Intended for healthcare professionals

Rapid response to:

Letters HPV vaccine and eradication of cervical cancer

Cervical cancer: WHO called for elimination, not eradication

BMJ 2019; 366 doi: (Published 26 September 2019) Cite this as: BMJ 2019;366:l5668

Rapid Response:

Re: Cervical cancer: WHO called for elimination, not eradication

Cervical Cancer: Elimination BMJ 2019;366:L5668

There is certainly considerable confusion over the terms used for the goals of prevention. To ‘eradicate’, (or is it ‘eliminate’?) further confusion I propose the following, which may only apply to one country or continent at any one time:

Control: while prevention is in progress but as yet not fully successful. We are controlling cervical cancer, but have not yet reached containment.

Containment: Prevention measure reached when the disease is no longer considered to be a public health problem, however this is defined or agreed upon. Measles and whooping cough reached this stage until recently, and Hib meningitis has probably achieved this at present. There was a hiccup in this process with measles when it was found to be affecting young adults, but then became contained again with the introduction of a second dose of vaccine. Now, with the fall in vaccine uptake rates, it is back to the control stage.

Elimination: Overt/Clinical infection no longer exists but the organism is still present. Polio has reached this stage in the UK. as the organism may still be present say, in sewage. Diphtheria and tetanus are other examples, at least in the UK.

Eradication: The organism (or primary risk factor if you like) is no longer present in the world. Smallpox is an example of this, even if there are a few secure stocks in laboratories. Clostridium tetani will never be eradicated.

Cervical cancer is most unlikely to be eradicated or eliminated, but we can certainly achieve containment………………… I would however hesitate to predict when we will reach this stage.

Norman Noah

Competing interests: No competing interests

10 October 2019
Professor Emeritus Infectious Disease Epidemiology
London School of Hygiene and Tropical Medicine
Keppel St. london WC1E 7HT