03 October 2009

HPV Vaccine

Normal service will resume, one day.  I'm just not feeling as inspired as I should do to write nice long, pretty posts about my knitting etc.  Weird frame of mind at the moment, I think.  But I am still knitting, you'll be happy to know, although I have come to the conclusion that I don't want to do a sock club again.  I love the Socktopus club and getting yarn and patterns and goodies every so often but I don't like the pressure I put myself under to get the socks knitted so that I ignore everything else I want to knit too.

Anyway...this post was not meant to be about all of that.  It's meant to be about my feelings and opinions on the HPV vaccine, plus some counter arguments to a website mulene pointed me in the direction of.

My involvement with the HPV vaccine was that I was part of the phase 3 trial of GlaxoSmithKline's Cervarix vaccine.  It was a four year trial that I started on about 5 years ago at the Manchester centre.  When I was unblinded at the end of the trial, it turned out that I'd had the placebo (a hep A vaccine) but was offered the chance of having the HPV vaccine and I jumped at it.  The basics of the trial were that I was given 3 injections (0, 1 and 6 months), having a pregnancy test before each one and had regular smears and blood tests throughout the 10 visits of the trial.  Yes, I was paid for my time but not an extortionate amount and I had normally forgotten all about it until the trial nurse got out the money paperwork.  I also had to answer questionnaires and read and sign updated info on the vaccine.  When Merck were given licensing earlier, I was informed and given the opportunity to leave the trial and pay for that vaccine privately.  At no time was I pressurised to stay on the trial and if I had questions, they were answered quickly.  I knew I'd get followups if there were any problems with smears of my HPV status and I developed a good relationship with the trial nurse.  I really feel that it was something important to be part of and I was delighted when they announced a vaccination programme in the UK.

But then I was informed of this website.  Alongside the hysteria that will have ensued due to the tragic death of Natalie Morton, I thought I had to say something.  Firstly, my heart goes out to Natalie's family and I thank them for being very open about her cause of death.  The vaccine wasn't the cause, just a horrible coincidence.  Secondly, if you are a parent and have any doubts about this vaccine, think about this statistic: 1 in 3 people with cervical cancer die.  If I can do anything to reduce the chance that I might get HPV then I will do.

Obviously, things are not so simply and there are a lot of factors to take into consideration.  Like the fact that they have no idea if boosters are going to be needed.  That data just isn't available, although the latest published figures show immunity for at least 6.4 years.  Due to the fact smear tests are still very necessary along with the vaccination, I'm sure it will be something looked into at those points.  I don't hear people complaining that tetanus jabs have to be done periodically so I don't really see why this is any different for those who take care of their health.  Other people seem very bothered about why the NHS chose Cervarix over Gardisil.  To be honest, I don't know the full details and they're not readily available but the two vaccines both protect at least as well as each other against HPV 16 and 18 and those are the cancer causing ones.  Chances are, money is involved but that doesn't mean Cervarix isn't as good.  It was just licensed slightly later and most countries who have introduced vaccination programmes started theirs before Cervarix was fully licensed.  A lot of this has to do with the way Merck chose to run their trial once the results looked promised; they chose to unblind early and GSK did not.  But Holland are also using Cervarix in their programme and it has been licensed in lots of other countries too.  Why would countries and the NHS put people at risk if it didn't look like it was safe?

Of course there are side effects when having the vaccine; there are for most vaccines.  My arm was really, really painful when I had my doses but it's worth the discomfort and it was the same for other potentially life saving vaccinations I've had.  There are obviously going to be some more serious reactions because there will always be someone who is unfortunately allergic to the vaccine but trained medical staff administer the vaccination and, if there are problems, they will deal with them promptly.  I have heard of deaths they think are related to the vaccines (actually, mainly in America where they are using Gardisil) but a lot of them have been fetal deaths.  There is a warning saying that you shouldn't have the vaccination whilst pregnant as I believe the effects are largely unknown (it's not something you take risks with as part of a trial).  

