Irish support for our initiative.
Dr. Mairead O'Connor has been working on cancers caused by human papilloma viruses (HPV) for more than nine years. More concrete, she is interested in behavioural research and its effects on health issues. She currently works at the National Cancer Registry in Ireland and shares interesting insights in our interview.
I’ve a background in Nutritional Sciences but have always been passionate about the public health effects of vaccination. I’ve worked in the area of HPV-related diseases for the past 9 years, researching cervical cancer screening attitudes and views on HPV infection and vaccination. I’m also doing some work in the area of HPV-related head and neck cancers. I’m very interested in using behavioural science to understand how people feel about things like cancer screening and make health-related decisions such as vaccinations. I work for a multi-disciplinary research group called CERVIVA (www.ncri.ie) and the National Cancer Registry in Ireland. Just before I started working for CERVIVA, HPV vaccines were becoming available and vaccination programmes were being rolled out in UK and Australia. I remember being fascinated at the time that there was a vaccine available to help prevent cervical cancer. Since then, we now know that the HPV vaccine has potential to protect against other HPV-associated cancers (e.g. anal, penile, vaginal and some oropharyngeal cancers). Any cancer is a devastating diagnosis but in the case of cervical cancer, it comes with multifaceted psychosexual complications and impacts severely on quality of life. Oropharyngeal cancer (a type of head and neck cancer) can also be a particularly debilitating cancer. Many oropharyngeal cancers are causes by smoking and drinking. However, we now know that HPV can also cause oropharyngeal cancers. HPV-related oropharyngeal cancers are increasing worldwide. The idea that these cancers can be prevented in the future and that future generations could live in a world where HPV infection is eradicated is very exciting.
10 questions to Dr. Mairead O’Connor:
1 Tell us about your broad commitment for higher HPV vaccination rates. Which are your core projects and how do you want to influence young women?
To ensure HPV vaccine uptake is high, it is important to understand the views and attitudes of a given population towards the vaccine. This can inform appropriate information and educational strategies to improve uptake. In 2010, myself and my research colleagues conducted a large nationally representative survey among women in around around their views on HPV infection and HPV vaccination. I would love to repeat this survey now, 8 years later, as Ireland has changed a lot in the last 8 years. A more up-to-date evidence-based study of women (and men’s) views on HPV vaccination could help inform our policy makers e.g. for example, if certain sub-groups of a population have specific negative attitudes to the HPV vaccine, they could be targeted in public campaigns about the vaccine.
I think some research among parents who have refused the vaccine for their daughters is needed in Ireland and elsewhere. Identifying the reasons for vaccine refusal in a scientific and rigorous way may help inform interventions for increasing uptake. Surveys are a good method of getting a “feel” for public sentiment but interviewing people about their experiences and views on vaccination provides rich and in-depth data.
More and more countries are now including boys in their HPV vaccination programmes. Currently in Ireland boys are not part of the school-based vaccination programme but may be in the future. Assessing the views of boys and the parents of boys towards the vaccine is important and its something that CERVIVA may look at in the future.
Committing to higher HPV vaccination rates is a high priority, but I also think that examining the subsequent cervical screening behaviours of women who are vaccinated against HPV and comparing them to the views of women who are not vaccinated against HPV is crucial. Some Previous studies have suggested that vaccinated women will be less likely to attend for screening. Other studies have suggested the opposite: unvaccinated women may be less likely to have screening. Cervical screening is still important in the era of HPV vaccination and uptake of cervical screening programmes must remain high if they are to be successful in reducing the cervical cancer burden. This type of research is something that I would love to do and I feel is highly important!
2 What is your personal motivation for higher vaccination rates in the society?
By getting vaccinated against diseases you are not only protecting yourself against serious and sometimes life-threatening illnesses but also your community. Certain groups of the population, e.g. cancer patients are at higher risk of developing vaccine-preventable diseases such as measles. When enough people in a population are vaccinated it offers protection against diseases for those that cannot be vaccinated (herd immunity). Although I’m too young, I remember hearing stories from my mother about major outbreaks of polio in Ireland in the 1940s and 1950s. Where she lived, it was quite bad and they weren’t allowed go swimming in the local lakes and rivers at the time due to the outbreaks. People think Polio and other diseases like TB are completely eradicated but just like there has been a rise in measles outbreaks, these awful diseases could make a return if vaccination rates continue to decline.
3 The HPV vaccination rates in Europe are not high enough. In Germany less than half of the female population is vaccinated against HPV. You have conducted large-scale surveys of women from the general population about their views and opinions towards the HPV vaccine. Which are the reasons and prejudices against this important vaccination?
The survey I conducted was in 2010 at a time when the national HPV vaccination programme was been rolled-out in schools across Ireland. Girls aged 12-13 years are offered the vaccine. We conducted it in over 3,500 women aged 20-64 years. Knowledge about HPV infection and HPV vaccination was quite low then – not many women had heard of HPV or HPV vaccines. However, we did find some worrying results: for example, over a quarter (25%) of women surveyed felt that girls should not get the vaccine as not enough was known about the long-term side effects. Nearly 30% of women felt that the benefits of the HPV vaccine did not outweigh any safety concerns. Among women with daughters in the vaccine age range who were surveyed, half (50%) were worried for their daughters safety as the vaccine was so new in 2010.
