Details of HPV immunisation need not delay decision

Editor—Lowndes and Gill are upbeat in their appraisal of the future for primary prevention of cervical cancer by immunisation.¹ But they then deliver a long list of questions that they suggest should be answered before starting human papillomavirus (HPV) vaccination. For most of their questions, this timing is not supported by recent historical precedent.

Without doubt ascertainment of the HPV types currently causing cancer, data for which are available in the United Kingdom,² is central to the modelling and cost effectiveness studies with which we must assume the Health Protection Agency and others in the UK are already engaged. Certainly, as for all recent new vaccines, cost is likely to be a key determinant. Likewise, careful evaluation of vaccine acceptability to children and parents will be important, although it should be pointed out that universal immunisation against hepatitis B, primarily a sexually transmitted disease and a cancer causing virus, is already widely established and accepted in many countries.

But the other questions need not delay implementation and have not done so for other immunisation programmes. The precise design and nature of any catch up programme is a wholly separate issue from the decision that will need to be taken as soon as possible after one or more of these vaccines become licensed and available in Europe—namely, whether to offer the vaccine to all girls before they become sexually active as a means of preventing the second most common cancer of women. It seems that this will be an important, although quite possibly expensive, public health opportunity. The case will need to be made in a clear and uncluttered way if needless loss of life is to be avoided.