Vaccinations are getting a bit of a bad press these days, particularly the HPV vaccine – Gardasil – which is administered to girls in their first secondary school year.
The vaccine protects against strains of the human papilloma virus which causes genital warts. HPV infections can lead to cervical cancer. About 3,000 women are diagnosed with, and treated for, pre-cancerous lesions each year.
Approximately 300 women get cervical cancer every year in Ireland and 100 women die from the disease. The vaccine can prevent seven out of 10 cervical cancers.
Several tabloids have recently published stories about how the lives of teenage girls have been destroyed because of HPV vaccination. A parent-led group called Regret (Reaction and effects of Gardasil resulting in extreme trauma) claim their daughters became ill after getting the vaccine, including suffering from chronic pain and fatigue-like conditions.
There is absolutely no scientific evidence of serious long-term effects. When it comes to various groups blaming the HPV vaccine for subsequent illness, there may be a hidden agenda. According to some of them, the HPV vaccine sexualises young girls and encourages promiscuity. Genital warts are transmitted during sexual intercourse or any genital contact with an infected person.
Some people are so opposed to sex between unmarried couples that they believe contracting a sexually transmitted disease is a well-deserved punishment. These beliefs are complete nonsense and dangerous.
Vaccines are extremely safe, including Gardasil, and although some children may experience side effects, these are unlikely to be serious or long-lasting. In Ireland over half a million doses of Gardasil have been administered and 200,000 girls are fully immunised.
In November 2015 the European Medicines Agency (EMA) reviewed the HPV vaccine and found no evidence it was linked to chronic fatigue or other conditions. In January 2016, the European Commission endorsed the conclusion of the EMA.
A new study from the Harvard TH Chan School of Public Health, published in the April 2016 journal Cancer, concluded that HPV vaccination, given to both boys and girls in the US, will substantially reduce overall rates of cervical and oropharyngeal cancer. "Our findings show that vaccination can lead to a dramatic decrease in HPV-associated cancers."
A world without vaccines would be a much more dangerous place. Parents who are fearful about vaccination forget how many children died from infectious diseases before vaccines became widely available.
In 1916, for example, the Irish infant mortality rate was 81 per 1,000 whereas it is now fewer than four. Nearly 12,000 children under five died that year. Almost 500 died from measles, 887 from whooping cough and 6,471 children and adults from tuberculosis (TB). In 2014 only 19 children aged five and under died and 25 cases of TB were recorded.
Recent research into the measles vaccine shows that it has long-term benefits in preventing all infectious diseases. When children contract measles, their immune systems are suppressed for a period of two to three years, predisposing them to contracting other infections.
In the past, measles was implicated in as many as half of all childhood deaths. In fact, measles control is now recognised as one of the most successful public health interventions ever undertaken.
Despite the success of childhood vaccination programmes, parents feel worried about safety and "vaccine hesitancy" is beginning to develop in high-income countries. This relatively new phenomenon is, according to the Sage Working Group on Vaccine Hesitancy, complex and context specific, varying across time, place and different vaccines. Determinants of vaccine hesitancy can be grouped into three categories: confidence, complacency and convenience.
In this 3C’s model, confidence is defined as trust in the effectiveness and safety of vaccines and trust in the health system and professionals. Complacency exists when perceived risks of vaccine-preventable diseases are low. Vaccination convenience is related to availability, affordability and accessibility. Perceptions of the pharmaceutical industry also influence parental decisions.
Irish take-up rates for childhood vaccines are generally high, ranging from 80-92 per cent, depending on the vaccine, the professional delivering the service, and whether it was administered in school or the GP surgery. However, there is no room for complacency and the HSE must continue to communicate effectively with parents.
Scaremongering stories need to be challenged immediately using easily understood language. The science is overwhelmingly in favour of vaccination, including the HPV vaccine. The HSE needs to communicate the evidence to parents who are well capable of understanding it. And it is time to start making the HPV vaccine available to boys as well.
Jacky Jones is a former HSE regional manager of health promotion and a member of the Healthy Ireland Council.