Allow trials for a vaccine to prevent cervical cancer
SHOBHA S. KRISHNAN, staff physician at Columbia University’s Barnard College Health Services in the US, shot to fame recently with her path-breaking publication on the Human Papilloma Virus (HPV), one of the most widespread sexually transmitted infections in the world. In the US, it affects 6 million new cases each year while in India it leads to one female death every minute on account of cervical cancer.
In her book titled, “HPV Vaccine Controversy: Sex, Cancer, God and Politics”, Krishnan makes a compelling case for countries to use the available HPV vaccines recommended for girls and boys before they turn sexually active. With India having suspended the trials of the two available vaccines – one developed by Merck and the other by GSK – in the wake of ethical and safety concerns, Krishnan, also founder of the Global Initiative against HPV and Cervical Cancer (GIAHC), strongly defends use of the vaccines, which, she claims, can save the lives of 80,000 Indian women every year.
Why is HPV such a huge cause of concern worldwide, more so in developing countries like India?
HPV is among the most widespread sexually transmitted viruses both men and women can have. At least 50 percent of all sexually active people will be infected with the HPV in their lifetimes. While 90 per cent infections resolve on their own, others persist and can be life threatening if not detected and managed.
What is the controversy around the HPV vaccine all about if its safety and efficacy has been tested and documented ?
The controversy really is about ideology versus scientific development. Critics of the vaccine believe that administering children with an HPV vaccine might lead to enhanced sexual activity among youths and undermine family values. They also say it might create a false sense of security among children that they have been protected against a dreaded STI once they have been vaccinated.
But the fact is we actually have enough evidence to support the safety and effectiveness of HPV vaccines and recommend them for children. This vaccine will potentially reduce the occurrence of the second leading cause of cancer in women around the world. Canada and Australia have included this vaccine for use.
In India, trial of HPV vaccines donated by GSK and Merck and funded by the Gates Foundation was suspended last year after seven tribal girls in Andhra Pradesh and Gujarat died during the trials. Are safety concerns around the vaccines not real?
Merck’s HPV vaccine Gardasil has been out for five years and 35 million doses of the vaccine have been administered. The Centre for Diseases Control (CDC)which recommended the vaccine in the first place, has been monitoring any adverse effects which show up six weeks after the vaccine has been administered. To date, we have found no link between the vaccine and adverse effects though some side effects like swellings have been reported.
What is the CDC’s argument behind recommending vaccines for children even when controversies continue to surround their use?
HPV is a silent disease and may cause no external symptoms. But 70 pc cervical cancers are caused by HPV 16 and 18 while 90 per cent of anogenital warts (an STI) are caused by HPV 6 and 11. All these strains can be prevented by the quadrivalent HPV vaccine. In my book, I have presented evidence of the vaccine being a cost-effective intervention.
Let us remember, cervical cancer is the only cancer that’s preventable with safe, inexpensive methods. Safety systems can be built into the programme of vaccine use.
You said most HPV infections get resolved automatically. Why do others like HPV 16 and 18 stay? What are the risk factors?
Tobacco use is a major risk factor. People who have HPV and who smoke are at 2.5 times higher risk of getting cervical cancer than those who have HPV and don’t smoke. Smoking releases carcinogens that weaken immunity.
In a country like India where 70 pc of the people live in villages, what is the easiest way to detect cervical cancer?
A Pap Smear Test is a must and it is a very simple test that can be easily administered in any location. The Government must build the capacity by roping in NGOs interested in strengthening the screening network for cervical cancer.
Read online at The Tribune.