Top critical review
1.0 out of 5 starsA generation done a disservice by a shoddy antivaccine polemic
Reviewed in the United States on November 7, 2018
In 2006, the first HPV vaccine (Gardasil) was licensed for use. Since then, 120 countries including the U.S. have adopted it, with marked success reported in decreasing the prevalence of HPV (human papillomavirus), which is implicated in the development of numerous cancers, including those of the cervix, anus, mouth and throat. In the U.S., despite limited uptake of the vaccine, HPV prevalence has been more than cut in half, with a markedly greater reduction in the age group getting the vaccine. In Australia where most adolescent boys and girls have received the HPV vaccine, the reduction in HPV infection is even more profound - with the prevalence rate among 18 to 24-year old women declining from about 23% to 1% from 2005 to 2015. Since about 99.99% of cervical cancers are caused by HPV, it's anticipated that Australia could in coming years be the first nation to essentially eliminate this cancer entirely.
This is great news - but not for antivaccine advocates. In "The HPV Vaccine On Trial", longtime antivax campaigner Mary Holland and two coauthors who similarly lack a medical or scientific background attack the HPV vaccine as ineffective, unnecessary and dangerous - but fail miserably to make an effective case.
While you won't find this information in the book, lead author Mary Holland has long condemned vaccines as a whole. She co-authored "Vaccine Epidemic", a misinformation-filled screed against immunization which included a defense of Andrew Wakefield, the researcher who published an unethical and fraudulent study suggesting a link between MMR vaccine and autism. The paper was later retracted by The Lancet after knowledge of Wakefield's transgressions (including accepting hefty payments from a lawyer's group hoping to file lucrative lawsuits against vaccine makers) became known.
"The HPV Vaccine On Trial" depends heavily on the same discredited tropes that have been commonly used in other antivax books and articles.
Most prominently there are anecdotes about young people who developed ailments somewhere around the time they were vaccinated - in some instances, much later (one case describes a young woman who started getting panic attacks months after HPV vaccination). Another case is that of Colton Berrett, a young man who reportedly had no problems with the first two doses of a three-dose HPV vaccine series, then developed a paralytic syndrome with onset two weeks after his final HPV shot. This ailment (transverse myelitis) has many potential causes, but vaccination has never been shown to be one of them (a study involving 64 million vaccine doses found no association). This hasn't stopped antivaxers from seizing on the sad outcome to Berrett's illness (he took his own life) as a vehicle to attack vaccines.
At least the book left out one of the more bizarre attempts to link the HPV vaccine to a death; an antivaccine website contains an account of a young woman who fell down a well and died, one month after being vaccinated.
In reality, HPV vaccines have been found to be very safe, with potential side effects mostly limited to minor problems like temporary injection site pain, swelling and redness. Holland et al list a whopping number of ailments alleged to be caused by the vaccine, but there is neither a logical mechanism nor convincing evidence for linking such a multitude of disparate conditions to the vaccine.
There isn't space in a single review to cover all the errors and distortions in this book, but examples include the laughable suggestion that HPV infection can be prevented by improved sanitation and clean water (since there are approximately 43,000 new cases of HPV-linked cancer in the U.S. annually, one wonders if Holland et al think the U.S. is a Third World country without access to clean water or sewers). In the case of cervical cancer, close to 100% of cases occur in HPV-infected women, but the book tries to play up the tiny minority of cases where HPV has not been demonstrated, in an attempt to show the vaccine isn't necessary. To that end, the book also claims that the infection "clears almost all the time". Consider that there are currently an estimated 80 million Americans with HPV, and about 90% of them will have their infections resolve within two years. That still leaves 7.2 million with persistent infection and the potential for precancerous and cancerous changes. We have no way to predict which infections will spontaneously resolve and which will dangerously persist. The book attempts to present Pap screening as a viable alternative to HPV vaccination. However, Pap tests do not prevent HPV infection - they can only monitor it; and while highly useful they are not perfect, occasionally missing serious abnormalities. Meantime, in addition to 43,000 Americans developing HPV-linked cancers each year, hundreds of thousands of people experience precancerous changes due to HPV, and must undergo costly, invasive and sometimes painful testing and procedures to check for and eliminate dysplasias (precancers.) The morbidity of these conditions is something the book glosses over or ignores entirely. This is a common antivax tactic - focus only on deaths due to disease (rather ghoulishly, antivaxers seem to think these numbers are low enough to be "manageable") while refusing to acknowledge complications and suffering due to vaccine-preventable diseases.
The book also makes liberal use of the "toxin gambit" - claiming that minute amounts of Scary-Sounding Chemicals are responsible for vaccine injuries (there is no viable evidence for such claims; for an excellent takedown of this ploy, search for the Science-Based Medicine article "Toxic Myths About Vaccines"). One such pseudo-toxin is blamed for fertility problems alleged to be caused by the vaccine. However, a recent large-scale study debunked the major claim in this area, refuting the idea that premature ovarian failure is linked to HPV vaccination.
Ironically, HPV infection itself may damage fertility, i.e. when cervical conization procedures or hysterectomy made necessary by high grade precancers or cancers compromise or eliminate potential for pregnancy. You won't find attention to this problem in the book.
