Cervical cancer is the second most common cause of death from cancer for young Irish women, despite an effective screening programme and free vaccine. Why has there been such a dramatic fall in the number of girls getting vaccinated? asks Jessica Casey.
Each year, 300 women in Ireland are diagnosed with cervical cancer. One in three loses their life as a result of the disease.
More than 6,500 women annually need hospital treatment for a precancerous form of the disease. And despite a comprehensive screening programme, cervical cancer is still the second most common cause of death due to cancer for young Irish women.
We now know that persistent infection with the human papillomavirus (HPV) is one of the leading causes of cervical cancer. Widely prevalent in the general population, 80% of people have or carry the sexually transmitted virus by the age of 50.
The infection is most common in people in their late teens and early 20s, with the rates of infection increasing quickly for both women and men in high-income countries such as Ireland.
As well as being one of the leading causes of cervical cancer, HPV is also a contributory factor in throat, mouth, tongue and tonsil cancers.
Since 2010, Gardasil, a vaccination against the main strains of HPV, is available free of charge to all girls here in their first year of secondary school. Although it does not remove the need for cervical screening entirely, the Gardasil vaccination is designed to give people immunity to the two strains of the virus that cause 70% of cervical cancers, strains 16 and 18, as well two strains of the virus which cause the majority of genital warts.
Overseas, countries with more established and longer-running vaccination programs have begun to report effective results.
Australia, one of the first countries to launch a publically funded national HPV vaccination programme, last year reported a 90% reduction in HPV types 6, 11,16, and 18, as well as a 90% decrease in genital warts, since the process began.
Closer to home, researchers in Scotland also recently found a 90% fall in the level of HPV in women there since the vaccine was made available in 2008.
In one of the largest studies to date on the impact of the vaccine, the government-funded project analysed samples from more than 20,000 women.
However, despite scientific evidence showing that the vaccination offered in our schools is both effective and safe, the number of girls receiving it across Ireland has fallen — a trend that is causing increasing concern in medical circles, according to the Royal College of Physicians of Ireland (RCPI), an independent organisation representing doctors.
“Eight years ago Mary Harney was being lambasted for not introducing the cervical cancer vaccination into Ireland,” says Matt Hewitt, consultant obstetrician and gynaecologist at Cork University Maternity Hospital (CUMH).
“Now we have it for free and it’s been shown to be safe, it’s been shown to be effective and people are listening to false stories, false rumors, unsubstantiated claims of harm, and not receiving the vaccine which is just frightening. It’s a massive concern.
“We have this amazing piece of science that’s gone on since the 30s where the papanicolaou [pap screen] [named after George Papanicolaou, a Greek pioneer in cytopathology and early cancer detection] realised we could take a smear to detect precancerous cells of the cervix.
“Now we’re at a stage where we can actually prevent people getting cancer of the cervix by getting a vaccination. That is an unbelievable scientific progress.”
So where has the concern about the vaccination come from?
Speaking at the recent Irish Medical Organisation (IMO) annual conference, Health Minister Simon Harris blamed “random social media accounts” for spreading unsubstantiated safety concerns about the vaccination.
“We have vaccines in this country that can prevent death,” said Mr Harris. “We have a vaccine that can prevent girls from dying of cancer. And yet we have uninformed nonsense interfering with medical efforts to save lives. Shame on them.
“If you want to give medical advice on vaccinations, become a doctor. If not, get out of the way and stay away from our public health policy.”
But whatever the foundations, concerns persist and are growing.
A support group set up by parents of Irish teenage girls who believes their daughters developed serious health problems after entering secondary school posted a Facebook video entitled “HPV vaccination for 12-year-old girls — Make up your own mind”.
At the time of writing, this video had amassed 1,328,562 views and more than 3,000 comments. The video has been shared almost 30,000 times across the social media platform.
Viewers are encouraged to “share and spread the word to ensure that parents are fully informed, before they make their minds up on behalf of their daughters.”
“The vaccine needs to be banned and discontinued forever!” one public comment on the video reads.
Other comments express concern — one wrote: “My daughter is due to get the HPV vaccine tomorrow in school and after seeing this and reading some of the comments I’m not sure she should get it.”
As with all health campaigns, especially one that can potentially save lives, getting the right information out to the public is essential, says consultant in infectious diseases at Cork University Hospital and president-elect of the RCPI, Professor Mary Horgan.
“What’s important from a doctor’s point of view, or a healthcare professional, is ensuring that the public get the best information that’s based on science, on research, on publications and on experience,” says Prof Horgan
The dropped uptake for the vaccination is very concerning, Prof Horgan says, especially from her position as a specialist in infectious disease.
