Lord Tony Hall
10th November 2017
Dear Lord Hall
We would like to complain strongly about the factually incorrect information given on the Victoria Derbyshire programme today in the segment about the HPV vaccination and the future screening changes.
Particular comments made by the presenter and her guest from Public Health England and Cancer Research UK were:
•  “HPV causes 99% of cervical cancers
•  “HPV is a virus that is linked to all cases of cervical cancer.”
•  Why is it important to have the HPV vaccine: “to stop them getting cervical cancer.”
•  “for women who have not been vaccinated it is incredibly important that they go and get their screening tests” – implying that those who have been vaccinated don’t?
•  How long does the vaccine last: “evidence is very strong that it lasts a long time but we continue to gather the data to see whether people remain protected.”
•  Could we get to a stage when we really do minimise cases of serious cervical cancer: “Yes, we have seen huge drops already.” And “We will stop more than 80% of cases of cervical cancer.”
Did anyone check the facts before this segment was broadcast?

HPV and Cervical Cancer
There are cases of cervical cancer that would not be detected by HPV testing:
In conclusion, rare adenocarcinoma of the uterine cervix may represent an entity unrelated to HPV, thus explaining instances of rapid onset cervical cancer.”

Necessity for Cervical Screening
The HPV vaccination will not stop women from getting cervical cancer because it only covers two strains out of more than 12 high-risk strains that are linked with cervical cancer – in fact the Patient Information Leaflet from the manufacturers stresses that patients must attend for cervical screening for this very reason.
The segment did not inform viewers that the HPV virus by itself does not cause cervical cancer – most people will have an HPV infection and it is cleared from the body naturally with no intervention. There are risk factors that make development of cervical cancer more likely (smoking, high number of sexual partners, long-term use of the contraceptive pill, other STD infections, poor nutrition etc.) but these were not mentioned.

Length of protection of HPV vaccination
Public Health England are currently carrying out a registered clinical trial to look at the HPV 16 and 18 antibody titres of women who had the HPV vaccination early in the programme, to see if the vaccination is still effective.
The BBC has today actively promoted a vaccination for which the efficacy is not yet known.
Dr Diane Harper has recently published a 10-year review of the HPV vaccines:
And raises these points:
  • Gardasil9 shouldn’t be used as a booster for women vaccinated with Gardasil or Cervarix (so evidence of efficacy will not be available until approx 2039/2049 for girls vaccinated at 13 with Gardasil9, in say, 2019, and these girls wouldn’t be called for screening until 2031)
  • Duration of antibody response is critical for clinical prevention of HPV infection. Cervarix has high anti-HPV16 and HPV18 antibody titers for at least 9.4 years [15]in longitudinal follow-up studies; Gardasil has plateaued anti-HPV16 titers well above natural infection titers for at least 9 years, but anti-HPV18 titers that are not different from natural infection titers as early as 24 months after vaccination [16].”
  • Nearly 20% of Gardasil9 recipients had a loss of detectable anti-HPV18 titers after 24 months. In Gardasil recipients, after 1.5 years over 10% of women had no detectable anti-HPV18 titers, after 3 years over 20% of women lost detectable titers, and after 5 years nearly 35% of women lost detectable titers [18]
  • Pertinent to the reduction in cervical cancer incidence is quality of the screening programs available in the high income and upper middle income countries. Without continued participation in these screening programs, the incidence of cervical cancer will increase [62].”
  • The immunogenicity data for HPV 18/45 induced by Gardasil and Gardasil9 indicates that long term surveillance for HPV 18/45 disease breakthrough must be in place.”
  • Vaccination does not replace screening. Prevention of cervical cancer must still rely on participation in ongoing screening programs. As we move into the next decade, the surveillance of the results of vaccine and screening programs will remain necessary.”

Rates of Cervical Cancer
Cervical Cancer Rates

Figures from the Office for National Statistics show that cervical cancer increased in the 20-24 year old group and in 2014 it is at its highest point since 1999, when approximately half of this group, at that time, had received the HPV vaccination (government estimates that 49% of the catch up cohort received the HPV vaccination)
Looking at the 15 – 19 year old age group and comparing the years prior to and after use of the HPV vaccination, there are more cases of invasive cervical cancer after the widespread use of the vaccine rather than before.
From 2004 – 2009, there were 9 cases of invasive cervical cancer in the 15-19 year old age group
From 2010 – 2015, there were 14 cases of invasive cervical cancer, in the 15-19 year old age group, which is populated by the vaccinated routine cohort of girls – at least 80% of this age group will have received the vaccination
Although the numbers are small, what explanation is there for this obvious increase in the number of invasive cervical cancer cases in the vaccinated cohort of girls? And why do these statistics present a very different picture to that given by your programme guests this morning?

Risks / Benefits / Equality of Risk
The segment on the Victoria Derbyshire show did not mention risk factors for cervical cancer at all.
The Institute for Advanced Study at the University of Princeton published this study recently, which gives a good account of the risk and potential benefit of the HPV vaccines.
Risk is much higher for poor girls and women. For example, a study in England found that  80 percent of cervical cancer incidence occurred in the bottom two-fifths of the population, while none occurred in the top fifth and 7 percent in the second fifth (Shack et al. 2008). This stark inequality echoes the global picture and calls for a biosocial approach to researching and testing medicines (Bruni et al. 2016). The chances of higher-risk serotypes leading to cancer seem to depend on several cofactors, such as impaired immune responses, which vary inversely with income, lifestyle risks, sexual activity, and frequency of reinfection (Cancer Treatment Centers of America 2017). Thus, framing HPV vaccination as a simple solution deflects attention away from these inequalities of risk between affluent women who have good immune responses, access to routine screening and good care, and poorer women who do not.”
“We will not know for years how effectively HPV vaccines actually prevent cervical and related cancers or how the population of viral serotypes adapts.”

Possible side-effects
Most importantly for us, as our daughters are among the 3,000+ who have reported suspected serious adverse reactions to the HPV vaccination, there was no mention at all about possible side effects. Our daughters and many others are suffering from serious long-term disabling symptoms that no-one wants to investigate. Taken in the context of other emerging health scandals (including vaginal mesh tape, sodium valproate etc.) where patients raised the issue of serious side-effects long before they were even discussed by the Government, we would urge caution and that full information is given to parents and patients – there are serious side-effects listed on the Patient Information Leaflet.

Finally …
Public Health England have highlighted concern about the falling take up of cervical screening and the BBC, with its coverage of this simulated study, will have increased the false sense of security felt by some women who have been vaccinated and mistakenly believe that they are fully protected against cervical cancer. Screening is a proven tool to protect against cervical cancer deaths, HPV vaccination has not yet been proven to prevent any deaths from cervical cancer – the impact on cervical cancer deaths has been estimated. The BBC has been irresponsible in its coverage of this study.
The BBC is a public service broadcaster paid for by our taxes and licence fees. The BBC should not be used as a vehicle to promote medical interventions in the way that was done this morning – the Victoria Derbyshire segment was like a promotional video for the pharmaceutical manufacturer.

On behalf parents and families of
Time for Action – UK Families Affected by HPV Vaccination