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Doubts on the appropriateness of universal human papillomavirus vaccination: is evidence on public health benefits already available?
  1. M Porta1,
  2. B González2,
  3. S Márquez3,
  4. L Artazcoz4
  1. 1
    Institut Municipal d’Investigació Mèdica, Universitat Autònoma de Barcelona, Spain
  2. 2
    Universidad de Las Palmas de Gran Canaria, Spain
  3. 3
    Fundación Instituto de Investigación en Servicios de Salud, Sevilla, Spain
  4. 4
    Centro de Análisis y Programas Sanitarios, Barcelona, Spain
  1. Professor M Porta, IMIM & UAB, Carrer del Dr Aiguader 88, E-08003 Barcelona, Catalonia, Spain; mporta{at}

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Marketing of human papillomavirus (HPV) vaccines is a scientific success for the biomedical research community and industry. Yet, exciting as it rightly is to scientists, technological progress does not guarantee public health impact, as anyone who cares for the public good knows. Trials of HPV vaccines, for instance, have had a limited duration with respect to the lifetime risk (and, hence, prevention) of cervical cancer; this is one reason why the long-term, true effectiveness of HPV vaccines to substantially decrease the population burden of cervical cancer and related pathologies is still unproven, even in countries with a high burden. In many societies worldwide, HPV infection is almost always benign, slow, naturally reversible and can be properly controlled with non-aggressive measures that do not further medicalise the lives of healthy women. Health authorities in many countries still cannot know how many cases of cervical cancer will be prevented—beyond those that good clinical prevention and public health programmes prevent—after millions of teenage girls are vaccinated over several decades. The realistic benefits that vaccines, population screening and primary care can yield as an integral part of private and public policies aimed at preventing clinically relevant pathologies must be assessed more strictly before publicly funded policy decisions are taken; and the realistic drawbacks must also be carefully assessed—not least, the potential for a harmful HPV-isation of the lives of many women and men. In some countries, we are indeed witnessing scientifically weak, profit-driven, vast exaggerations of the risks that infections with HPV (which is not per se a disease) carry to die of cervical cancer. We believe that such public (mis)representations are unacceptable attempts to medicalise (HPV-ise) and biopoliticise the lives of millions of healthy teenagers and their families. Assumptions in cost-effectiveness models should be clearly laid out, real social and healthcare conditions must be integrated in analyses, and a proper assessment of the cost opportunity of other public interventions should be performed—independently of industry and other parties with legitimate but particular interests.1 2 Indeed, disclosure of interests is of paramount importance to properly separate scientific, clinical, public health, commercial and political value.36

Reasonable doubts have been raised by health professionals in Spain on the appropriateness of HPV vaccination of all girls of a certain age. The main reasons are linked to the very low incidence of cervical cancer in Spain, with numerous uncertainties about the mid- and long-term benefits that inclusion of the vaccine in vaccination schemes may provide to the health of the population; to the high costs to society (ie citizens) of the vaccine and of the additional resources needed to implement public vaccination programmes of high quality; and to the rush with which Spanish authorities have adopted the decision to universally vaccinate teenage girls before 2010. In fact, large areas of opacity cover the campaign that continues to be massively developed by some sectors of the biomedical industry (with uncritical assistance from some medical organisations, non-scientific journals and some commercial mass media) to oversell the potential individual and societal benefits of mass vaccination programmes against cervical cancer, to ignore mid- and long-term uncertainties, and to determine the political agenda on publicly funded HPV vaccination programmes.57 In November 2007, a group of professionals promoted a declaration requesting that the authorities have a moratorium on the inclusion of the currently marketed HPV vaccine in regional vaccination calendars.7 8 The declaration8 has so far been signed by over 4400 health professionals and other citizens, mostly women, who are concerned that the interests of public health may not have taken precedence over other interests.



  • Competing interests: None declared.

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