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Tuesday, 10 January 2012

The HPV vaccination is scientifically unnecessary

 Dear Editor,
I am writing to express my concern about the recently announced plans by Minister of Health Ramsaran to begin mass vaccination of schoolgirls in Guyana with the HPV vaccine on Wednesday, January 11, 2012. To a general public that is scientifically untrained, conditioned or browbeaten into not questioning those in authority, and easily manipulated, this may seem like a good initiative. We are told that HPV caused cervical cancer, and at that dreaded word, everyone is supposed to quietly and obediently line their daughters up for the injection. However, there are many serious issues with regard to this vaccine and proposed campaign that the Guyanese public should be aware of- from a public health as well as child rights perspective.
Speaking first to the public health issues- in my opinion as a trained public health professional and someone with years of experience in this field- this vaccine is unnecessary. The fact is that 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 [Source: http://jama.ama-assn.org/content/297/8/813.abstract?ijkey=85292b84748848d91264576bb538b4148404c962&keytype2=tf_ipsecsha. * Note- JAMA is the Journal of the American Medical Association- a highly credible publication, not some quack source.]
Also problematic is the fact that- with lack of proper public education about this vaccination effort (as happens so often in Guyana)- one of the unintended but inevitable consequences is likely to be that a significant number of sexually active girls and women will mistakenly believe that this vaccine also protects them from other sexually transmitted infections [it does not] and will then not use the appropriate protection or get the necessary testing to really safeguard themselves. So, in addition to being scientifically unnecessary, from a prevention standpoint- this mass vaccination could be even more harmful than helpful.
This vaccination campaign also makes no sense from a cost effective standpoint. Minister Ramsaran said that this was one of the most expensive vaccines in the vaccination programme. The fact is that the incidence of cervical cancer in Guyana (from the questionable data available) does not warrant such mass vaccination. While there have been reports of increasing numbers of cases over the last five years, that is explained by the fact that screening has also increased.
Any competent statistician will tell you that simply observing more of a thing when you’re looking out for it does not automatically mean that you have a problem.
In a country like Guyana when resources are scarce, data collection and statistically-credible, cost-benefit analysis need to be properly done and decisions more carefully made- with an eye towards providing the best possible services and care to the most people, not just looking good in the court of public opinion.
To do otherwise is reckless, unconscionable, and shows that those in power care more about projecting an image of competency instead of making real improvements in people’s lives. But sadly, the choice of flash over substance is something that has become an epidemic in Guyana.
Still, the fact remains that there are many other pressing public health issues- mental illness, alcohol and drug abuse, child abuse, maternal mortality, domestic violence, obesity, diabetes, etc- just to name a few, that are far more prevalent in our society and that would make better choices for investment and action.
So, if you really know what you’re doing and truly care/want to improve people’s lives, there are much better ways to do that than to waste money on this unnecessary mass HPV vaccination.
The issues in terms of child rights are equally problematic. What kind of information, if any, has been provided to these children and their parents/ guardians? Has informed consent been sought? Will girls/parents who object to receiving this vaccine be allowed to opt out?
When and where was the public discussion held? Who decided schoolgirls in Guyana needed this vaccine?
Indeed, one must question why this mass vaccination is being pushed at all. In a country like Guyana with a low prevalence of cervical cancer, there is no need for mass vaccination of schoolgirls.
Also worrying is the fact that this is a new vaccine, with effects that are still not completely known and may not show up for many years afterwards. Research is still ongoing and serious side effects have been observed.
I am a scientist and public health professional, not an anti-vaccine fanatic or conspiracy theorist. I feel compelled however, when I see it, to point out fear-mongering, dishonesty, manipulation of facts and the vulnerable, and misallocation of public funds and resources. Parents- if you have daughters aged 11 and older, in school in Regions 3, 4, 5, and 6- make sure you get all the facts before you allow them to be injected with this vaccine. Minister Ramsaran- please show us the data that compelled this decision.
Yours faithfully, 
Sherlina Nageer, MPH