
Australia could become first country to eradicate cervical cancer - DanBC
https://www.theguardian.com/society/2018/mar/04/australia-could-become-first-country-to-eradicate-cervical-cancer
======
RcouF1uZ4gsC
I think this shows that a technical solution trumps social solutions. If
Australia had relied on telling children not to have unprotected sex, the HPV
rate would not have moved much. Now, a simple vaccine is eradicating cervical
HPV.

Malthus made a big deal how people should have fewer children and the
population still grew. With the invention of safe, effective, convenient birth
control, world population levels are stabilizing, and even starting to shrink
in developed countries.

We need more "fire and forget" solutions. If we want to save our environment
and slow down global warming, we need solutions that at most require people to
do something relatively painless 1 time. Anything that relies of persuading
humans to change their long term behavior is doomed to failure.

~~~
pbhjpbhj
Or in other words solutions that are applied have a possibility of working.
The solution of no genital contact with others isn't inferior, it wasn't
applied.

I find it interesting that, AFAIA HPV is a sexually transmitted disease but
that, certainly in the UK, healthcare professionals seemingly lie (by omission
at least) in order to further vaccination.

Also, that insistence on screening seems likely to have been a major cause of
widespread infection (eg [https://obpmedical.com/resource-center/blog/non-
sexual-trans...](https://obpmedical.com/resource-center/blog/non-sexual-
transmission-of-hpv-101-what-you-need-to-know/)), though I've never heard of
this from a major news outlet?

It amazes me that until 2016 it seems no-one bother to check that sterilised
reusable gynaecological instruments were actually sterile, mind-blowing.

~~~
madeofpalk
> but that, certainly in the UK, healthcare professionals seemingly lie (by
> omission at least) in order to further vaccination.

I mean, you can't just leave a claim like that dangling. A source would be
ideal, but at least explain the claim of what the lie is would be nice.

------
jacobkg
This is amazing!

"As a result, the HPV rate among women aged 18 to 24 dropped from 22.7% to
1.1% between 2005 and 2015."

~~~
masonic
Not amazing at all to me, considering that they are completely different
populations.

The youngest subject at the start of that window dropped out of that
population 7 years ago (3 years before the last survey). The figure doesn't
count _cures_ , or even reduced transmissions, among the original subjects.

That said, I find the quoted statistic suspect. First of all, the _first_
vaccine wasn't even _licensed_ until 2006, and there wasn't a vaccine that
addressed more than 4 of the cancer-causing subtypes until _2014_ [0]. Second,
they only targeted girls of age 12-13 (although they provided free
vaccinations on manual request through age 19), leaving out girls in the upper
70% of the age range altogether from the survey population.

So, I don't take those numbers at face value, although I don't debate the
safety or efficacy of these particular vaccines, being genetics-based. It's
the profiteering by the planned-obsolescence model of the manufacturers that
bothers me. If you're a parent and you followed the public-health experts'
recommendations, and you wanted the full (nonavalent vaccine) functionality,
you would have given a three-injection treatment of the bivalent spanning 6
months, then (later) a three-injection treatment of the quarivalent spanning 6
more months, then another cycle of the nonavalent vaccine... giving the
manufacturers a lot of money out of your public health budget and a proof-of-
concept for the drug companies to do this in lots of other vaccines and drugs
in the future.

[0]
[http://apps.who.int/iris/bitstream/10665/255353/1/WER9219.pd...](http://apps.who.int/iris/bitstream/10665/255353/1/WER9219.pdf?ua=1)

Human papillomavirus vaccines: WHO position paper, May 2017

~~~
thedailymail
I don't think this represents a planned obsolescence scheme, just stages of
progress in the development, testing and approval of successively better
vaccines.

~~~
masonic
Check the dates again. The quadrivalent (4 strain) vaccine was licensed
_before_ the bivalent (2-strain Cervarix) vaccine, and Cervarix is inferior in
other respects. Yet medical systems paid $50-2000 a dose for hundreds of
millions of doses, _knowing_ that it was obsolete.

~~~
thedailymail
Sorry, you're absolutely right on the dates! But how would planned
obsolescence work if the inferior product is made by a competitor? It sounds
more like a me-too drug scenario. Was Cervarix competing with Gardasil on
price, with a tradeoff of less protection for lower cost?