Other commonplace antivax tactics that the book employs include references to low quality publications by poorly regarded researchers such as Sin Hang Lee and Yehuda Shoenfeld (whose mouse paper attempting to find fault with a vaccine adjuvant was retracted due to methodologic flaws). A much, much greater amount of quality research in support of immunization is either ignored or attacked as tainted by conflicts of interest. Actually citing good evidence to counter this huge body of positive research (much of it by independent researchers) is apparently too hard for the book's authors - much easier for them to dismiss it via innuendo.
Speaking of "conflicts of interest": one wonders why, if money rules in the Medical Mafia (as antivaxers like to regard the great majority of physicians), the American College of Obstetricians and Gynecologists promotes HPV vaccination. Consider that for a long time, routine Pap tests have been an income generator for gynecologists, assuring frequent patient visits for health assessments and other reasons. Routine HPV testing (also endorsed by ACOG) and HPV vaccination will greatly cut down on the need for Pap tests, reduce patient visits and deprive gynecologists of significant income. Yet the members of ACOG, because they care deeply about the health of their patients, strongly support HPV vaccination. As the ACOG website notes:
"It is crucial that obstetrician–gynecologists and other health care providers educate parents and patients on the benefits and safety of human papillomavirus (HPV) vaccination and offer HPV vaccines in their offices. A health care provider’s recommendation to vaccinate is a strong influence in parents’ decision making."
The drug companies that make Gardasil and Cervarix (another HPV vaccine) are potentially sacrificing $$$ that could be made supplying cancer drugs and other pharma products to the many people afflicted by HPV-associated diseases. That doesn't seem to occur to the authors of this book.
Meantime, on the horizon are new and improved HPV vaccines targeting even more virus subtypes (the current version of Gardasil targets 92% of the high-risk HPV strains), and vaccines to treat HPV-induced cancers. Antivaxers dread the idea of widespread use of anticancer vaccines, perhaps because they know it'll be a lot tougher to get the public to avoid an effective means of preventing or treating widespread deadly malignancies, as opposed to vaccine-preventable diseases like polio and measles which don't seem as important to modern parents who've never had to experience children made miserable or deathly ill by them.
Whether you choose to buy Holland's book or (like me) save money by reading a library copy, know that there are much better, fair-minded and accurate sources of information on the Internet. Particularly recommended are Science-Based Medicine, immunize.org, pkids.org, and the website on immunization sponsored by Children's Hospital of Philadelphia. For a book that answers virtually any question you might have on vaccines, using facts and good evidence while not taking sides on "the controversy", read Kristen Feemster's "Vaccines: What Everyone Needs To Know".
Update: claims that the HPV vaccine's effectiveness is unproven have taken a hit, with news that rates of precancerous lesions caused by HPV have declined dramatically, thanks to vaccination. A study published in the British Medical Journal reports major reductions in precancerous cervical lesions among young women who were vaccinated against HPV - up to an 88% drop in high grade cervical dysplasias caused by the virus.
And a new report from the CDC has demonstrated huge drops in HPV infection rates in the U.S. following vaccine introduction.
Even more data from Finland and Japan shows HPV vaccination is sharply reducing cervical neoplasia caused by HPV.
June 2019 update: a new comprehensive review confirms that 1) HPV vaccination has greatly lowered HPV infection rates and the incidence of serious precancerous lesions caused by the virus, and 2) decreased infection rates in unvaccinated people, thanks to greater herd immunity.
November 2019 update: Two more published studies demonstrate the safety of HPV vaccination, both in the journal Pediatrics. Excerpt from one of the studies:
''VAERS received 7244 reports after (Gardasil): 31.2% among females, 21.6% among males, and for 47.2%, sex was not reported. Overall, 97.4% of reports were nonserious. Dizziness, syncope, headache, and injection site reactions were most commonly reported...
CONCLUSIONS:
No new or unexpected safety concerns or reporting patterns of (Gardasil) with clinically important (adverse events) were detected. The safety profile of (Gardasil) is consistent with data from prelicensure trials and from postmarketing safety data of its predecessor, the quadrivalent human papillomavirus vaccine.''
- Safety of the 9-Valent Human Papillomavirus Vaccine.
Shimabukuro TT1, Su JR2, Marquez PL2, Mba-Jonas A3, Arana JE2, Cano MV2.
2020 update: Long-term followup of young Scandinavian women receiving the HPV vaccine (in a randomized, double-blind, placebo-controlled study) shows impressive effectiveness of the vaccine. Excerpt from a report in The Lancet: "No cases of HPV16/18-related high-grade cervical dysplasia were observed in the per-protocol effectiveness population (N = 2121; 24,099·0 person-years of follow-up) during the entire study. Vaccine effectiveness of 100% (95% CI 94·7–100) was demonstrated for ≥12 years, with a trend toward continued protection through 14 years post-vaccination... There was no evidence of waning immunity, suggesting no need for a booster dose during that period."
September 2020: One of the largest studies to date to look at whether autonomic dysfunction is associated with HPV vaccination (Hviid et al, British Medical Journal) found no association between vaccination and chronic fatigue syndrome (CFS), complex regional pain syndrome, or postural orthostatic tachycardia syndrome. In fact, CFS was a little over a third as common in HPV vaccine recipients compared to the unvaccinated, a considerably lower incidence.
Meanwhile, the FDA has expanded the indication of Gardasil-9 to include prevention of oropharyngeal and other head and neck cancers caused by HPV types 16, 18, 31, 33, 45, 52 and 58. The benefits of this vaccine extend far beyond preventing cervical cancer.
Results from around the world confirm that HPV vaccination is safe and effective.
