What is the hurry?

angry doc found this letter to the ST Forum published in January this year (emphasis mine):


Cancer vaccine poses risk of degenerative diseases

I REFER to the letter by Ms Karen Tan of the Ministry of Health ('Cervical-cancer vaccine has its limitations'; ST, Jan 9) and the advertisement by Empowered to Protect (The Sunday Times, Jan 7).

We should not rush into advising mothers to protect their daughters against cervical cancer by recommending the anti-cancer vaccine to them. As rightly pointed out by Ms Tan, 'the long-term effectiveness of the vaccine is still not known'.

As the human papillomavirus is transmitted sexually (a sexually-transmitted disease like syphilis and gonorrhoea), mothers should instead teach and advise their daughters (and concerned doctors, their patients) how to protect themselves, e.g., by not exposing themselves to multiple sexual partners and to take other appropriate measures.

Aluminium hydroxide is one of the vaccine's components. With three injections over six months, a young girl would have received 675mcg of aluminium. This aluminium will stay in the body, and studies have shown that aluminium is associated with degenerative diseases like Alzheimer's, Lou Gehrig's and even Parkinson's disease.

If you consider having such diseases is better than having cervical cancer, then having the anti-cancer vaccine injection would be your informed choice.

With proper Pap-smear screening programmes, the incidence of cervical cancer in Singapore has been declining over the past 30 years, as Ms Tan mentioned. We should work on this instead of depending on a vaccine that has not weathered the test of time, unless, of course, those who will be having the injection become part of the ongoing experiment to test its efficacy.

There is still doubt about the efficacy of the vaccine, otherwise why should patients who have been vaccinated be advised to continue with Pap-smear screening for cervical cancer?

The Health Sciences Authority should not have approved the use of Gardasil if this doubt exists. What is the hurry?

Dr Tan Soon Kiam


What's the hurry, Dr Tan? Well, if I may quote Associate Professor Tan Huay Cheem of the National University Hospital: 'In real practice, we can't always wait for clinical trial data.'

Here is the Ministry of Health's reply to Dr Tan's letter (emphasis mine):


Gardasil safe but discuss vaccination with doc first

I REFER to the letter, 'Cancer vaccine poses risk of degenerative diseases' (ST, Jan 11), in which Dr Tan Soon Kiam raised concerns about the safety of aluminium present in vaccines and the basis for the approval of Gardasil by the Health Sciences Authority (HSA).

Aluminium salts have been used widely in vaccines for more than 70 years, as an adjuvant to enhance their efficacy. Their safety record is well-established.

Many scientific and regulatory agencies have reviewed the use of aluminium in vaccines. They have found no sound scientific evidence of long-term adverse effects such as Alzheimer's, Lou Gehrig's or Parkinson's disease.

Besides Gardasil, many other commonly-used vaccines contain aluminium. They include vaccines for hepatitis A and B, and immunisations against childhood diseases like diphtheria, tetanus (lockjaw) and pertussis (whooping cough).

As the national regulatory authority for medicinal products, HSA ensures, through a scientific review process, that approved medicinal products in Singapore meet appropriate standards of safety, efficacy and quality.

Several scientific studies have demonstrated that Gardasil is effective for preventing cervical cancer, precancerous lesions and infection caused by sexually-transmitted human papillomavirus (HPV).

Hence, there is sufficient basis to approve this vaccine for the target group of females aged nine to 26 years.

Gardasil has also been approved for marketing in the United States, Australia, Canada, Europe and New Zealand.

HSA wishes to emphasise that Gardasil has not been approved for use in the general population. Anyone interested in the vaccination should discuss this with a doctor who will consider factors such as age and personal history of previous exposure to HPVs.

Vaccination does not replace the need for ongoing Pap-smear screening. Healthcare professionals should familiarise themselves with the approved indications and relevant prescribing information on Gardasil to provide the most appropriate advice to patients.

Dr Gerard Wong
Deputy Director (Product Evaluation & Registration)
Health Products Regulation Group
Health Sciences Authority


The reply does not tell us that Gardasil does not guarantee 100% protection against HPV infections (no vaccine is 100% protective, Dr Tan), or that not all cervical cancers are caused by the strains of HPV which Gardasil is designed to protect against. That is why Pap smear screening will still be required.

The 'vaccine scare' is as old as the practice of vaccination itself, but it certainly has become more widespread in recent years with the availability of internet access. The problem facing the modern parent/patient is not one of lack of information, but one of information overload: how does one decide if the information one is reading is reliable?

Can vaccines cause harm? Certainly they can; but so can many diseases which one can now be immunised against. To paraphrase House, pretty much everything in modern medicine is about the risk-benefit ratio; vaccines just happen to be a more emotionally-charged aspect of modern medicine because we give them to babies and in many cases they are compulsory.

While doctors need to acknowledge parents' and patients' concern over vaccine safety, we must continue to base our advice and decisions on evidence and science, and not seek to convince our patients with anecdotes and unproven theories.