Doubts on the appropriateness of universal human papillomavirus vaccination: is evidence on public health benefits already available?

摘要

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 (misrepresentations 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. Indeed, disclosure of interests is of paramount importance to properly separate scientific, clinical, public health, commercial and political value.