Intended for healthcare professionals

Practice 10 Minute Consultation

Discussing human papilloma virus vaccination

BMJ 2017; 357 doi: (Published 22 June 2017) Cite this as: BMJ 2017;357:j2730

Re: Discussing human papilloma virus vaccination

In his response, acknowledging comments about the above article which he co -authored, Yang Ling Quah states “ there is no proven linkage between HPV vaccination and mortality following the vaccination. “ Nor, for that matter, is there any linkage nor proof that the vaccine reduces the incidence of cancer, as the article confirmed.

The billions of dollars in income for Merck and GSK, and for doctors outside the UK NHS, who administer the HPV vaccine, are dependant on the media hype which often suggests that the HPV vaccine prevents cancer. (1)
Peter English, a Public Health Physician suggested in an earlier response that young people might best be greeted with the words “ You’ve come for your HPV vaccine to prevent cancer ? ”.
Is this Public Health England policy ?

The article by Quah and Aggrawal has a confident, optimistic tone which does not reflect the extent of post vaccination morbidity, and deaths, that have been reported, and referenced in part, in my earlier response, and also summarised, country by country, by Handley. (2)

An editorial in the current BMJ “ Judging the benefits and harms of medicines” suggests that “optimism bias” is one of the most relevant factors in formulating such judgements.
” Poor science, research misconduct, and publication bias all contribute to the systematic exaggeration of benefit and understatement of harm.” (3)
I noted in my earlier response that Jefferson has pointed out the difficulty in putting the doubts about HPV vaccine safety into professional and public debate. (4)
One experienced US paediatrician who began to use the HPV vaccine in 2009 has written “ In my practice we saw a child lose consciousness within minutes of vaccination, which left me and my staff deeply concerned. I started doing extensive research to better understand the risks and benefits of this vaccine. “
As a result of his research, he concluded, “ Is this vaccine safe ? Clearly it is not.
Do the benefits outweigh the risks ? Weighing the the risk of death or of a severe vaccine reaction, including the possibility of a lifetime of pain, thyroid malfunction or autoimmune disease against theoretical prevention of a slow growing highly treatable cancer, I would have to say no. Japan has got it right . “ (5)
Japan stopped using the HPV vaccine five years ago, because of safety concerns.

Medical journals enjoy a significant income from reprints ordered by pharmaceutical companies.
Is it likely that Merck and GSK, makers of Gardasil and Cervarix, will purchase and distribute reprints of Quah and Aggarwal’s article, to further increase the marketing success of their HPV vaccines, with the added recommendation that the BMJ imprint ensures ?
GSK Biologicals, Singapore, manufacturer of Cervarix HPV vaccine, is listed as the first Research Collaborator of Singhealth Polyclinics, Singapore, on the Singhealth website.
Singhealth is given as Quah’s address, and as Aggarwal’s email address, in the BMJ.
The authors declared that they had no competing interests.
Quah explains that the European Medicines Agency continues to survey the safety of HPV vaccines. When the EMA recently protested about a BMJ report on the finding of particles in vaccines, the EMA responder declared that she had no competing interests. (6) The EMA website states that 89% of EMA funding comes from fees and charges for regulatory services, presumably from Pharma.

These observations may be dismissed as inconsequential, not necessarily raising any conflict of interest issues.
Nevertheless they perhaps illustrate why your editorial wrote of “ the systematic exaggeration of benefit and understatement of harm “, which interfere with our attempts to judge between benefits and harm.
These are phenomena that often remain in the shadows when important decisions are made about patient safety, and profits.

2 HPV (Gardasil ) injury scandals worldwide, Why is US media silent. Parents beware.
3 BMJ 2017;357:j3129
5 Paul Thomas and Jennifer Margulis, The Vaccine Friendly Plan, Ballantine 2016,

Competing interests: No competing interests

10 July 2017
Noel Thomas
retd/ part time GP
BronyGarn, Maesteg, Wales CF34 9AL