My thoughts on the Gardasil meeting in Ballincollig this evening. This is going to be a long post, sorry!
It was well attended, maybe 150 people there. A large audience in any case.
The speakers were Jill, a lady who had cervical cancer some years back, Matt Hewitt, a consultant gynaecological oncologist in Cork, and Professor Margaret Stanley, emeritus professor of Ephithelial biology in the University of Cambridge. Jill talked about her own experience of cervical cancer. Dr Hewitt discussed the cancer itself, its treatment, its prognosis, and how current diagnostic techniques (e.g. smear tests) were inadequate. Professor Stanley talked about the vaccine, how it works and the evidence to date of its effectiveness and safety. The meeting was then opened for questions. Dr. Robert O’Connor, from the Irish Cancer Society, chaired the meeting.
The meeting was broadcasted on Facebook and a video of the meeting can be seen at this address. https://www.facebook.com/IrishCancerSociety/
I thought all the speakers did a very good job in presenting the case for the vaccine, although what the attraction was with Comic Sans font is, I will never know. Dr Hewitt was really matter of fact. Although he is often gratified by cases such as Jill’s, he has to tell one person each week that they will die due to cervical cancer. The prognosis after Stage III is really poor. He talked about how the smear test was not perfect and that, outside of the developed world, the infrastructure was simply not there to perform smear tests on women, so cervical cancer rates are still very high. A vaccination programme would address many of these issues.
Dr Stanley spoke about the vaccines and the science. She discussed the different strains of HPV, calling out HPV 16 and HPV 18 as the really bad ones. Over 80% of people will be infected by HPV at some time of their life, but only a small percentage of these will go on to develop lesions and cancer. HPV is not only responsible for cervical cancer, but also anal cancer, penile cancer, neck and throat cancers also, and of course, genital warts. She talked about how cervical cancer was particularly a problem for younger women under 35, as it is still difficult to detect and diagnose cancers in this age group. The current Gardasil vaccine hits four types of HPV, but trials are underway for a vaccine that addresses 9 types of the virus – addressing 90% of issues cause by the virus.
The vaccine is currently administered in 3 doses for people over 15, and in 2 doses for people under 15. Most girls in Ireland now get 2 doses. The variance in the doses is because children under exhibit much better immune responses than adults. Across the EU, Ireland is no different than other countries in the age at which young teens receive the vaccine. Results from Australia have been very encouraging, with big drops in cancers and warts. Now Australian boys are receiving the vaccine as part of the overall programme. To date 230 million doses have been given to 85 million people and the health outcomes continued to be monitored intensively by the various regulatory authorities around the world.
There are 2 ways to monitor the outcomes – passively, by checking the self-reporting through individuals and doctors, and actively, by comparing vaccinated populations with unvaccinated populations, and checking if there is any overall difference between these groups. To date, regulatory authorities across the world are satisfied that the vaccines are safe. They will continue to review the data on an annual basis. Professor Stanley also mentioned that vaccines tend to have very specific side-effects, and the side effects being reported about Gardasil are not consistent with these. What is not at issue is that children do get sick during childhood and some illnesses are debilitating and long lasting. In some cases, children get sick after having had the vaccine, but the question is whether this is caused by the vaccine, or a co-incidence. Research, based on over 100,000 girls presenting to Emergency Rooms in America, then matched against when the girls received the vaccines, is that the vaccines are not causing the illnesses.
One of the points made by Professor Stanley was that in all trials, all deaths are monitored for 5 years, whether they be from suicide, illness or car accidents. I think one woman in the audience thought that the vaccine was causing all these deaths. That was not at all what the Professor has said. Deaths occurred with equal likelihood whether people took the vaccine or not.
One woman lamented Andrew Wakefield having being responsible for the re-emergence of measles. True, but somewhat off-topic.
Another woman was devastated that her daughter, who was very ill, had been given 3 doses of the vaccine instead of 2. Yes, this is called science. The vaccine schedule was changed when it was found that the girls did not need a third dose. She seemed to be of the belief that the 3rd dose was an overdose, which is a misunderstanding of how vaccines work.
Then we had a shouter. This woman also has a very sick daughter and she started shouting about how the HSE does not show the information leaflet and shouting how if she had read the information leaflet she would not have allowed the vaccine to be administered. I could hear murmurs of agreement with her from the audience. “Let her speak, etc”. REGRET have made a connection between the information leaflet and the illnesses affecting their children, despite the face that information leaflets must show all reported side effects, whether or not there have been any studies to examine the linkages. She was shouting down the speakers and it took a short while to get further questions.
Another woman asked about the Number Needed To Treat, suggesting that 250 to 300 vaccines needed to be administered to prevent just one extra HPV case. The number given by the doctors was 159. While this still seems like a very small number, it was pointed out that it’s higher for pre-cancers. In any case we should also remember that cervical cancer is not a common disease in the population, but nevertheless devastating to those people who do develop it. Paralytic Polio also had similar treatment numbers.
The next woman got very agitated about her boys getting the vaccine. To her, the vaccine seemed like an invitation for her 13 year old boys to have oral sex. Um… no.
Heather then spoke. Heather also had cancer. “If I thought I could have a vaccine, I would absolutely urge people to go for it”. Yay Heather. Big clap for her too.
Jackie wanted to know if the Australian vaccine was the same as the one in Ireland. Yep.
Another woman asked about Gardasil 9 and whether it was available in Ireland. The answer is no, not yet.
The final question was about bad reactions in animals. Dr O’Connor explained that the doses given to animals were often far greater than those given to humans and that there was no evidence of it being an issue.
The Q&A then came to an end among more shouting, but also a very big clap for the speakers. REGRET did not have it all their way tonight, despite a clear attempt by Shouty Woman to hijack the meeting at one stage. Apparently there was far more disruption at the Galway meeting, bordering on a security incident.
I spoke briefly to Dr O’Connor and Professor Stanley afterwards. Very nice people. I didn’t see any of the REGRET people speaking to them, but they may have. Shouty Woman was holding court with some of her team towards the back of the room.