HPV vaccine: the medical profession struggles to rise above the school gate

In secondary schools across the country, HPV vaccinations have been taking place for girls in first year.

What started out as a success story in 2010 – with more than 80 per cent take-up of the vaccine that protects girls from cervical cancer caused by human papilloma virus – has turned into a controversy that has seen those percentages plummet. In 2014, the rate of take up was 86 per cent. The following year it fell to 76 per cent. Last year, it was just 50 per cent.

Most people's instinct is to trust the multitude of national and international health organisations who have advocated categorically that this vaccine will, and already is, saving lives. But there has been a vocal group of dissenters in Ireland who claim that the vaccine itself is damaging, or that it isn't appropriate at 13.

So, as a parent dithers over their signature on the consent form, how can they make an effective decision?

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Three hundred women are diagnosed with cervical cancer in Ireland every year – 90 will die. It is one of the biggest killers of women worldwide – and it is preventable.

That much we know.

We also know the HPV virus causes almost 100 per cent of cervical cancers, as well as 70 per cent vaginal and vulvar cancer, anal cancer in men and women, and 70 per cent of head and neck cancers which are increasing in men.

In fact, the number of men with head and neck cancer is expected to overtake women with cervical cancer by 2020.

"The vaccine has been in use in Scotland since 2008, and the rates of cervical cancer have decreased significantly," explains Dr Brenda Corcoran, head of the National Immunisation Office. "In fact, the results exceeded expectation with a 90 per cent drop in the rate of HPV infections. It is great we have the cervical-screening programme in Ireland, because we know the earlier the diagnosis, the better the outcome. But we really want prevention. The vaccine is also being considered for boys here in Ireland, having been successfully brought out in Australia. "

Gardasil

HPV is sexually transmitted and more than 6,000 women each year undergo some form of surgical procedure for precancer as a result of the virus. Gardasil HPV vaccine is used in the school programme in Ireland, which protects against two high-risk types of HPV which cause 70 per cent of cervical cancers, and is currently used in more than 25 European countries, the United States, Canada, Australia and New Zealand.

Gardasil is the most tested vaccine in history, but some parents started vocalising concern after they believed their daughters appeared to suffer from extreme side-effects after having the vaccine.

A social media outcry ensued and affected parents formed the group REGRET (Reactions and Effects of Gardasil Resulting in Extreme Trauma). According to the REGRET website, 929 girls have been adversely affected by the vaccine, developing conditions such as chronic fatigue.

While the individual cases of the girls cannot be ignored, the link to the vaccine has never been proven. The medical community insists there has been no increase in cases of chronic fatigue – which usually affects more teenage girls than boys anyway – since the vaccine has been introduced.

“We expect to see about 600 cases of chronic fatigue cases every year in Ireland,” explains Dr Corcoran, “and this hasn’t gone up since the vaccine was introduced here. Both girls and boys get diagnosed with chronic fatigue and you would expect the number of girls to have gone up since 2010, but it hasn’t.”

In various trials of vaccinated and non-vaccinated children, no difference has been shown between the groups.

REGRET highlights 10-15 issues they say have been caused by the vaccines, but Dr Corcoran challenges this. “All of these girls need care and attention for the issues they have. Vaccine reactions would never be so widespread, with so many different conditions. We want these girls to be okay, and be treated properly for the issues they have. We have approached and met members from REGRET to listen to their issues, but we weren’t able to persuade them.”

Vaccine at 13

Another area that seems to cause confusion is the age at which the vaccine is being administered. Because the HPV virus is transmitted sexually, many parents feel that it is not yet relevant for their daughters.

“The reason we give the vaccine at 13 is because that is the age that their immune system will best respond to it and make it the most effective. It works on the same principle that we give babies hepatitis B vaccine to prevent them developing the disease in later life,” explains Dr Corcoran.

Research has shown there is a better immune response in young girls between nine and 15 years of age compared with older teenage girls and young women aged 16-26 years. Girls under 15 only need two doses of the vaccine – older girls need three doses.While in Ireland the age for the vaccine to be administered is 13, in some countries it is given even earlier.

"This is a vaccine for their future, and I advise parents not to think of it in terms of preventing a sexual disease. The vaccine is actually licensed from nine years of age and in Austria it is done then. The age is about getting the best immune response and has nothing to do with sexual activity."

With the numbers accepting the vaccine dropping dramatically, this year the HSE has campaigned relentlessly in schools and across social media to encourage uptake and reassure parents and girls.

"There has been a huge amount of mis-information and persuasive arguments as to why you shouldn't get the vaccine, but we use science, facts and research to help parents to choose the vaccine," explains Dr Corcoran. "The important thing is that expert groups like the World Health Organisation, the European Medicine Agency and all the international expert bodies are saying the vaccine is the best way to prevent cervical cancer."

Other health professionals such as GPs and pharmacists, along with the Irish Cancer Society, a wide-ranging group of women's rights groups, youth groups, cancer charities, and teachers have formed the HPV Vaccination Alliance to spread the word. Initial feedback on this year's uptake has been positive and Dr Corcoran is cautiously optimist.

“You normally would expect a medical fraternity to be split, but there is a groundswell of opinion throughout the medical profession in support of the vaccine. If parents are uncertain, they should talk to their GP, practice nurse or pharmacist. That’s where we want them to go, but to have a conversation is really important. But often they talk at school gates and research through social media where there is no credibility of information.”

A starting point for parents is the HSE website hpv.ie, which is accredited by the World Health Organization as the only website in Ireland with reliable information on vaccine safety. And for those who did refuse to allow their daughter to have it, there is still time.

"It's not too late for any parents who still aren't sure. We are currently doing 'mop-up clinics' for any schoolgirls who missed out, and that applies to any girls. If people want to send in questions to the website, we answer those within a working day. We are on hand to help," says Dr Corcoran.

The facts

– The HPV vaccine Gardasil is close to 100 per cent effective in preventing 70 per cent of cervical and other cancers.

– The optimum time for the vaccine to be most effective is between nine and 15. This is not because girls might become sexually active at this age but it’s the best age for their immune system to build the resilience.

– Girls under 15 only need two doses of the vaccine; older girls need three doses to be fully protected.

– The incidences of chronic fatigue or any other long-term condition in girls has not gone up since the vaccine was introduced.

[ Read: HPV vaccine: one parent says yes, one says no ]