Sarah Boseley’s Guardian article on the keen interest of many African countries in rolling out the HPV (human papillomavirus) vaccination, which will help prevent a large proportion of cervical cancers, is very encouraging. The article quotes the CEO of the Global Alliance for Vaccines and Immunisations, on the importance of the HPV vaccine:
“A woman dies every two minutes from cervical cancer,” said chief executive Seth Berkley at the forum. “There are about 275,000 deaths [every year]. If we don’t do better in preventing it, there will be 430,000 deaths by 2030, all of which are occurring in the developing world. It strikes women down at the absolute peak of their lives.”
As with any public health discussion that goes anywhere near sex, there are controversies around the introduction of HPV vaccination, which unlike many other immunisations is best introduced to pre-adolescent and adolescent girls. But just like in Europe and the US, conservatives are claiming that the vaccine will encourage promiscuity:
“There are a lot of myths and rumours. The reaction from religious groups has been that talking about sexuality is encouraging them to be sexually active. We have had to start to refine our message,” said Kaseba. The government is now talking about cancer prevention, rather than blocking sexual transmission of a virus.
That last statement, The government is now talking about cancer prevention, rather than blocking the sexual transmission of a virus, is worth thinking about. To be sure the main reason that the HPV vaccination is being recommended, from a public health point of view, is because of its effect on cervical cancer – not because of its effect on HPV. So in some ways this message is correct, as it flags up the primary reason for the intervention being introduced. But the primary purpose of the intervention is to prevent HPV – and there’s certainly merit to that (not just for women and girls but for men and boys too). Moreover it would be ethically wrong to hide from vaccine recipients (and their parents, since they are by and large minors), what the actual effect of the vaccine is. And besides, there is no evidence that having the vaccine does cause girls to have earlier, riskier, or more sex; but while standalone biomedical interventions such as the HPV vaccine will protect girls and women from HPV and cancer, there are many other medical and social issues in the realm of sexual and reproductive health that will be neglected. Rolling out the vaccine while avoiding the topic of sex won’t improve this situation.
So what’s the answer? Is it right that messaging should focus on forging the path of least resistance in order to get the job done on HPV and cervical cancer? What other options are there?