Human papillomavirus vaccination: stabbing in the dark?

Abstract

In September, the human papillomavirus (HPV) vaccine will become part of the UK’s immunisation programme. Initially, 12–13-year-old girls and a catch-up group of 17–18-year-old girls will be targeted in schools, with a three-dose vaccination schedule at 0, 1, and 6 months. Cervarix, a bivalent vaccine developed by GlaxoSmithKline, has been chosen in favour of Merck’s quadrivalent Gardasil. This vaccination programme could prevent 70–80% of cases of cervical cancer and over 90% of cases of genital warts, but its potential success depends on uptake. In a pilot study of just over 2800 schoolgirls in Manchester aged 12–13 years, overall uptake was 71% for the fi rst dose and 69% for the second. Uptake was lower among girls from less affl uent backgrounds and minority groups, and results from the third dose were not reported. Cancer Research UK reports these results as “encouraging”, but higher uptake would be desirable, particularly as cost-eff ectiveness models assume uptake greater than 80%. There are many possible explanations for poor uptake: fi rst, the logistical diffi culty of administering three doses of vaccine at specifi c times. Second, fears of the girls, their parents, and perhaps even teachers that the vaccination is dangerous. Third, concerns on moral or religious grounds that use of the HPV vaccine will promote sexual promiscuity. Fourth, girls, parents, and teachers lacking awareness of the advantages of immunity to HPV. Awareness is necessary for informed consent, which is a prerequisite for vaccination. However, a recent study reported that only 23% of 1348 Italian 14–24-year-old women knew that HPV can infect genital mucosa and had heard about cervical cancer. If these results can be extrapolated, it is worrying that most girls being off ered vaccination against HPV might have no concept of what the virus does, and certainly therefore no understanding of the benefi ts of immunity. If the programme is extended to include boys, conveying the value of herd immunity will be an even greater challenge than promoting individual immunity. Raising awareness of the link between HPV and cancer of the male genital tract, oral cavity, oropharynx, and larynx may be a more successful route for encouraging vaccination. The Department of Health has planned an advertising campaign, directed at young girls and their parents, to coincide with the fi rst injections. Hopefully, the multimedia messages will illuminate all those who are in the dark about the benefi ts of vaccination.