“How many more uteri do we have to dig up?” asked a young Obstetrics and Gynaecology Doctor.
Dig up here means hysterectomy, or the surgical removal of the uterus.
The answer is “100 000”.
Above is an excerpt from the book “A hundred thousand wombs” (10万個の子宮 in Japanese) by 2017 John Maddox prize winner, Dr. Riko Muranaka [1].
Cervical cancer is the fourth most common cancer in women, and a major public health problem both in developing and developed countries. In 2018, 570 000 women were newly diagnosed with cervical cancer and more than 310 000 lost their lives to this disease [2].
In the near future, however, women might no longer have to suffer from this terrible cancer, owing to the development of a remarkable vaccine. The Human Papillomavirus (HPV) vaccine was first introduced in 2006, and after 14 years with millions of doses administered globally, it has been shown to be extremely safe and effective against cervical cancer. In Australia, where HPV vaccination and cervical screening program have been the most successful, new cases of cervical cancer are simulated to be below an elimination threshold of fewer than four new cases per 100 000 women in 2028 [3]. Globally, WHO released a document in November 2020 on “cervical cancer elimination,” calling for an action to make cervical cancer a disease of the past [4].
Japan, a developed country with many advances in healthcare, is supposed to lead the way. However, contrary to expectations, the situation there is not promising. Only two months after the introduction of HPV vaccine into the National Immunisation Program (NIP) in April 2013, several reports of adverse events following vaccination caused the government to suspend the active recommendation for HPV vaccine, despite no evident linkage between the vaccine and the reported adverse events. [5]
Soon after that, sensational stories of “vaccine’s victims” were widely reported by some of the most authoritative newspapers. Videos of girls who suffered from chronic pain and walking abnormalities appeared extensively on television and the Internet, and vaccines were said to cause those symptoms. Doctors who support the vaccine were condemned by the media and were accused of receiving money from pharmaceutical companies.
To make the situation worse, some medical professors have come forward to publicly support the claim that the HPV vaccine may cause the reported adverse events. A research group proposed a novel disease titled “HPV Vaccination Associated with Neuropathic Syndrome (HANS)” for the set of diverse physical and psychological symptoms appearing after HPV vaccination [6]. Even though their paper was later retracted due to an inappropriate experiment approach, the impact of the study was devastating. It was mentioned in many newspapers and was used as scientific evidence by “vaccine’s victims’ groups” to raise a lawsuit against pharmaceutical companies and the government.
All those events resulted in a very negative public’s perception toward the HPV vaccine. A survey showed that Japanese mothers overestimate the frequency of the severe adverse events 10-1000 times, while underestimating the burden of cervical cancer [7]. According to a recent study, only about 10% of Japanese mothers allow their daughter to get the vaccine under the current situation. [8]
On the other hand, the government, so far, has been very passive in addressing the issue. Authoritative information about vaccines and their adverse events was not released timely, resulting in an information void that was filled by misinformation and fake news. The HPV vaccine leaflet published by the government was not made aware to the public; 86.3% answered that they have never seen the leaflet before [9]. The temporary suspension of the vaccine’s active recommendation remained unchanged for seven years and lasted until now, despite robust evidence of vaccine’s safety and efficacy both globally and nationally.
HPV vaccine coverage has stagnated at below 1% for the past seven years. If the crisis continues, 100 000 uteri will have to be dug up. 100 000 Japanese women will lose their uteri, some will never have the privilege of being a mother, some will live in worry of cancer recurrence, and some may eventually lose their lives.
Actions have to be taken promptly to protect the lives of girls who are and will be affected by the vaccine hesitancy.
The message is simple, “HPV vaccine saves life. Get the vaccine and protect our future.”
References
- Riko Murakana. A hundred thousand wombs. 2017
- International Agency for Research on Cancer. Cancer today. 2018. http://gco.iarc.fr/today/home (accessed Oct 26, 2020)
- Hall MT, Simms KT, Lew JB, et al. The projected timeframe until cervical cancer elimination in Australia: a modelling study. Lancet Public Health. 2019;4(1):e19-e27. doi:10.1016/S2468-2667(18)30183-X
- WHO. Global strategy to accelerate the elimination of cervical cancer as a public health problem. 2020. https://www.who.int/publications/i/item/9789240014107 (accessed Feb 7th, 2021)
- Japanese Ministry of Health, Labour and Welfare. The 2nd meeting of the Vaccines Adverse Reactions Review Committee (in Japanese). 2013 https://www.mhlw.go.jp/stf/shingi2/0000091965.html (accessed: October 12th, 2020)
- Aratani, S., Fujita, H., Kuroiwa, Y. et al. Murine hypothalamic destruction with vascular cell apoptosis subsequent to combined administration of human papilloma virus vaccine and pertussis toxin. Sci Rep 6, 36943 (2016). https://doi.org/10.1038/srep36943
- Egawa-Takata T, Ueda Y, Morimoto A, et al. Survey of Japanese mothers of daughters eligible for human papillomavirus vaccination on attitudes about media reports of adverse events and the suspension of governmental recommendation for vaccination. J Obstet Gynaecol Res. 2015;41(12):1965-1971. doi:10.1111/jog.12822
- Yagi A, Ueda Y, Masuda T, et al. Japanese Mothers’ Intention to HPV Vaccinate Their Daughters: How Has It Changed over Time Because of the Prolonged Suspension of the Governmental Recommendation. Vaccines (Basel). 2020;8(3):502. doi:10.3390/vaccines8030502
- The Ministry of Health, Labor, and Welfare. Evaluation of HPV Vaccine Information Provision. 2018. https://www.mhlw.go.jp/content/10906000/000541822.pdf (accessed: November 2nd, 2020)
Author’s Data
Name: Tai Nguyen Van
University: International University of Health and Welfare, School of medicine
AMSA Japan