The staff comment below is in reaction to news that Guyana will begin immunizing girls 11 years old with Gardasil
Guyana to begin vaccinations to help stem cervical cancer
Tuesday 10th January 2012
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.