Comment on Almutairi et al.—Understanding the boundaries of Human papillomavirus vaccine protection

Dear Editor,

I have read with great interest the article by Almutairi et al., “Knowledge and attitude of parents toward human papillomavirus (HPV) infection and HPV vaccination in Riyadh, Saudi Arabia.”[1] The article provides insight on HPV awareness levels and vaccine attitudes and highlighted the need of targeted interventions to boost up public understanding. Cervical cancer stands as a global health challenge, especially in low- and middle-income countries. It stands as the fourth most common cancer among women globally. Most cases of cervical cancer are due to persistent infection by HPV. HPV vaccination programs have shown significant success in reducing the prevalence of HPV infections. Prophylactic vaccination along with screening and treatment of pre-cancerous lesions are believed to curb out the pressing issue of cervical cancer.[2]

However, there are some key limitations remain regarding the reliability of HPV vaccination for preventing cervical cancer. To start with, cervical cancer often develops several decades after HPV infection, meaning that definitive long-term evidence on cancer reduction following vaccination is only emerging now. While reductions in infection and pre-cancerous changes are strong, the observed prevention of actual cancer cases relies on extended surveillance and time. The other point to consider is that the current vaccines (bivalent, quadrivalent, and 9-valent) primarily target HPV types 16 and 18, which are responsible for about 70% of cervical cancers; other oncogenic types remain unaddressed, requiring continued screening even among vaccinated individuals. At last, the vaccine’s effectiveness is highest before sexual activity and decreases with age or prior exposure—the impact on older or previously exposed populations is less predictable. Immunity appears to last beyond nine years for some vaccines, but the true duration of protection and long-term comparative outcomes remain uncertain.[3] Research has claimed that Gardasil can possibly induce and increase, in some cases, the risk of autoimmune diseases and other serious health complications, including Postural Orthostatic Tachycardia Syndrome, Neuropathy, and Fibromyalgia. Gardasil has also allegedly been linked to premature ovarian failure and infertility.[4] Adverse effects following vaccination of HPV have led to Japan withdraw active promotion of the vaccine.[5]

In summary, while real-world studies do validate the positive impact of HPV vaccination on the reduction of cervical cancer and its precursors, its reliability as a standalone cancer prevention measure does have its own limitations. Ongoing surveillance, broader vaccine coverage for more HPV types, effective education, and continued screening are all essential. HPV requires cofactors like early marriage, multiple partners or pregnancies, poor hygiene, malnutrition, and low education—focus on these via targeted screening, preferable over mass vaccination. As Almutairi rightly says, collaborative efforts between healthcare providers, educational institutions, and government can address this public health issue strategically.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.