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UK to vaccinate teenage girls against cervical cancer – question you should ask about this proposal

June 21st, 2007

Dr Petra

Update 06/10/10
Please note this blog is not anti vaccines. It discusses issues about the HPV vaccine and sex education policy in the UK. If you see this quoted on an anti vaccine blog please be aware it’s being used out of context.

There’s plenty of coverage in the press today about a UK government panel’s recommendations for a vaccination to be given to teenage girls to protect them from the HPV (human papilloma virus) that can lead to cervical cancer.

Most of the reports and quotes from health professionals enthusiastically welcome the idea of a compulsory vaccination programme to be rolled out across the UK in the near future. The vaccine is to be given to young girls aged around 12/13 before they become sexually active. Worryingly many accounts have reported the vaccine as a ‘cure’ for cancer or something that will prevent HPV transmission, which isn’t accurate and may well mislead the public.

While I welcome any efforts to protect the sexual health of young people, it’s worrying that the government committee and the wider media appear to have overlooked the wider scientific debate about this vaccine, as well as the political issues it raises.

In a recent issue of the Journal of the American Medical Association clinicians outlined the wider debate about the vaccine, questions that should be asked about it, and raised wider issues about the possibility of a compulsory vaccination programme. The New England Journal of Medicine also ran editorials from medics questioning aspects of the proposed vaccination programme – you can read them here and here. Other bloggers have also documented many concerns about the drug – and also the way in which it has been marketed and promoted in the US (this is interesting reading, although skeptics may criticise the anti-vax tone to some of it).

Debates have raged within the US about the ethics of compulsory vaccination, the use of girls as the recipients of the vaccine, and whether the programme could be one big drug trial. Parents have raised worries about the effect of the health on their children as well as whether the availability of the vaccine could encourage sexual activity or put girls in an increasingly vulnerable position. Since many parents probably wouldn’t approve their child to be vaccinated there are wider worries that any vaccination programme would have to be enforced – and that would presumably apply to the UK as well.

We know that young people may not be all that willing to consent to the vaccine simply because already the threat of HIV, other STIs or even pregnancy doesn’t prevent many young people (and adults) having unprotected sex. A vaccine to protect against a disease you may never get when you’re a lot older may not seem relevant to many young girls.

Although cervical cancer is a terrible disease and many women are affected, there are suggestions that a vaccine alone isn’t going to help. Although it may prevent girls getting HPV and therefore risk developing cervical cancer (and save health services the cost of treating that cancer long term), there are suggestions that the availability of a vaccine could lead to young people having unprotected sex believing the vaccine is keeping them ‘safe’. I don’t particularly hold with that school of thought, but media suggestions that it might cause problems certainly aren’t going to help with sexual health promotion messages. And young people do get confused about sexual health topics. Currently many young people believe the contraceptive pill offers this protection (it doesn’t). Who knows what they may make of the HPV vaccine – particularly if it’s given in an atmosphere where sex education is inadequate.

What strikes me as shocking in all this is the suggestion of a compulsory vaccination programme where in the UK we do not have compulsory sex education. Surely before we consider a widespread vaccination programme we should also consider sorting out high standard sex education for all young people?

Currently our school sex education system is in a mess. Some schools cover it well, some do not. Teens complain even when it is delivered well it doesn’t tackle what they really want to know, and most need sex education that includes confidence building, negotiating skills and assertiveness. Not just a list of contraceptives and an instruction to ‘just say no’. We need to address peer pressure, gender inequalities and coercion. We also need to let young people know what sexual health services are available to them at youth friendly times – and for that we need services that are well staffed and open – which again is a problem due to our chronic underspending on sexual health.

We have to wonder why in the UK there’s enthusiasm for a highly expensive vaccine whose long term effects are unknown, but little effort made to fund sexual health services or make school sex education compulsory for all.

Update 06/10/10
Please note this blog is not anti vaccines. It discusses issues about the HPV vaccine and sex education policy in the UK. If you see this quoted on an anti vaccine blog please be aware it’s being used out of context.

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