IAN KIRKWOOD: Cure has odd reaction

IN 2006, a Scottish-born Australian immunologist, Ian Frazer, was named Queenslander of the Year and Australian of the Year for his pioneering work in developing and patenting a world-first vaccine against cervical cancer.

They were the first of a string of awards and citations that would come his way, and the medicines that arose from his work, sold as Gardasil and Cervarix, are sold around the world. Gardasil was added to Australia’s national immunisation program in 2007, and every year thousands of school children are given the vaccine, free, with similar schemes under way in various other nations. 

To its supporters, the Gardasil program epitomises preventative medicine at its best.

But the scheme had its critics from the start, and the mass immunisation program led to a spate of media coverage about adverse reactions after the injections.

Back then, I was a touch surprised about the way the vaccine was being promoted, because while ‘‘vaccine against cancer’’ is an accurate enough description, it is more correctly a vaccine against four strains of human papillomavirus (HPV) – a sexually transmitted disease known commonly as genital warts.

Although it might be stretching the argument a bit, the same logic says that if Gardasil is a vaccine against cancer, then similar claims could be made for nicotine chewing gum or any other tobacco alternative, because the causal link between smoking and lung cancer is as concrete – and far more widely documented – than the link between HPV and cervical cancer.

(Although I should clarify that by saying I am not questioning the link between HPV and cancer – although some people still do. It’s just that Gardasil acts against something that causes another thing, not that other thing itself. I trust that’s clear. Back to the story.)

The NSW Cancer Council says the four HPVs that the vaccine prevents are responsible for 80per cent of cervical cancers in Australia, and 70per cent worldwide.

As to the overall rate of HPV infection in the adult population, estimates vary, but the US National Cancer Institute said in 2007 that almost 27per cent of American women aged 14 or over tested positive for one or more strains of HPV.

 ‘‘Among all participating women, the prevalence of high-risk types of HPV was 15.2per cent,’’ the institute said.

‘‘The prevalence of HPV types 6, 11, 16, and 18 – the types targeted by the HPV vaccine Gardasil – was 3.4 per cent ... ’’

With government figures showing cervical cancer at fewer than seven cases per 100,000 women, most women who contract HPV do not go on to develop cancer, and the medical literature confirms this, saying the causal links are still being explored and that other factors including genetics and lifestyle choices, such as smoking, are involved.

With unsubsidised doses of Gardasil selling at more than $350 for a course of three, publicly funded vaccination programs have been a money-spinner for those involved. Allegedly adverse reactions to the injections created publicity from the start, and a recent Japanese government warning to doctors said ‘‘the possibility of neurological or immunological diseases associated with the vaccination cannot be ruled out’’.

Most EU nations have mass immunisation programs under way, but a handful of politicians, including Greens European Parliament member Michèle Rivasi, have questioned the efficacy or usefulness of the vaccine, claiming that at least 18 of the 100 or so HPVs known to medicine are linked to cervical cancer, and that Gardasil only works against four.

In April, a French physician, Bernard Dalbergue, described Gardasil as ‘‘worse than useless’’ and predicted it would become ‘‘the greatest medical scandal of all time’’.

Dalbergue was described as having worked for Gardasil’s maker, Merck, but one sceptical investigator says he had lost his job in a corporate takeover and was driven by revenge to lash out at a product that has been shown to be safe and will save thousands of lives around the world.

Given the small but persistent and vocal anti-immunisation lobby, it’s perhaps surprising that more concerns have not been raised against a program that a generation ago would have had the churches up in arms.

And Professor Frazer hasn’t given up. He’s now working on a vaccine for herpes.

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