------
caio1982
Just a sidenote from the other side of the world: Brazil has been offering
free HPV vaccines for girls under 15 for a while and since last year to all
boys at 12; they plane to have it available to both sexes between 9 and 15 in
the next couple of years. It is estimated that nearly half of young people
(16-25 years of age) have some form of the HPV in the country. I don't have
any results numbers to share or source from now, however, my apologies. Let's
hope Australia is not the only country to do that though!

~~~
ShorsHammer
Australian parents lose their childs tax benefits if they refuse vaccination,
it's an enormous incentive (thousands per year) for the average wage earner.

The article seems to not mention this.

Sadly it still doesn't stop entire communities of well-off antivaxxers
forming, these particular areas are now ravaged by whooping cough outbreaks, a
disease that was almost eliminated ten years ago.

~~~
thedailymail
Australia does have a variety of no-jab, no-pay programs to promote pediatric
vaccines, but I believe HPV vaccine (which is given later) is not included in
them

~~~
ShorsHammer
May have not been the case before, some angry politicians have managed to
tighten up tax and conscientious objection laws in the last few years.

So HPV vaccine is now on the national immunisation program which your child
must be up to date with to claim family tax benefits.

[https://www.humanservices.gov.au/individuals/enablers/immuni...](https://www.humanservices.gov.au/individuals/enablers/immunisation-
requirements)

------
Gatsky
When HPV vaccination in Australia was first being considered, there was a bit
of debate - of course it works best if given prior to any sexual activity,
which meant telling parents of young girls you were vaccinating their child
against a sexually transmitted disease (eg see [1] for typical concerns).

The policy makers were undeterred, and strong advocacy from doctors and
scientists pushed things forward. The vaccine was partially developed in
Australia which also helped.

[1] [https://www.theguardian.com/science/blog/2016/jan/11/why-
is-...](https://www.theguardian.com/science/blog/2016/jan/11/why-is-there-
opposition-hpv-vaccine-cervical-cancer)

~~~
rabboRubble
>... works best if given prior to any sexual activity,...

Not entirely correct. The HPV vaccine works best in the young for the best
immune response. If I were a 40 year old virgin and wanted the shot, the
vaccine probably wouldn't be effect as my immune system would not respond.

Yes the shot should be administered before sexual activity, and it just
happens the best immune response happens in these youngish teenage years, far
earlier than a lot of parents are comfortable.

~~~
Gatsky
By 'works best' I'm talking about preventing HPV infection, so giving it
before one encounters HPV is pretty important.

~~~
andyjohnson0
I agree. But it is worth noting that there are multiple types of HPV and an
initial infection may be with one not targeted by the vaccine. So receiving
the vaccine after that may still provide protection against subsequent
infections.

------
tedsanders
I'm confused.

Maybe a dozen strains of HPV cause cancer.[1] Only two are covered by Gardisil
(~70% of cancers), and seven are covered by Gardisil 9 (~90% of cancers).[2]

Therefore, with a vaccine that only vaccinates against ~90% of HPV cancers,
how can we hope to eradicate cervical cancer?

Additional reading:

[1]
[https://en.wikipedia.org/wiki/Human_papillomavirus_infection...](https://en.wikipedia.org/wiki/Human_papillomavirus_infection#Cancer)

[2] [https://arstechnica.com/science/2015/02/new-hpv-vaccine-
is-e...](https://arstechnica.com/science/2015/02/new-hpv-vaccine-is-effective-
against-9-strains-of-the-virus/)

[3] [https://www.cancer.gov/about-cancer/causes-
prevention/risk/i...](https://www.cancer.gov/about-cancer/causes-
prevention/risk/infectious-agents/hpv-fact-sheet)

~~~
nostrademons
From your second article:

> There is some evidence that the bivalent and quadrivalent vaccines already
> provide some protection against additional strains of HPV. A recent paper in
> Clinical and Vaccine Immunology reporting on the clinical trial for Cervarix
> reported that the vaccine is more than 96 percent effective against disease
> associated with strains 16 and 18, and more than 50 percent effective
> against diseases associated with any HPV strain.

There are network effects in disease transmission. In order to catch a
disease, not only do you have to be susceptible, but you have to catch it
_from_ someone. If you cut the risk of contracting HPV by 90%, then not only
has the chance of a vaccinated person contracting the disease gone down by
90%, but _the chance that an unvaccinated person will come in contact with a
carrier_ goes down by 90%. Eliminate all the most prevalent strains and
provide some protection against the remainder, and you can cut the virus's
ability to replicate itself below the threshold needed to sustain itself in
the population. Same reason that anti-vaxxers can get away without vaccinating
their kids for measles as long as they don't come in contact with too many
other unvaccinated people.

