Will HPV vaccination be pursued more vigorously?
A recent study reported in today’s Journal of the American Medical Association that more than 25% of women in the US had the human papilloma virus – a sexually transmitted virus – that could cause cervical cancer.
Scientists led by lead author Eileen Dunne of the Centers for Disease Control, claimed this could be a significant finding with respect to widespread prevalence of HPV in women and could have implications in estimating their risk of developing cervical cancer.
About 25 million women between the ages of 14 and 59 harbor the HPV although just 2% had the most risky strains that cause 70% of cervical cancers. Women in the sexually active phase have more than half probability of being infected although in nearly 20% of these women, there is progression into full-blown disease.
The report raises concerns about the efficacy of vaccination against HPV. This debate assumes importance in the light of recent developments with respect to Merck’s HPV vaccine, Gardasil.
Those who wish to make vaccination mandatory cite the report to show the positive correlation between HPV infection and the risk of developing cervical cancer. Texas has made HPV vaccination mandatory for girls seeking admission to schools in the state. Forty-four other states are discussing appropriate legislation along the lines of the Texan requirements.
Opponents to the proposed mandatory vaccination laws claim there are simply too many knots to be untied and that inoculation might not work as effectively as envisaged. They cite insufficient evidence of efficacy of the vaccine in women who are sexually active and who harbor the virus. The vaccine works only when administered to young girls before they become sexually active.
Two other major irritants in the path of mandatory vaccination against HPV are the high cost of the vaccine and a perceived hurry by state officials to make vaccination mandatory for school admission ostensibly under the lobbying by the manufacturer, Merck.
Merck decided to suspend its apparent lobbying with the government departments and announced so a couple of days ago.
But the question is one of balance of cost with benefit. While one agrees a woman should not be deprived of a potentially life-saving vaccine merely on the basis of cost considerations, the guidelines for making HPV vaccination a compulsory affair do seem to be made in a hurry without a full evaluation of scientific evidence.