Recent media attention on the HPV vaccine in Ireland has improved women’s awareness of HPV, and therefore, the vaccine. A more up-to-date large-scale population-based survey of people’s attitudes towards HPV vaccination in Ireland is needed, this time also including men and fathers. A recent successful social media campaign by our national vaccination office has helped to combat myths and fake news that had been circulating online, particularly around side-effects of the vaccine. I think the main reasons against this important vaccine both in Ireland and in Europe stem from worries about possible side-effects which have been falsely published online. There is also a belief that girls who receive the vaccine will be more sexually promiscuous (as HPV is mostly sexually transmitted) – again, this idea has been proven untrue time and time again.
4 How can we bring those obstacles down? How do you approach the problem?
More educational work around dispelling the myths around the HPV vaccine and its safety is needed in Ireland, and in Europe to ensure more girls are vaccinated against HPV. It’s important for health professionals, policy-makers and other key stakeholders to work together to get the facts out there about the HPV vaccine.
5 How can we support your work? Which steps do we all have to take to improve the situation?
Ongoing messages to the public about the importance of HPV vaccination are key. In some countries where there has been a drop in the uptake of the vaccine, the governments, health professionals and other key experts have been reactive in their approach to the lack of confidence in the vaccine rather than being proactive – being well prepared to deal with a crisis in the uptake of the vaccine, having clear and concise messages around the vaccine are key. Monitoring social media (e.g. Facebook and Twitter) for good/bad sentiment around the vaccine may also help in organising public message campaigns to improve vaccine uptake.
6 HPV vaccination for girls and boys: Yes or no?
Yes, both. Although cervical cancer burden is huge, HPV-associated head and neck cancers (particularly oropharyngeal cancers) which effect both sexes are increasing worldwide. HPV is also responsible for some penile and anal cancers. There are arguments that it is not cost-effective to vaccinate boys, but it is also an issue of gender equality. In Ireland, girls are vaccinated free of charge through the school-based vaccination programme but why should parents of boys have to pay for their sons to be vaccinated at their GPs?
7 Concerning the vaccination process in general: Where do you see us in 10 years? Which should be the most valuable and useful innovations of tomorrow?
A preventive vaccine for HIV would be a huge advance in public health, especially for low and middle income countries.. Around 2 million people worldwide were newly infected with HIV in 2016. There are several HIV vaccines currently being trialled but more research is needed.
Therapeutic cancer vaccines to help treat patients already diagnosed with cancer would also be a huge step forward in medicine. Again, clinical trials in these vaccines are ongoing but hopefully in 10 years’ time some would be approved for use in cancer patients.
8 There have been a lot of measles outbreaks in Germany due to vaccination gaps. Not only measles are affected. How about the situation in Ireland? Do you reach the recommended vaccination rates?
Like Germany and other countries, we have had a few measles outbreaks in Ireland in recent years. Most of our measles outbreaks have been in unvaccinated teenagers and adults. Overall, we have good uptake of the MMR (measles, mumps & rubella) vaccine among the eligible population in Ireland of around 90-94% but in order to achieve herd immunity, this figure needs to be ≥95%. There were around 40 cases of measles confirmed in Ireland in 2017. Certain regional areas in Ireland have lower uptake of the vaccine than others. Vaccine hesitancy is clearly playing a role in these measles outbreaks.
9 Compulsory vaccinations in Europe: Yes or no and why?
No, compulsory vaccinations may be going too far and may be a short-term fix. However, rules around getting exemptions from vaccinations should be much stricter. I think more work around understanding what drives people to accept/reject vaccinations is needed – there a strong place for behavioural science in trying to understand this. Improving communication strategies around vaccinations is also needed.
10 How do you face anti-immunization comments? Do you have a message for unvaccinated people?
It’s tricky. I can understand someone challenging me or others online on vaccination. And I’m more than happy to try answer questions people may have around the HPV vaccine. People are entitled to their own opinions and views and that needs to be respected. However, when people are deliberately scare-mongering and spreading fake news online, they need to be called out and corrected. This is particularly true in Ireland where anti-HPV vaccine campaigners on Facebook and Twitter are thought to have influenced parents’ decisions to have their daughters vaccinated against HPV and lead to a worrying decline in uptake of the vaccine for a few years.
The vast amounts of vaccine information available online (particularly social media) can be quite confusing for those unsure about vaccinating themselves or their children. Get yourself informed about the benefits of vaccination. It’s not a pharmaceutical conspiracy!, they actually work and have saved millions of lives. All the reputable scientific evidence strongly points to this. Some think that vaccines are one of the greatest medical inventions to date.
There has been a lot of misinformation around vaccine side-effects perpetuated online. In the case of the HPV vaccine, there is no scientific evidence to support the idea that the HPV vaccine causes any long term medical condition. Don’t be afraid to ask your doctor or nurse about any concerns you may have, they will put your mind at ease.
11 (Do you vaccinate your dog?)
No, but I foster a dog with the Irish Guide Dogs and they are very rigorous in ensuring that the dogs are up to date with their vaccines so they are as healthy as they can be.