HPV vaccination: waiting for evidence of effectiveness

The Lancet

The Lancet, Volume 375, Issue 9715, Pages 639 – 640, 20 February 2010

Eric J Suba aEmail Address, Stephen S Raab b, on behalf of the Viet/American Cervical Cancer Prevention Project

As noted by Gary Clifford (Dec 12, p 1948),1 the greatest source of uncertainty about the potential effectiveness of human papillomavirus (HPV) vaccines remains the duration of the immune response. However, even if the most optimistic scenario of HPV vaccine effectiveness is realised, the introduction of HPV vaccines to populations not yet fully covered by screening services may compete with limited budgets for the build-out of screening services and thereby decelerate global reductions in deaths from cervical cancer by creating populations of women who will not be protected by either screening or vaccination.2

Moreover, the most optimistic scenario of HPV vaccine effectiveness may not be realised: we will not know for many more years whether HPV vaccination will prevent cancer or, in the worst case, do harm;3 and leading scientists, including Nobel laureate Harald zur Hausen,4 predict that even the best-case scenario of HPV vaccination will require booster doses.
In matters pertaining to life and death, it is essential to choose the sure thing, and, by definition, dangerous to choose otherwise. With regard to cervical cancer prevention, Papanicolaou cytological screening, done correctly, is a sure thing; HPV vaccination, done correctly, is not. We must not allow our hopes to cloud these observations. Therefore, developing countries should allocate their limited resources to cervical screening, rather than HPV vaccination, until the possibility has been excluded that HPV vaccines may be ineffective for cervical cancer prevention, or until full coverage of target demographic groups by screening services has been achieved, whichever comes first.5

We declare that we have no conflicts of interest.


1 Clifford GM. Global access to HPV vaccination: what are we waiting for?. Lancet 2009; 374: 1948-1949. Full Text | PDF(485KB) | CrossRef | PubMed
2 Suba EJ, Murphy SK, Donnelly AD, Furia LM, Huynh ML, Raab SSViet/American Cervical Cancer Prevention Project. Systems analysis of real-world obstacles to successful cervical cancer prevention in developing countries. Am J Public Health 2006; 96: 480-487. CrossRef | PubMed
3 Haug CJ. Human papillomavirus vaccination—reasons for caution. N Engl J Med 2008; 359: 861-862. CrossRef | PubMed
4 Michels KB, zur Hausen H. HPV vaccine for all. Lancet 2009; 374: 268-270. Full Text | PDF(266KB) | CrossRef | PubMed
5 Suba EJ, Raab SSViet/American Cervical Cancer Prevention Project. Human papillomavirus vaccine. N Engl J Med 2007; 357: 1155. PubMed
a Department of Pathology, Kaiser Permanente Medical Center, San Francisco, CA 94115, USA
b Department of Pathology, University of Colorado Health Sciences Center, Aurora, CO, USA
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Author: Leslie Carol Botha

Author, publisher, radio talk show host and internationally recognized expert on women's hormone cycles. Social/political activist on Gardasil the HPV vaccine for adolescent girls. Co-author of "Understanding Your Mood, Mind and Hormone Cycle." Honorary advisory board member for the Foundation for the Study of Cycles and member of the Society for Menstrual Cycle Research.