~~~
tedsanders
I assumed the tetravalent vaccine only worked against the four named strains.
If it's semi-effective against all strains, then I see how eradication is
possible. Thank you for the clarification.

Edit: Wait, the article does not say the vaccine is semi-effective against all
strains. It says the vaccine is semi-effective against cervical cancer caused
by all strains. My confusion is not removed.

~~~
nostrademons
I would assume that the vaccine couldn't be semi-effective against cervical
cancer caused by all strains without it being effective against all strains,
since your first link says 95%+ of cervical cancer is caused by HPV and
there's no known mechanism for the vaccine to act directly against cervical
cancer without first acting against the HPV virus.

~~~
tedsanders
I apologize for the ambiguity of my prior comment. To illustrate what I'm
thinking: Suppose cervical cancer is caused by two strains, 1 and 2, which are
equally present in the population. A vaccine works 100% against strain 1 and
0% against strain 2. That vaccine is 50% effective against all strains causing
cancer, despite having 0 power to eradicate strain 2.

Therefore, it's not clear to me that being 'semi-effective against all
strains' implies 'semi-effective against each strain.'

I am now looking for sources that say Gardasil is semi-effective against each
strain of HPV.

Edit: Reading this source[1] I see that Gardasil protects against strains
31/33/45/51 (grouped) with 33%-51% effectiveness. Still can't find conclusive
evidence that Gardasil protects against each strain.

[1]
[http://cvi.asm.org/content/early/2015/01/29/CVI.00591-14.ful...](http://cvi.asm.org/content/early/2015/01/29/CVI.00591-14.full.pdf+html)

~~~
nostrademons
I would assume that the context ("already provide some protection against
additional strains of HPV") implies that it provides additional protection
against additional, individual strains, but will grant that the wording
doesn't conclusively say that and alternate interpretations are possible.

~~~
tedsanders
Agreed. From the evidence I was able to find, certainly Gardasil seems to
prevent at least some closely related strains. I am wondering if it prevents
all cancer-causing strains though, which would be needed for eradication.
Probably, given the title of the article, but I wish I could find a primary or
secondary source.

------
otakucode
Sure they might eradicate cerival cancer - but at what cost? Parents having to
deal with the fact that their kids just might not be reduced to terrified
neurotic messes when it comes to their own sexuality! Certainly that might be
OK in some nations, but not in the USA. Our neurosis, especially when it comes
to this, is far more important than any reduction in suffering or saved lives
such vaccines might promise.

(This comment has been sarcasm, but bears the unsaid words believed by the
groups in the US who oppose these vaccines because they are terrified
adolescents might have healthy active sex lives.)

------
jimjimjim
This is fantastic.

I have a friend that recently had a cervical cancer scare (reasonably small op
to remove some worrying cells). When someone you know gets something like this
you tend to gather a lot of info about it. And in this case it is remarkable
how closely linked it is to a single cause (hpv)

------
muriithi
Good progress, while in Kenya a national roll-out was postponed because of
high global demand for the vaccine.

[https://www.nation.co.ke/news/Demand-for-cervical-cancer-
vac...](https://www.nation.co.ke/news/Demand-for-cervical-cancer-vaccine-
grows/1056-4309132-jyirbfz/index.html)

------
coldnose
That's a pretty clickbaity title. It's really an article about increasing HPV
vaccination and plummeting cervical cancer rates. But I'm skeptical that you
can ever "eradicate" cancer as a form of disease, even a particular type of
cancer.

~~~
jacobkg
I believe they are discussing eradication of the HPV virus, which the article
states causes 99.9% of cervical cancer.

We do have proof of humanity once before successfully eradicating a virus,
namely smallpox:
[https://en.wikipedia.org/wiki/Smallpox#Eradication](https://en.wikipedia.org/wiki/Smallpox#Eradication)

~~~
pbhjpbhj
An interesting titbit:

>In 2017, Canadian scientists recreated an extinct horse pox virus to
demonstrate that the smallpox virus can be recreated in a small lab at a cost
of about $100,000, by a team of scientists without specialist knowledge. This
makes the retention controversy moot since the virus can be easily recreated
even if all samples are destroyed. //

