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Worldwide, the sexually-acquired human papillomavirus (HPV) is found in 85% of cervical cancer cases, and it is generally accepted that persistent HPV infection of the uterine cervix is necessary but not sufficient for the development of cervical cancer. Most people at some time in our lives acquire genital infections with HPV. In almost all cases, HPV infection is of no clinical significance, but genital cancers such as cervical and penile cancer can be uncommon consequences of this extremely common sexually-acquired infection. Decades may elapse after initial infection with HPV and before the clinical manifestations of cancer. During this lengthy time interval, specific cellular changes occur within the cervix that are sometimes referred to as "precancerous" cervical lesions or "high-grade cervical abnormalities." Papanicolaou screening ("Pap screening") prevents cervical cancer by detecting and removing these "precancerous" cervical lesions before they become cancer. According to the widely-respected U.S. Preventive Services Task Force (USPSTF), Pap screening reduces cervical cancer rates by 60%-90% within three years of its introduction. According to the USPSTF, these reductions in suffering and mortality are "consistent and equally dramatic across populations." It is correspondingly unlikely that more recent technological innovations, such as HPV tests and HPV vaccines, will substantially improve on the performance of Pap screening for cervical cancer prevention.
It may nonetheless be desirable for females who can afford both HPV vaccination earlier in life (before the onset of sexual activity) and Pap screening later in life to access both of these preventive interventions. However, because all females who receive HPV vaccines must continue to be screened, and because it is uncertain whether HPV vaccines will provide any additional protection against cervical cancer for females who are also screened, the eventual added benefit of HPV vaccines for cervical cancer prevention is uncertain.
In developing countries such as Vietnam, providing access to HPV vaccination for some females may reduce access to Pap screening for others. From the population perspective of public health, this compromise is not appropriate.
In May 2007, the New England Journal of Medicine published a series of articles that cast doubts about the effectiveness of HPV vaccination. The accompanying editorial published in the New England Journal warned that "a cautious approach may be warranted in light of important unanswered questions about overall vaccine effectiveness, duration of protection, and adverse effects that may emerge over time."
In August 2008, an editorial published in the New England Journal of Medicine warned that "we still lack sufficient evidence of an effective vaccine against cervical cancer.... the bad news is that the overall effect of the vaccines on cervical cancer remains unknown.... the real impact of HPV vaccination on cervical cancer will not be observable for decades...we will not know for many years whether [HPV vaccination] will work or — in the worst case — do harm."
In June 2009 the British medical journal Lancet published an editorial warning that "HPV vaccination programmes risk being costly failed public health experiments in cancer control."
In February 2010, in the British medical journal Lancet, the Viet/American Cervical Cancer Prevention Project published our position regarding HPV vaccines:
"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."
Our position regarding HPV vaccines is entirely consistent with our mission to improve health outcomes as rapidly as possible among as many women as possible.
However, because few global health organizations share our mission, few global health organizations share our position regarding HPV vaccines. For example, the Global Alliance for Vaccines and Immunization (GAVI) has declared that "For women in developing countries, HPV vaccination is the only option" for cervical cancer prevention. Although this declaration is scientifically absurd, it is entirely consistent with GAVI's mission of promoting vaccination in developing countries.
As we have documented in peer-reviewed medical journals, the Bill & Melinda Gates Foundation promotes HPV vaccination, but not Pap screening, in developing countries such as Vietnam. As we have carefully explained in peer-reviewed medical journals, the position of the Gates Foundation regarding HPV vaccines is prone to decelerate, rather than accelerate, global reductions in mortality.
In April 2010, the government of India suspended HPV vaccination demonstration projects funded by the Bill & Melinda Gates Foundation. This suspension occurred in response to objections from more than 70 civil society groups, public health organizations, women's groups, and other organizations. These Indian citizens were concerned about the lack of information provided to the Indian public about HPV vaccines. Each year, more cases of cervical cancer occur in India than in any other country on Earth.
In June 2011, the British medical journal Lancet reported that, in a study of 2.9 million females in Australia, HPV vaccines appeared to cause diseases they are advertised to prevent. In this report, the Australian scientists claimed that "we have shown a decrease in high-grade cervical abnormalities in young women after the implementation of the HPV vaccination programme." Among Australian females under age 18, this claim is true. However, among Australian females over age 21, the same Australian study reported an increase in high-grade cervical abnormalities after the implementation of the Australian HPV vaccination program. In other words, among Australian females over age 21, HPV vaccination appeared to cause diseases it is advertised to prevent.
It appears that many disturbing, legitimate scientific concerns regarding HPV vaccines have not been widely shared with the American public.
The United States government makes the market and regulates the market for HPV vaccines. Because HPV vaccines are the #1 source of external revenue for the U.S. National Institutes of Health (NIH), during an era when government budget deficits darken the future of taxpayer funding for the NIH, enormous potential conflicts of interest exist between the U.S. government and HPV vaccine manufacturers. Astonishingly, details of the financial partnership between the U.S. government and HPV vaccine manufacturers (Merck and GlaxoSmithKline) are top-secret and are protected from disclosure under the Freedom of Information Act.
We question whether it is in the best interests of the American people for giant pharmaceutical companies, which continue to pay billions of dollars in fines for criminally corrupt behavior, to make never-ending, top-secret financial payments to the U.S. government from the sales of HPV vaccines.
This question will not be answered until enough people choose to ask it.
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HPV Vaccines 
