Allow the community of physicians to lead!
Medicine is a complex undertaking. Practicing it requires experienced, well-trained clinicians to work with patients and their families so that the risks and benefits of any treatment are balanced against the particular circumstances of an individual. My recommendation is that government and society, first, let the physicians take the lead, and, second, reduce the role of public agencies and their proscriptive policies in determining how HPV vaccination should be used during its first few years of clinical availability.
Here’s an example of what I’m calling for. The Advisory Committee on Immunization Practices (ACIP) recommends the HPV vaccine for girls at 11 and 12 years.2 Given the heterogeneity of sexual mores in the United States, this recommendation is likely to alarm, and even anger, some citizens.
But there is an alternative open to the ACIP: It can recommend strongly that clinicians, patients, and parents thoroughly discuss the pros and cons of vaccination and, in concert, weigh giving the vaccination at an age that is appropriate for the individual girl or woman, given her circumstances. ACIP should also strongly communicate, as an important public health message, that the vaccine is most effective when a girl or woman is immunized before she is exposed to HPV.
It was likely a strategic error for HPV vaccine advocates to attempt to make it a prerequisite for 11- and 12-year-old girls to be admitted to public high school. Of course, government mandates that touch on personal and private matters often trigger resistance from citizens who oppose what they perceive as intrusive.
Again, I urge: Let physicians take the lead to help their patients determine the best approach to how the HPV vaccine is used, based on each woman’s personal circumstances.
Any preventive strategy must be broad
The HPV vaccine will continue to be a key means of preventing cervical cancer. But this is a complex disease phenomenon; it’s certain that a multimodal approach to prevention will be required to tame it. Individual and societal actions that are likely to reduce the risk of cervical cancer include:
- interventions to reduce poverty and improve education
- delaying sexual debut until maturity
- routinely using a barrier to help prevent transmission of sexually transmitted infection
- limiting the number of one’s sexual partners
- large-scale vaccination programs.
It helps us greatly in this effort that we already have a vaccine that works and is safe.