On March 20, the world lost an incredible human to the hands of cervical cancer. Laura Brennan was diagnosed with cervical cancer in 2016, and thereafter dedicated the remainder of her life to being an ardent advocate of the HPV vaccine. She campaigned nobly throughout her cancer treatment for HPV vaccination of teenage girls, becoming the most memorable face of the HSE advertising campaign. Brennan was both heroic and inspiring, and her selfless promotion of HPV vaccination for young girls and boys was central to the increase in uptake levels of the vaccine to 70% in 2018. At the tender age of 26, she is now survived by her parents Bernie and Larry, and her brothers Colin, Fergal, and Kevin.
HPV stands for human papillomavirus and is a common infection usually transmitted from sexual activity. HPV infection rates are highest in more prosperous countries and are currently rising rapidly in both men and women. HPV is a group of more than 200 viruses which can present in many different guises. The virus can infect cells on the surface of the cervix and over many years culminate in cellular abnormalities. In some women, these abnormalities may turn cancerous. Every year in Ireland, about 300 women contract cervical cancer, and 90 of these women die from the disease. Virtually all cervical cancers are caused by HPV. The HPV vaccine protects against infection with nine HPV types: the two low-risk HPV types that cause most genital warts, plus the seven high-risk HPV types that cause most HPV-related cancers. Thus, if we prevent HPV infection, we can prevent most HPV-related cancer, including cervical cancer.
Since 2010, the HSE have offered HPV vaccine to all girls in first year of secondary school. The HPV vaccine works, as most do, to train the immune system so that it can fight a disease it has not come in contact with before. In 2018, the Health Information and Quality Authority (HIQA) recommended that the vaccine programme should be extended to boys. This is due to evidence that the virus has implications in a number of cancers including penile, anal, and oral cancer. Minister for Health, Simon Harris, soon after announced that the school-based programme will extend to male students by the beginning of the 2019 school year. The vaccination is free and the programme is school-based to ensure high vaccine uptake. Unfortunately, Brennan had left second-level education before the programme had been established.
“Every year in Ireland, about 300 women contract cervical cancer, and 90 of these women die from the disease.”
Despite the number of lives this programme has and will save, the development of the HPV vaccine and its administration to young women has been fraught with difficulties. Initially, uptake was 70%, but dropped by 10% in recent years due to campaigning by parents that the vaccine was causing chronic illnesses in young girls. These claims have no scientific evidence and are refuted by academics as being false. Yes, the vaccine comes, like most medications, with potential side effects. One in 10 people vaccinated may experience pain and swelling in the area of needle administration. Headaches, nausea, and dizziness have also been reported. Rare side effects occurring in one in 10,000 individuals include wheezing and chest pain. These side effects, both common and rare, are miniscule when juxtaposed to the effects caused by the infection itself. The HPV vaccine, like many vaccine programmes, has fallen foul of the anti-vaccine movement which undermines the major successes of life-saving medicine.
Laura Brennan missed out on the HPV vaccine, and, as a result, fell victim to the effects of the infection. The work she did in sharing her story as well as the effectiveness of the HPV vaccine has likely saved many lives. Academics have published their concrete findings on the safety and efficacy of the vaccine and yet, still have failed to convince all members of the public of their findings. It has become clear that lay people are cognitively dissonant to such governmental pleading. This dissonance may stem from difficulty people have in relating to papers published in journals such as Nature or Science. They may find it hard to put their faith in a study showing efficacy in mouse models, instead relating more easily to personal stories and anecdotes.
“This distrust is founded in the reality of being continuously bombarded by contradictory advice each week, amplified by social media and clickbait news sites.”
There is a palpable distrust amongst the public when it comes to white-coat, and often governmentally-funded, research teams dictating what they should and shouldn’t do to their bodies and their children. This distrust is founded in the reality of being continuously bombarded by contradictory advice each week, amplified by social media and clickbait news sites. However, Laura Brennan was able to effectively bridge that divide through her own personal story. She was an intelligent, powerful, and real person, whom so many people could relate to. Citing the literature and echoing the words of the science community, Brennan’s voice proved to be a powerful force for change. During her time as face of the HSE HPV-vaccine campaign, uptake levels rose by 20%.
Science has told us that HPV causes cervical cancer and Laura Brennan has reminded us why no-one should fear a vaccine, but rather fear the consequences of passing it up. Cervical cancer kills 90 women every year in Ireland. It is the second most common cause of death due to cancer in women aged 25 to 39. HPV infections rates are rising in Ireland each year and in order to prevent any more deaths, uptake of the vaccine needs to be increased.
If Ireland can achieve near 100% vaccine uptake, along with rigid screening and treatment, the prospect of eliminating HPV-related cancer in the near future is possible. Let us continue Brennan’s legacy and campaign for increased vaccine uptake so that we can stop the spread of HPV and stop the unnecessary death of young people.
