The Ministry of Health and Quality of Life found itself in the centre of a controversy recently when it introduced the human papillomavirus (HPV) vaccine for teenage girls in schools. The vaccine, which is said to keep cervical cancer at bay, is also believed to be associated with some serious side effects. Weekly caught up with the acting director of the Health Services at the Ministry of Health, Shahina Aboobakar to talk about this issue.

The controversy around the HPV vaccine in schools is becoming fierce. There are some concerns about the side effects of this vaccine, how do you react to these?

Yes, there are side effects, but they are just of short duration and quite mild. There may be redness at the site of the injection and some pain. Some girls may have low-grade fever, which disappears within 48 hours. If they take paracetamol on the day of the vaccination and on the next day, it will relieve the symptoms. Some girls have nausea and some, because of the fear of the injection, may feel weak, but this is not directly related to the vaccine. Studies have shown that there have been no serious side effects of this vaccine in the last 10 years that it’s been used.

When this vaccine first came out, it looked like the magic solution to the cervical cancer problem, but now, you know and I know that there are a lot of debates internationally raised by very reputable doctors who are concerned that first of all, this vaccine hasn’t proven its effect. Secondly, the long-term side effects are not worth it. Are you aware of that?

I am aware of those concerns but they are not evidence-based. There have always been protests against different vaccinations; it's not the first one and I’m sure it won’t be the last as there have always been people who have resisted vaccines. This vaccine, however, does give primary prevention and it should be coupled with screening for cervical cancer, which is a secondary prevention. A PAP smear – a scraping of the cervix looked at under the microscope – also needs to be done to rule out any precancerous lesions. So, the vaccine and the screening should go together.

The point is that so far, there is no evidence, according to some doctors, that the vaccine actually attenuates the risk of cervical cancer.

No, there have been studies. In countries like Australia, which started the vaccine around 2007 and monitored it for the following 10 years, studies have found out that the incident of HPV infection in women has reduced considerably with the vaccine.

What about the long-term side effects?

There have been no serious long-term effects in the past 10 years abroad or in Mauritius.

In Mauritius, it has been used on a very small scale, hasn’t it? What is the population that chose to get vaccinated?

I don’t have the figures but I’ve spoken to a few gynaecologists and paediatricians. They all tell me that they do these vaccines in the private sector quite frequently. No long-term side effects have been reported.

This vaccine was licensed as recently as 2007. How do we know what will happen to the vaccinated girls when they are 50?

In Australia, nothing happened to them except a decrease in the cases of infections leading to cancer. The World Health Organisation (WHO), which is the directing and coordinating authority on international health within the United Nations’ system, recommends the vaccine. We are following its recommendations. So far, they haven’t come up with any side effects that are long term or severe. If the HPV vaccine was having such serious, debilitating side effects, I’m sure that WHO would have been the first to know and ask us to stop using it.

What is intriguing is that we are suddenly embarking on this huge vaccination campaign without any communication and without consulting anyone. We just went to the schools and said to the parents 'OK, do you want your children to be vaccinated or not?’ Is that the normal way to go about it with something like this?

It is not true. First of all, we are not embarking on it suddenly. This was in the government programme and in the budget speech. And the ministry has been trying for a couple of years to look for funding for this vaccination because it's quite expensive. Last year, we managed to locate the funding. When you work in a big enterprise, there are procedures to follow: procurement, launch tenders, evaluation etc. All this started from August last year. So it took us one year to complete everything and then procure the vaccines and then we informed the Ministry of Education. Consent forms were given out to the teachers explaining to them what it was and asking them to relay the information to the girls. There was also a media campaign.

Wouldn’t it be logical for the ministry to inform the parents and the public, listen to their concerns and see if they are willing to go for the vaccine?

We don't have access to parents.

Through the media…

We did put out a communiqué in the press. It was published in some newspapers but not in others but

I can assure you that this vaccine does not have any long-term side effects.

Why are these doctors up in arms then?

This is not the first time. In Mauritius, thanks to vaccination, we have eradicated polio, dysteria and tetanus. All these diseases were very common in Mauritius 35 to 40 years ago. Polio was crippling the children. You still see adults who were polio victims. But because of the vaccination programme, we don't have polio, tetanus or dysteria. If we didn't have vaccinations, we'd still have children suffering from all these diseases.

The most optimistic doctors are saying that the protection against cervical cancer conferred by this vaccine is no more than 70%, leaving a 30% risk of cancer in the best of circumstances. Is the game worth the candle?

We never claimed that this vaccine offered 100% protection. That is why we have a PAP smear screening programme for women between 30 to 60 years of age for screening for cervical cancer.

If one has experienced the pain of cancer first hand, even protecting ONE person is an achievement, let alone 70%.

Even if we could be certain of their effectiveness, shouldn’t these anti-viral vaccines only be administered to high-risk populations?

Our population is at a high risk. The incidence of cancer has been increasing. I would like to stress that there is no politics involved in this vaccination. It is we, as technicians, who have advocated and initiated the introduction of this vaccine as a preventive measure against cancer in the public sector. This vaccine has been given in the private sector for a number of years by gynaecologists, one of whom has vaccinated both his own daughters. As a member state of the WHO, we abide by the recommendations of this body.

What is the cost of this vaccine?

It's Rs13 million. We have taken a consignment of 9,500. Our cohort is 8,000 something. We have sent 500 to Rodrigues, six to Agalega and the rest of the vaccines are being used here. This cohort will be vaccinated before the end of the third term. Next year, we will give them the second dose after six months. Every year, we need to have Rs13 million for the HPV vaccine. WHO recommends giving the vaccine before the onset of sexual activity because the HPV virus infects people when there is close sexual contact.  They recommend 9 to 13 years – which is a huge cohort. So, we are starting with the nine- and 10-year-old girls in Standard V and as soon as the next batch comes in Standard V, we’ll vaccinate them.

Wouldn’t it have been smarter to start with 13-year-olds because they won’t have a second chance and then go down in order of age?

No, because girls at 13 are already sexually active. Believe it or not! A survey conducted by the Ministry of Health in collaboration with the World Health Organisation, in 2011 revealed that, among 13 to 15-year-olds, 22% girls and 29% boys had had sexual intercourse. And then we all know that teenagers are becoming sexually active at an earlier and earlier age.

If you have Rs13 million rupees to spend on a health programme, how do you pick your priorities?

Cervical cancer is a priority; it is the third most common cancer in Mauritius now after breast cancer and colorectal cancer in women. In 2014, we had 99 new cases of cervical cancer. It is a priority because a woman who dies of cancer is a huge loss for the whole family. So even if the target is 99 cases, even one is too many.

Why don’t we use that money to tackle the drug problem, where there are more victims?

(Laughs) I will not make any comment about that. I am only in charge of the HPV vaccine.

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