program. Additionally, they stated that they don’t see “the vaccine itself as problematic from the viewpoint of safety.” If the vaccine is safe, why is the government making changes to the guidelines. I’ll have to leave it to you to decide if the guidelines fell victim to political expediency or if there were legitimate reasons for making the changes.

Risks if you do and risks if you don’t.

Until we have vaccines with 0 serious adverse reactions per 1 million inoculations, the decision to vaccinate or not vaccinate will remain difficult. In making the decision, it is very important to gather all the facts and evaluate the risk of the vaccine. In most cases, adverse reactions can be explained by pre-existing health issues that put the person at odds with the vaccine; things like birth control pills, legal or illicit drug use, anorexia, poor nutrition, and pre-existing conditions (diabetes, epilepsy, etc). Much more rarely, they adverse reactions are genetic and almost impossible to predict; and sometimes, the reactions are just a coincidence. Maybe the person was recently exposed to a cold or flu or some other illness and the two immune challenges happening at the same time creates an adverse reaction. Once the risk of the vaccine is evaluated, you have to very carefully and realistically assess the risk of getting the disease the vaccine was meant to protect you from. In this sense, vaccines aren't that different from life insurance or home insurance.

Once you have all the facts, then comes the hard part – making the decision.