Vaccination for the nation
Helen Jaques
Tuesday, 29 April 2008 23:40 UTC
Last year the New England Journal of Medicine published a double-blind, placebo-controlled, randomized trial demonstrating that young women vaccinated against human papillomavirus (HPV) had considerably lower incidence of cervical cancer than those not immunized. HPVs are also responsible for causing genital warts and other skin growths.
As a result of this research and other papers, the UK Department of Health recommended that all girls aged between 12 and 13 years receive a vaccination against HPV, starting from September 2008.
However, a paper published last week in the British Medical Journal investigating uptake of the HPV vaccine in a cohort of girls in Manchester found that 20% of parents refused to have their daughters vaccinated. The research paper reported that the primary reason parents turned down the vaccine was because of insufficient information its long term safety. The media, on the other hand, jumped on the suggestion that parents thought a jab against an STD would encourage sexual promiscuity
The ongoing MMR/autism saga has highlighted the detrimental effect on public health of parents responding to media hype and refusing to vaccinate their children.
What do you think? Should parents and children have a choice which routine vaccinations they want to receive? Or should doctors insist on immunizations for the greater good of society? More controvertially, should some vaccinations be made compulsory?
Updated 30 April 2008 12:46 UTC
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Replies
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Just spotted this story on Nature News. It seems that the human papilloma virus is also implicated in lung cancer. More reason to insist on vaccinating against this virus?
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I would certainly recommend MMR vaccine and the other standard vaccinations – essential I believe. I am not so sure about HPV, though. Maybe it is best to let the girls decide, not the parents, in that case?
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To be honest, I think once a vaccination has been proven safe and effective, everyone should be strongly urged to have it.
Of course, there aren’t actually that many papers on the HPV vaccine yet so the safety hasn’t been proven beyond all doubt. Parents, and, more importantly, the girls being immunized, should therefore have the choice whether to receive it.
The vaccine is recommended for girls aged 12-13 years, so I feel parental consent is probably important for this young age group. On the other hand, I hope the girls themselves have last say as to whether they are immunized.
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I think it also depends on the extent to which lifestyle factors are involved in the disease.
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There is also growing evidence that infection with human papillomavirus increases the risk of head and neck cancer, e.g. this case control study from last year.
I would compare HPV vaccination to Hepatitis B (HBV) vaccination. Both will dramatically decrease the risk of cancer (hepatocellular carcinoma in the case of HBV). But in contrast to measles, neither HBV nor HPV are easily transmitted in schools or other social gatherings. It should therefore be left to the parents, but I expect widespread acceptance of the HPV vaccine within a few years.
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Martin, you write: “But in contrast to measles, neither HBV nor HPV are easily transmitted in schools or other social gatherings. It should therefore be left to the parents”
Why not the person who knows whether or not he or she is at risk, rather than the parent (who may well not have a clue one way or the other?). I question the ethics of a parent making this decision, but maybe there are factors that haven’t occurred to me. (I don’t think the age of the person is a factor – but again, there may be aspects to this argument that haven’t occurred to me.)
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Similar to the UK Department of Health, the German STIKO last year recommended HPV vaccination for all girls age 12 to 17 (!). The vaccination was recommended for all girls and not for particular subgroups at risk. In Germany a vaccination of a 12-year-old girl would of course require her consent but would not be possible without the consent of a parent.
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A major issue in whether “a vaccination has been proven safe and effective” or not is who proves it, and to whom. Any company making a useful vaccine stands to make whopping profits and is likely to find many ways to put pressure on regulatory agencies to approve going to market. I think it’s reasonable to remain slightly skeptical about newer vaccines until a little more perspective can be gained.
This unfortunately gets to the issue of “test it on other people’s kids, not mine” which makes it quite so difficult and expensive for companies to invest in such development to begin with. Or they have to take it off to a developing country and recruit in exchange for another product of theirs, and that’s iffy ethical territory. It’s a vicious circle.
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Yes indeed, Heather. And then there is the whole military “volunteers” aspect.
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I think for young girls the parental consent issue may apply to any vaccine rather than HPV especially, in case the recipients don’t fully understand what they’re receiving. It’s worth finding out if this issue only applies to this vaccine.
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