Parents need to base their decisions about the vaccination on scientific evidence and not on advice from social media, she advises.
“Individuals impart information that may not be based on scientific background. I think that’s in the context of knowing that many diseases are drastically reduced or even eradicated because of vaccines.
“People don’t remember the 1950s when there were outbreaks of polio that impacted on patients — people died from it, people were disabled from it. The onset of vaccines for polio prevented that and we don’t see it anymore.”
However, the Reactions and Effects of Gardasil Resulting in Extreme Trauma (Regret) support group, set up by parents of Irish teenage girls who developed serious health problems after entering secondary school, says concerns are not being addressed.
“These parents are certain that the HPV vaccine (Gardasil) is the cause of their daughters’ otherwise unexplained illness,” the group’s website reads.
The group maintains there are hundreds of Irish school girls who have developed serious, inexplicable health issues after receiving the vaccination.
Sean Wynne, a teacher from Leitrim, became involved with the Regret support group after his daughter became ill. Today he is the secretary of a separate organisation called the Gardasil Awareness Group.
He believes there is a complex political manoeuvre by “official Ireland” to ostracise anyone with reservations about Garadsil.
“If you are calling for an investigation, that there should be a review, they say the science is there to say it’s 100% safe.
“But I contend that it is not 100% safe having had a daughter wander around for four years in the medical wilderness.”
Mr Wynne claims his daughter became ill after receiving the HPV vaccination in secondary school, developing symptoms such as food intolerances, continued tiredness, constant head pain, buzzing in the ears, brain-fog, and lack of concentration, sensitivity to light and unexplained rashes post-vaccination.
Doctors could not offer Mr Wynne or his family an explanation as to what was causing her symptoms.
“I would be 100% for vaccinations,” he said. “My wife and I wouldn’t have put our daughter through this if we thought there was a risk. To come along and ostracise and almost refute the existence of these girls is a terrible silent injustice.”
Last year, a review by the European Medicines Agency found no evidence that HPV vaccines cause chronic fatigue-like conditions, complex regional pain syndrome (CRPS), or postural orthostatic tachycardia syndrome (POTS).
The study found no evidence that the overall occurrence of these syndromes in girls who received the HPV vaccine is different to those who had not, even taking into account possible underreporting.
Mr Wynne disputes this study. “The HSE expects that 300 parents and their families and all their connections to accept that it’s this chronic fatigue syndrome.
“That these girls would have all these conditions, that my daughter would have these conditions even if they had never got the vaccine.”
However, Prof Horgan says parents must base their decision on scientific evidence such as the EMA study.
“I respect people coming from different areas,” Prof Horgan says.
“But all we can do, and all you can do, is base it on the scientific evidence that is out there.
“When you do see people coming in with vaccine-preventable diseases you are left saying ‘Oh my god, I wish this person had been vaccinated.’ We see the bad outcomes of vaccine preventable disease.”
In her professional opinion, is there anything in the argument that this vaccination causes extreme adverse effects?
“There isn’t, I mean because the function of drug regulatory programmes, we have the Health Product Regulatory Agency here or in Europe we have the European Medicines Agency, is to monitor adverse reactions to drugs, and vaccines and devices and there has been no signal with HPV vaccines.
“If you look at the side effects of everything we take that’s medicinal, there has to be a huge array of side effects put on because potentially they could happen. But the thing with vaccines is that there is a huge amount of monitoring. If side effects are reported they are looked at,” Professor Horgan explains.
“What happens is there is a huge database, not just a report here and there, it’s everything that’s looked at together to see if there is a signal, in other words what side effects seem to be more common, anything that would alert us or give us concerns about it.”
The Health Protection Regulatory Body (HPRA) received 245 complaints of adverse reactions associated with the use of the HPV vaccine over the last two years.
The majority of reports are consistent with reactions described in the vaccination’s product information such as fainting, gastrointestinal symptoms, malaise, headache, dizziness and injection site reactions, although there have been some reports describing persisting or chronic fatigue, the HPRA added.
At their annual conference last month, the Teachers’ Union of Ireland called for a review of the HPV vaccine programme in schools.
But according to the health minister, there is no need for a review. The vaccine is safe, and doctors must do all they can to get that message out.
“Doctors have an extremely important role in reassuring parents by providing clear and accurate information on the benefits of vaccination
“Let’s tell people — in no uncertain terms — that it is you, the doctors, who are the experts, and the people who are most trusted to know what is best for our people’s health and well-being, young and old.”
© Irish Examiner Ltd. All rights reserved