The introduction of the Humanpapilloma Virus (HPV) vaccine into our school system has generated so much controversy that I feel compelled to present some facts which I hope will help parents and students as well as those in the general public understand some more about cervical cancer and HPV to assist them in making an informed choice as to whether or not to get the vaccine.

Cervical cancer is still a major problem worldwide, especially in developing countries such as Jamaica. Over 400,000 cases of this cancer are reported each year worldwide, 80 per cent from the developing world. In Jamaica, the rate of 17.4 per 100,000 is very high and is similar to rates reported in the UK and Finland in the 1970s. The reported mortality rate of 15.8 per 100,000 is also alarming and is similar to rates reported in some European countries in the 1950s. These rates represent data mainly for Kingston and St Andrew, where we have a cancer registry. The rest of Jamaica may, in fact, have higher rates.

The high rates in developing countries such as ours are due to our inability to screen the population properly with pap smears due to many reasons. The main reason is that we do not have enough doctors and laboratory staff to read and process pap smears, even when they are done. Secondly, we do not have a proper system to do smears on the most vulnerable women. Also important is the fact that there is a lack of enough specialists to treat women diagnosed with cancer.

HPV is extremely common with over 300 types identified to date. However, only about 30 are high-risk types that are associated with cancer. Two types, 16 and 18, are responsible for 70 per cent of cervical cancer. Types 45 and 33 also cause cancer, but are close relatives of 16 and 18. In Jamaica, type 45 has been found in about 10 per cent of cervical cancer.

In Jamaican research we sampled women who had no symptoms from a maternity hospital in Kingston and non-pregnant women from a rural clinic in Westmoreland. We found high-risk HPV in over 80 per cent of both groups of these women. This high rate of HPV has also been reported in American women under the age of 50 years. Most women who get HPV will get rid of it on their own; however, it is difficult to say who will rid themselves of it and who will not.

There is ample evidence that HPV causes cervical cancer. If we compare cigarette smoking and lung cancer the relative risk is only 10. With HPV and cervical cancer the relative risk is much higher at 500.

Because we have extremely high rates of cervical cancer, and because the screening processes do not work well in our country, about 10 years ago we were very happy when this new vaccine was introduced. This is the first vaccine designed to prevent a cancer. Vaccination has been around for many years and has resulted in the elimination of many common diseases such as poliomyelitis and small pox. There are many vaccines given to children in school resulting in healthy populations worldwide. Many diseases which were common in the 1950s are now rare, such as whooping cough, mumps, German measles, chicken pox, and measles.

The introduction of the HPV vaccine has shown great success in countries in which it has been introduced, reducing cancers of the cervix, as well as cancer of the vagina and the vulva in women, and cancer of throat, anus in men and women and penis in men. The vaccines also prevent precancerous lesions of all of these areas.

The vaccine has been introduced into many countries across the world over recent years, and even here in the Caribbean our neighbours in the Cayman Islands, Barbados and Trinidad and Tobago have been administering the vaccine for quite some time. The vaccine has been one of the most studied drugs ever and there have been no major side effects confirmed after careful study.

There are three types of vaccine available. One contains HPV 16 and HPV 18 only. This is the one being administered to school girls in Jamaica. (Recall, these two HPV types are responsible for 70 per cent of cervical cancer.) There is a second type containing HPV 16 and 18 as well as HPV 6 and 11. These additional HPV types are responsible for non-cancerous genital warts. The final type is very new and contains nine different HPV types, including HPV 45 and 33 and HPV 16 and 18. This new vaccine is available in Jamaica, but is not subsidised and costs much more that the other types.

The Ministry of Health has been able to get the vaccine through the Pan American Health Organization at a good price (US$5 per injection) that the country can afford to give the vaccine free of cost to schoolgirls. In the private system the vaccine costs about J$6,000 per injection, with two to three injections being the usual dose over six months. The new injection with nine types of HPV costs about J$15,000 per injection with the same 2—3 injections required. In private practice in Jamaica many women have had the vaccine over the last 10 years, including many schoolgirls without any incident, and this is also what has been reported across the world. It should be said that any woman can buy the vaccine and take it in private practice; however, it is most effective before any sexual contact, which is why it is being given to school girls age 9—12.

The vaccines do not contain the harmful DNA that causes cancer, only the shell of the individual HPV types. It is also important to recognise that, unlike many other viruses which invade our entire system and sets off our own immune response, HPV that is acquired naturally during sexual intercourse is confined to the most superficial layer of the skin and does not set off our immune system as occurs with the vaccine which goes into our system.

From the introduction of these vaccines it was recognised that there would be sceptics. The anti-vaccine lobby is very strong and has produced much propaganda to suit their own case. However, after 11 years of study no serious side effects due to the vaccine have been confirmed. This has also been the case with other vaccines, and one notable outbreak of polio occurred in rural Nigeria when religious leaders convinced parents that the vaccine was dangerous and was designed to reduce fertility in black people.

We in Jamaica are 40 years late in decreasing cancer of the cervix, 60 years late in decreasing cancer of the cervix deaths, and now 10 years late in introducing this valuable vaccine. Please support the programme and stop the useless misinformation.