A vaccine that protects against the cervical-cancer-causing human papillomavirus is making headlines today after a 14-year-old British girl, Natalie Morton, died Monday, hours after being injected. No, it's not the Gardasil vaccine used in the United States, but Cervarix, which may become available here in the next few months. (A Food and Drug Administration advisory committee voted a few weeks ago to recommend Cervarix—the HPV vaccine of choice in Britain—for approval.)
Awaiting the results of Morton's autopsy, British health officials are stressing today that they don't yet know whether the vaccine is linked to her death. One health official said it was "unlikely" that the girl's death was caused by Cervarix and says parents should still get their daughters immunized. Yet at the same time, the school where the girl's vaccine was administered has been ordered by the government to halt its program, at least temporarily, and certain batches of the vaccine have been recalled.
It may never be known whether Cervarix caused Morton's sudden death. My previous reporting on Gardasil revealed how tough it is for public-health officials to determine whether suspected vaccine injuries, especially rare events, truly occurred because of the immunization. These folks emphasize that vaccines are safe and that side effects occur only rarely. But if the HPV vaccine truly caused a serious injury or even death, is it still safe? What if it caused three or four deaths or more? Those are the questions that Jenny Tetlock's father posed to me in a previous E-mail. His daughter died last March about a year after receiving her third Gardasil injection; her autopsy report raises the possibility that she died from a paralyzing condition triggered by a Gardasil-related autoimmune reaction.
At first blush, young women and parents of teenage girls may think that even one death from a vaccine is too many. But we do need to weigh the possible risks of rare side effects against the vaccine's established benefits. Mike Skinner, a vaccine researcher at the Imperial College of London, did an interesting breakdown of the risks versus benefits of HPV vaccination in this piece published in the British newspaper Telegraph. He points out that the immunization—in this case Cervarix, but it also can apply to Gardasil—protects against 70 percent of cervical cancers, which translates into 700 cervical cancer deaths prevented every year. (In Britain, 1,000 women die each year from cervical cancer; in the United States, about 4,000 women die every year from cervical cancer, which means immunization of every young girl could prevent 2,800 deaths here every year.) Skinner concludes:
"Even if the girl's death proves to be a consequence of the vaccination, and it is still a big 'if', only one death would be prevented for every 500,000 girls who decided not to be vaccinated—albeit at the cost of 700 deaths to cervical cancer."
While Skinner makes it sound like HPV vaccination is a no-brainer, his logic is faulty in two ways. First, he assumes that Morton—if her death is found to be caused by the vaccine—is the only person who has died from it, which may not be true. (In the United States, government health officials are investigating a few more deaths due to a paralyzing condition that may have been triggered by Gardasil, as well as other sudden deaths.) Also, Skinner doesn't mention the fact that women have another way to protect themselves from cervical cancer: It's called the Pap smear. I'd like to know how many women who die of cervical cancer every year had regular Pap smears, which can detect cell abnormalities before they turn cancerous. There are certainly some cancers that Pap smears miss, but I'd also bet that a greater number of deaths are in women who weren't regularly screened.
Morton's death, if indeed related to Cervarix, shouldn't necessarily scare parents or young women away from vaccination. It just makes our decision harder concerning whether or not to immunize.