Sometimes a decision really is a matter of life or death. Deciding whether your child should take a vaccine is just such a decision, one that can have a profound impact on their lives.
People are familiar with the controversy over the measles-mumps-rubella (MMR) vaccine. A vaccination programme was bringing the measles infection rate down sharply until a UK scientist claimed the vaccine was linked to autism.
This happened in 1998 and although the research later proved to have been falsified, too many parents still resist MMR vaccination nearly 20 years later, leading to unnecessary deaths.
History now seems to be repeating itself, as the number of parents allowing their young teenage daughters to be vaccinated against cervical cancer declines.
The human papillomavirus or HPV is a known cancer-causing agent that accounts for virtually all of the cervical cancer cases that occur here, according to Dr Robert O'Connor, head of research at the Irish Cancer Society.
Full use of the vaccine could eliminate nearly 90 cervical cancer deaths a year and the need for 280 women a year to undergo treatment for the disease.
The vaccine used here is Gardasil produced by Merck. There is a similar vaccine Cervarix sold by GlaxoSmithKline.
"We had a very successful HPV vaccination programme launched in 2010 and with an immunisation target of 80 per cent," says Dr Brenda Corcoran, a consultant in public health medicine and the head of the HSE's National Immunisation Office.
“We increased uptake to 87 per cent during the 2014-15 campaign. Everything was going very well and parents were consenting to their children getting the vaccine. Then, about 2015, uptake started to decline and we were getting more refusals. The final figures aren’t out but they are unlikely to change from an estimated 70 per cent.”
The sudden fall has caused great concern among Irish health officials given the direct link between cancer risk and vaccination.
The World Health Organisation also expressed its concern, asking Ireland to attend a meeting in Copenhagen where it was to discuss falling vaccine uptake figures being seen in Denmark.
HPV vaccination would have brought Ireland quickly back into line but that is now jeopardised by concerns over safety being raised by groups opposed to the use of the vaccine.
“Groups were set up, Regret (Reaction and Effects of Gardasil Resulting in Extreme Trauma) and Irish Vaccination Awareness, both of which have concerns the vaccine causes problems for some girls,” she says.
Regret has a list of more than 400 girls it says were harmed as a side effect of Gardasil. It claims the girls suffer from chronic fatigue, lethargy, autoimmune diseases, fibromyalgia and other conditions as a consequence of vaccination.
Many of these conditions however are common in adolescence and are much more common at this age than in later years, Dr Corcoran says.
“There have been many studies done on this. All the studies have shown the rates of these conditions in vaccinated girls is the same as in unvaccinated girls,” she says. The groups have no evidence to back up what they claim. “Certainly it is not caused by the vaccine.”
Dr O’Connor concurs. “These conditions were described 100 years ago,” he says. “Unfortunately parents go on line and put in symptoms and this raises concerns about the vaccine. There is no causative association, as shown by numerous studies.”
Even so more than 400 families believe the vaccine harmed their children. “We are a voluntary support group of parents. We are not anti-vaccination as we are sometimes portrayed,” says Anna Cannon, spokeswoman for Regret.
The group lacks hard scientific evidence that Gardasil was the cause, but the conditions developed by the children are very real to them and their parents.
“We are not out to wreck the vaccination programme, we are parents concerned about our children.” She is urging the HSE to include a full patient information leaflet in the materials given to parents.
She is also asking that the HSE assess these children in case there is some unknown risk with the vaccine. “We are looking for an independent investigation of this group of girls whatever the outcome. If the vaccine impacted their health we need to establish how we can restore their health. That is a fair request,” Ms Cannon says. “We are not asking them to take the vaccine off the market.”
The Department of Health continues to promote the vaccine given it reduces cancers in later life. Some have "unsubstantiated concerns" about the safety of the HPV vaccine but these have "no scientific basis", it says.
It urges parents to ensure their daughters receive the vaccine.
‘MMR is a life-saving vaccine, so too is HPV’
The use of any vaccine comes with a small risk that there will be side effects. The question is whether these risks are outweighed by the benefits of vaccination.
The risks may also include death but sometimes the risks are worth taking. Polio infection can cause various degrees of paralysis and also death. Three in one million children given the polio vaccine will develop paralysis but without vaccination one in 200 children who are infected will become paralysed.
Many parents blocked the MMR vaccine for their children due to health fears later proven to be false. The scare in 1998 led to a measles outbreak in Dublin in 2000 involving 1,600 cases. Three of these children died because they had not received the vaccination.
The HPV vaccine also causes side effects. One in eight girls may faint a short time after the injection, a common problem when vaccinating teenage girls, says Dr Brenda Corcoran of the HSE.
One in 10 girls will get pain or redness at the injection site. One in 100 might feel nauseous or run a temperature and one in 10,000 might develop a skin rash. The risk of a severe allergic reaction is a one in a million chance, making this a very safe vaccine.
There has been constant study of these side effects since the vaccine came into use a decade ago, including by the World Health Organisation, the European Medicines Agency and the US Centres for Disease Control and Prevention.
More than 200 million doses have been given and the side effects seen are the same as those seen when subjects are given a placebo vaccine.
Dr Robert O’Connor of the Irish Cancer Society says HPV vaccine numbers have fallen because of undue fears. “It is like the MMR situation. MMR is a life saving vaccine.” And so too is HPV, he says.