I think one of largest concerns are that the vaccine was not trialled on the age range of girls who are now being vaccinated.  This is a problem but, whilst talking to the trial nurse at Manchester, she explained how hard it was getting 15 and 16 year olds involved.  It's because of the parental consent issue as HPV is sexually transmitted and parents don't want to think about their little girl having sex.  But think about how you'd feel if your daughter died from cervical cancer?  All drugs have to be trialled and it's often hard to know of the possible outcomes with different age groups and what will happen a long way down the line but most vaccines are based on several well established methods of action and most vaccinations are given at a young age so that they have the most benefit.  The HPV vaccines are more effective if given before the person becomes sexually active so they have to start young.  That isn't to say it doesn't have any effect if given later, just if you already have HPV, it won't get rid of it.  

I think a lot of the statements made on that website are unfortunately going to make people worry.  The website is run by a mother, who does not seem to have a heath background.  There is a disclaimer on the site about not reading it as medical advise (and I will be posting similar) but I think it is likely to be read by other confused parents and make matters worse.  And this will end up like the MMR jab were thousands of confused parents chose not to get their children vaccinated and then people died unnecessarily from measles.  The pockets of the NHS are not lined with money from GSK (if they were, we wouldn't be having funding problems) and thus they will give out information based on the facts that are known.  Yes, we don't know the long term effects but would it be ethical to deny possibly life saving treatment is that we could run the trial for 10, 20, 30, 50 etc years?

My main point of all of this is to say to parents and young women: make an informed decision.  Talk to doctors and nurses, read information on reliable websites (I'll make a list at the bottom), think about the benefits, risks and consequences and above all, remember to get your smear test regularly.  Just as we say, check your breasts and bodies carefully for changes, do the sensible thing and get yourself checked out fully too.  It might be annoying, it might be uncomfortable but at the end of the day, it can save your life.  Oh, and practice safe sex.  Condoms are the only thing that will reduce the risk of sexually transmitted infections AND pregnancy.  Nothing it full proof (well, abstinence is) but you can dramatically reduce your risk.

Websites I suggest looking at:
http://www.cervarix.co.uk/ - if you have any understanding of more scientific talk, take a look at the heathcare professionals section too.  This site is run by GSK
http://en.wikipedia.org/wiki/HPV_vaccine - read with some caution as Wikipedia can be edited by anyone.
http://www.gardasil.com/ - Merck's website on their vaccine
http://www.fightcervicalcancer.org.uk - NHS Scotland's site on the vaccine

Disclaimer:  I am not a doctor or practising healthcare worker who should be giving out medical advice and thus anything that is said on this blog is personal opinion and summisation from the information available out there.  Please see a registered practitioner for proper advice and information.  I am also not paid by GSK (I was reimbursed by they as part of the trial), NHS (well, I am for my job) or any other organisation to condone the vaccination.  I have personal opinions on this and if you choose not to again, that is your prerogative but if required, please make an informed decision rather than one based on media hysteria.  


Twila Jean said...

It appears you are not in the states like myself, and I know we function a quite bit differently here with our medical system, But I must quite strongly disagree with you here.

Even Doctors in the states are refusing to give that vaccine to their children. (ours is called gardasil. does that differ from your vaccine?) The head Doctor who did the trail studies on Gardasil, is no longer backing it saying there is no way to know its safe.

Major new stations here are reporting on the dangers of the vaccine, not just the crazy anti-mmr people :)

this is a quote, "By the summer of 2009, Gardasil had already caused more than 15,000 thousand reports of adverse vaccine reactions, injuring more than 3,000 and killing 48, with 14 deaths claiming girls under the age of 16."

Also, the US Vaccine Adverse Reactions (VAERS) report shows that there are 44 deaths associated. this website is run by the government.

I think encouraging teen girls to get regular pap smears is a safe alternative here. As I have HPV, and Had been found to have precancerous cells that we removed. and I am fine now, and I continue to make my yearly check-ups to the DR. I was informed at the doctor, that nearly every case can be cured, with regular check ups and close monitoring of abnormal cells.

anyway.. I just think both sides should be shown.