EDITORIAL: Getting it right the first time

We are going to wade into the discussion of the much-hyped Human Papillomavirus (HPV) vaccine because there are simply too many questions and not enough answers.  We are not anti-vaccine crusaders, but it does not take a lot of research to know that the HPV vaccine and its rollout into communities around the world have been highly controversial and we believe that basic questions must be answered before we throw blind faith behind this drug and start using it to vaccinate our children.
Recently, the ministry of health hosted a media/stakeholder breakfast meeting to provide information on the upcoming release of the drug to the public. The “Fight Against Cancers in Antigua and Barbuda” was a good step towards providing information to the wider community. However, we were disappointed by the lack of detailed answers to important questions that should be at everyone’s fingertips on the eve of such an important rollout.  
A quick background is necessary. According to the Center of Disease Control and Prevention, “HPV is a group of more than 150 related viruses. Each HPV virus in this large group is given a number that is called its HPV type. HPV is named for the warts (papillomas) that some HPV types can cause. Some other HPV types can lead to cancer. Men and women can get cancer of mouth/throat, and anus/rectum from HPV infections. Men can also get penile HPV cancer. In women, HPV infections can also cause cervical, vaginal, and vulvar HPV cancers. But there are vaccines that can prevent infection with the types of HPV that most commonly cause cancer.” And that is where the HPV vaccine comes in.
In most cases, HPV goes away on its own, but when it does not go away, it can cause health problems as described above; and that includes cancer.  The health officials, rightfully believing that prevention is better than cure, have enthusiastically embraced and endorsed the HPV vaccine and have targeted boys and girls from the ages of nine to 13 as their priority.  On the surface, everything seems good so far, if you are not anti-vaccine, right?  Except, the devil is in the details and this is where we have problems with the information being disseminated by the HPV vaccine cheerleaders.
Let’s start with the vaccine itself.  The drug currently on island is called Gardasil 4.  It is produced by the pharmaceutical giant, Merck.  Gardasil is not without its controversies and there is ample discussion of its side-effects that you can research for yourself online.
We found it interesting that Dr. Diane Harper, one of the lead researchers for the drug has come out and questioned the vaccine’s risk-versus-benefit profile being aggressively promoted by the health industry.
That aside, our main concern with Gardasil 4 is its effectiveness in our community.  The health officials tout a “70 percent effectiveness” in their promotion, but that is based on effectiveness in (primarily) Caucasian women.  According to a Duke University study, HPV 16 and HPV 18, which cause about 70 percent of all cervical cancers, are about 50 percent less likely to be found in African American women with abnormal Pap test results.
(The research results were published in the clinical journal Cancer Causes Control https://www.ncbi.
nlm.nih.gov/pubmed/24928693). The early indicators are that African American women may be less susceptible to infections with HPV 16 and 18 and more susceptible to be infected with HPV 35 and 58 and other high-risk HPV types.  That is according to the study’s author, Adriana C. Vidal, PhD, assistant professor of obstetrics and gynecology at Duke University School of Medicine.
Our health professionals have gone with Gardasil 4 which prevents, you guessed it, HPV subtypes 16 and 18 (along with 6 and 11).  The newer Gardasil 9 targets those strains along with 31, 33, 45, 52 and 58.  Now, we are not medical professionals but it would appear to us that based on the Duke University study, we should be administering Gardasil 9 and not the product that has been procured, Gardasil 4.
When our representative at the Fight Against Cancers in Antigua and Barbuda breakfast meeting queried this exact point, her queries were met with more promotional banter than hard answers.  From our perspective, saying that we don’t have hard data on the strains that affect our population, strengthens the need to go with Gardasil 9.  Otherwise, we may be lulling people into a false sense of security by giving them a vaccine that does not help with the strains of HPV that may be prevalent in our society because of our racial background or ethnicity.
When you couple the Duke University study with the opinion of Gardasil researcher Dr. Harper, who has said that there is no data showing that it remains effective beyond five years, then this needs better research and a better plan than just following the global community.  According to Harper, the false sense of security is real.  She says, “If we vaccinate 11 year olds and the protection doesn’t last… we’ve put them at harm from side effects, small but real, for no benefit … The benefit to public health is nothing, there is no reduction in cervical cancers, they are just postponed, unless the protection lasts for at least 15 years, and over 70 percent of all sexually active females of all ages are vaccinated.”  And that is not all, she also says that enough serious side effects have been reported after Gardasil use that the vaccine could prove riskier than the cervical cancer it purports to prevent – 090-12H8J9K0PI-” BNM, which is usually entirely curable when detected early through normal pap screenings.
This is a lot to absorb but, if you have children in the target population, it is worth doing the research.  By asking questions, we can all help make our nation healthier because questions do not seek to derail the initiative, they are simply helping to put it on the right track.
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