Answer the following questions:
To those who wish to promote HPV vaccination as a means for reducing cervical cancer burden, perhaps the following should be asked:
Given those are lifted straight from the source article maybe we should just use the
published response to said article?
I've given my edited versions of the responses for brevity. Please read the full article for the original response and wording.
Also note the responses comment: "
When trying to respond to the 8 questions that the authors bring forward I realized that Tomljenovic are questioning the whole system of how the public health stake holders are evaluating research, take decisions and monitor the safety of the population. It is thus difficult to counter argue so many queries from the part of one researcher."
1. HPV vaccines have not been demonstrated to prevent any cervical cancers so why are they being promoted as cervical cancer vaccines?
Several clinical trials have all been consistent of an enormous efficacy in the reduction of HPV and related pre-neoplasic lesions. Given the robust data if we remove the etiological factor in the long run this should lower the burden of invasive cervical cancer.
2. If the majority of HPV infections and a great proportion of pre-cancerous lesions clear spontaneously and without medical treatment and are thus not a reliable indication of cancer later in life, then how can these end-points be used as a reliable indicator of the number of cervical cancer cases that will be prevented by HPV vaccines?
By the same rationale that screenings effectiveness is based on.
3. How can the clinical trials make an accurate estimate of the risk associated with HPV-vaccines if they are methodologically biased to produce type-2 errors (false negatives [2,4,13])?
This does not represent all the monitoring for side affects.
4. Can a passive monitoring system such as that used by most vaccine surveillance systems world-wide allow the medical regulatory agencies to make accurate estimates on the real frequency of HPV-vaccine related adverse reactions?
This system is deemed sufficient and is heavily used and critiqued for most other interventions, why should this vaccine be singled out as different given its good record in trials?
5. Can an accurate estimate of the real frequency of HPV-vaccine related adverse reactions be made if appropriate follow-up and thorough investigation of suspected vaccine related ADRs is not conducted but instead, these cases are a-priori dismissed as being unrelated to the vaccine?
This is an innacurate summary of the process, appropriate follow up and investigation has been performed in many countries.
6. Why are women not informed of the fact that in some circumstances (i.e., prior exposure to vaccine-targeted and non-targeted HPV types), HPV vaccination may accelerate the progression of cervical abnormalities [4,26-28]?
Further data has contradicted this initial concern and indicates the vaccine is still beneficial for these people.
7. How can women make a fully informed decision about whether or not to consent to vaccination if crucial information regarding HPV vaccine efficacy and safety is not being disclosed to them?
The author disagree that information is not provided.
8. Should the medical health regulators and authorities rely solely on data provided by the vaccine manufacturers to make vaccine-policy decisions and recommendations [12,29]?
They have not relied solely on such data and further new independent data is still being generated.
Addit: The following editorial also discusses the discussion between the two groups and is instructive and interesting.
Infections and cancer: debate about using vaccines as a cancer control tool