Vaccination questions need patient response

THE quadrivalent human papillomavirus (HPV) vaccine is now in its tenth year of use in Australia’s national immunisation program. HPV vaccines are now included in national programs in over 65 countries around the world and more than 200 million doses of the vaccine have been given.

It is fair to say that they are among the most well studied and scrutinised vaccines ever and that they are more effective than we would have dared to hope. Australia has led the world in observing dramatic declines in HPV infection, genital warts and precancerous cervical lesions.

The Global Advisory Committee on Vaccine Safety of the World Health Organization has reviewed the safety of HPV vaccines six times now and every time has concluded that they are safe. In following up possible concerns from routine surveillance systems for adverse events following immunisation, analytical and population-based studies have not confirmed that any illness – not one – occurs more frequently in vaccinated than in unvaccinated girls.

So why do parents still come to us scared of this vaccine and worried it is somehow different to all the others? And how do we convey this incredible depth of scientific knowledge that supports the remarkable safety and efficacy of the HPV vaccines?

The issue seems to be that bad news, scary news and anything shocking, travels fast, and faster than ever and with wider reach in this age of social media.

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While in the past it was perhaps reasonable to ignore unscientific anti-vaccination claims spread by pamphlet and newsletter, for fear of giving them oxygen, it is now a reality that anti-vaccination messages are already out there. They have a wide reach and, if not refuted by trusted sources, can continue to spread and erode trust in vaccines, no matter how outlandish the claims made.

Recent research shows that bad news is more likely to be shared, that well intentioned searches for information on the internet can easily produce skewed and negative results (McDermott T, Hawkes D, Benhamu J. The role of pejorative search terms and professional anti-vaccine advocates on search engine results for Human Papillomavirus Vaccine. Journal of Adolescent Health 2016. In press), and that once a myth is heard it is very difficult to remove the seed of doubt that has been planted.

An example of a frightening rumour currently doing the social media rounds is concerns about HPV vaccines and premature ovarian failure, also called primary ovarian insufficiency (POI).

This has been prompted by a statement for more research into this issue released (and then widely reported by anti-vaccination groups) by the deceptively named American College of Pediatrics (ACP), a small group of conservative clinicians who split off from the esteemed American Academy of Pediatrics in 2002 over ideological disagreement about same-sex adoption. The ACP has strong religiously based views across a number of policy areas including homosexuality, abortion and drug regulation.

Globally there are six cases of POI, with inconsistent temporal associations to vaccination, published by clinicians known to have conservative religious agendas or anti-vaccination beliefs. One case series described three cases of POI, which included cases in two sisters, but it was later revealed that the senior author on that study was acting as a witness in a legal case brought by the two sisters, which was still in active litigation at the time of the article’s publication.

POI fits the classic type of illness for which vaccines are blamed – rare, serious and of unknown cause. There is no evidence from a decade of HPV vaccine safety surveillance and analysis globally that the vaccine causes reproductive problems in women. Claims of infertility caused by vaccination are surely chapter one in the anti-vaccine campaigner’s handbook for derailing immunisation programs (eg, polio vaccine campaigns).

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So, how can we as doctors and health care professionals respond?

We suggest a need to listen, understand and acknowledge parental concerns, be informed about the latest anti-vaccine rumours or know where you can go to find out (eg, the excellent Skeptical Raptor blog maintains a page updating circulating HPV vaccine rumours and providing evidence about vaccine safety), and know where you can access reliable information about vaccines.

The reality is that scientific facts about vaccines alone won’t necessarily remove all doubts – but explaining why there is misinformation online about vaccines and that it is ideologically driven rather than scientifically based may well help parents to understand that the “community” they see on line is not representative of either the vast majority of the parent community or the scientific community.

There are also some excellent parent communities online which are supportive of vaccines, evidence-based and non-judgmental about legitimate questions about vaccine safety (eg, The Vaccine Page on Facebook).

The reality may be that, in this day and age of clickbait, predatory journals and celebrities giving medical advice, we all need to step up with confidence as advocates for science, for medicine, and for prevention of disease.

Associate Professor Julia Brotherton, is medical director of the National HPV Vaccination Program Register. Dr David Hawkes is an honorary fellow at the Department of Pharmacology and Therapeutics at the University of Melbourne. Associate Professor Marion Saville is executive director of the Victorian Cytology Service.