Dear Editor,
The Ministry of Public Health in Guyana has stepped up its campaign to administer the Human Papilloma Virus (HPV) vaccine to children in schools. There is much being said about the vaccine and the programme, both by those implementing it and those who appear to be affected by it, such as parents.
As a parent of two very young children, one of whom is in nursery school, I am not yet directly confronted by the choices facing other parents. I do, however, share some of their concerns, and have questions of my own that I’d appreciate being answered before being confronted by those choices.
On Sunday last, March 17, 2019, all of the newspapers ran a double page message from the Ministry of Public Health addressing HPV and the vaccine being provided. I have also seen the consent form received by some parents in respect of the vaccine. From these pieces, and against the background of information obtained from other sources, I would appreciate if the following questions can be addressed by the Ministry.
My first question is in relation to the manner in which the programme is being implemented. There is information that parents from at least one school were informed that the Head Teacher gave permission for nurses to administer the vaccine to the children of that school. Those parents were also informed that if they do not want their children to receive the vaccine, they must write a note to the school indicating this. I am aware that other schools are sending permission slips, but is the Ministry working to ensure that ALL schools follow this protocol? I would also like to know if Parent-Teacher Meetings have been utilized in educating parents about this programme.
My other questions deal with the transmission of HPV. One permission slip sent to parents states that “The HPV vaccine is the only guaranteed way to prevent cervical cancer in women”, while the double page message in the newspapers states that, “Contrary to popular belief, HPV is not spread only through sexual contact. It is also spread through direct skin to skin contact with an infected area or bodily fluids”.
Apart from the fact that the American Cancer Society says that HPV is not the only cause of cervical cancer, the World Health Organization (WHO) says that HPV is sexually transmitted and the US Centers for Disease Control and Prevention (CDC) says that it is transmitted through intimate sexual contact. Though it is clearly stated that this is not limited to penetrative sex/sexual intercourse, the only exception to transmission by sexual contact with the genital area of an infected person identified is mother-to-child transmission during delivery, which is said to be very uncommon and is nevertheless as a result of contact with the genital area of the mother. This gives rise to two questions.
First, considering that both WHO and the CDC say that HPV is transmitted through intimate sexual contact/contact with the genital area, is it true that HPV is also transmitted via bodily fluids? And, if so, through which bodily fluids can it be transmitted?
Second, in light of the fact that HPV is said to be transmitted through intimate sexual contact, would having sex with only one person, who only has sex with you, also be a ‘guaranteed way’ to prevent cervical cancer (caused by HPV)? The double page message appears to say this at No. 3 under ‘How can I prevent any HPV related infection?’, where it says that everyone can be protected from HPV infection if they only have sex with one person during their lifetime and their partner does not cheat. However, this is listed after getting vaccinated and using a condom, the latter of which admittedly cannot guarantee protection. It is, therefore, not clearly stated that two persons only having sex with each other throughout their lifetime is a guaranteed means of preventing transmission.
To be clear, in respect of my question in the paragraph above, if persons abstain from sexual activity (not just intercourse but any genital contact) until marriage, and then remain faithful to each other in marriage, isn’t this a ‘guaranteed way’ to prevent cervical cancer caused by HPV, as well as every other sexually transmitted infection? And, if this is so, isn’t the message to parents on those consent forms misleading, especially if that is all that they ever hear about HPV?
I understand that the general thinking is that abstinence until and faithfulness in marriage is not common, but shouldn’t persons who hold and live by such values, and desire to share such values with their children, benefit from the full information instead of being scared into consenting to what the Ministry desires to do?
If it is that HPV is only transmitted through some form of sexual activity, part of the responsibility of the Ministry should be to inform the public of the importance of the choices that we make in this respect, as well as the benefits of making certain choices and potential harm of making others. This is particularly so since HPV is only one STI of many.
Previously, when the focus was primarily on the Human Immunodeficiency Virus (HIV), condoms were the most popularized means of prevention (even though it was also not an absolutely guaranteed way to prevent HIV transmission). However, persons who had sex with condoms to prevent HIV transmission were constantly putting themselves at risk for HPV transmission, against which condoms are far less effective. It is clear, then, that the information that using a condom was practicing ‘safe sex’ was not only misleading, but was, and continues to be, harmful.
Now that HPV has risen to the fore, and the HPV vaccine has been developed, the public is being told that children must be vaccinated to protect against transmission of this STI. I assume that condoms will still be promoted to prevent transmission of HIV and other STIs (though still not a guaranteed means of prevention, according to the CDC). Is it possible that another STI may then require another means of ‘guaranteed’ protection?
If abstinence until and faithfulness in marriage would guarantee protection against those STIs and ALL others as well, isn’t this still valuable information that should be highlighted to the public? And if the time to decide whether children should be immunized against an STI is while they are in schools before they become sexually active, shouldn’t it also be imperative to educate them at this stage on the potential consequences of the choice to become sexually active or not?
It is not for the Ministry to decide whether persons will choose to abstain and/or be faithful. It is the responsibility of the Ministry to arm persons with the best information available to make informed choices for themselves. It is in this light that I write, requesting and hoping that the Ministry will address the questions/concerns raised above.
Yours faithfully,
Kurt Da Silva
