The power of vaccine
A national programme of cervical cancer vaccination was introduced last year in the United Kingdom (UK) for girls of 12 and 13 years of age. Other European countries, Australia and North America are also recommending mass vaccination. This development, at least in the UK, has been greeted with rather mixed reactions. This comes as a surprise to me. It had not occurred to me there may be reservations about such a seemingly valuable development. But for some, the vaccination programme is viewed as being controversial, whether on grounds of religion, questionable justification, or the belief that it will increase promiscuity among young people. For me, however, on three counts – as a woman, a nurse and a mother – I can see only the positive benefits of a vaccination programme with the power to prevent distress and death from cervical cancer.
And so it delighted me to read in Duval et al.’s paper in this issue of JAN (pp. 499–508) that a survey of nearly 1000 nurses showed that the vast majority perceived routinely available vaccines as very useful and, in the case of this new vaccine, 85% of the nurses said they would recommend it to their patients. The results of this survey, undertaken in Canada in 2007, cannot necessarily be generalized, but they do identify important issues, particularly in terms of the importance of well-grounded education. The success of any vaccination programme in any country is reliant on the support of healthcare professionals, and particularly nurses, who play a crucial role in conveying sound knowledge and positive attitudes to those with potential to benefit from a vaccine.
The vaccine under discussion here is not, of course, technically ‘a cervical cancer vaccine’ as I have referred to it for short, but a vaccine that targets the human papilloma virus (HPV). HPV, as Duval et al. explain in their introduction, is the primary causal factor for cervical disease, notably cancer. The two vaccines on the market (Gardasil and Cervarix) have been shown to be 100% effective in preventing infection with the two strains of HPV (16 and 18) that together cause about 70% of cervical cancer cases. HPV vaccination will not eradicate this cancer, but it could reduce it very substantially. But, of course, mass HPV vaccination is a costly undertaking, especially on top of the cervical screening programmes that must still be maintained.
And so, alas, the mass use of the HPV vaccine will be out of reach financially for most of the developing world, just as finance and logistics have prevented the introduction of systematic screening for cervical cancer which, in the UK, has already helped to reduce mortality by about 70% over a 30-year period. Yet it is in the developing world where cervical cancer causes death on a scale that overshadows the problem in the developed world. Ponder this statistic that I found on the internet: ‘Cervical cancer contributes over 2·7 million years of life lost among women between the ages of 25 and 64 worldwide, some 2·4 million of which occur in developing areas and only 0·3 million in developed countries’ (http://info.cancerresearchuk.org/cancerstats).
Tackling a problem of such enormous scale seems daunting, if not well nigh impossible, yet it is worth remembering that vaccination programmes have been singularly successful in fighting death and disease on a worldwide basis. Vaccines have achieved more than any other single measure aside from the provision of safe drinking water. The total eradication of smallpox exemplifies the ultimate power of a vaccine. It is reassuring to have early evidence from Canada that nurses are supportive of HPV vaccination. But dare we hope that the potential power of this vaccine also can be harnessed for the even greater need of the developing world?