Friday, 8 March 2019

Free cervical cancer vaccine for Secondary 1 female students from April 2019

Offer will be progressively extended to all girls currently studying in secondary schools
By Salma Khalik, Senior Health Correspondent, The Straits Times, 7 Mar 2019

All Secondary 1 girls in national schools, including madrasahs, will be offered free vaccination from next month to protect them against cervical cancer.

About 200 women get the cancer each year and 70 die from it, said Senior Minister of State for Health Amy Khor yesterday.

She added: "This cancer, which is caused by infection with the human papilloma virus (HPV), can be prevented with vaccination and screening."

The vaccine protects women against common HPV strains, which primarily cause cervical cancer, but can also cause vulva, vaginal and anal cancers.

As a one-time catch-up, the offer will be progressively extended to all girls currently studying in secondary schools. Those of similar age studying in private education institutes will also be offered free vaccination, if they are Singapore residents.

This is an opt-in scheme.

The Government has put aside $10 million for this year, and $2.5 million annually from next year.

Singapore has picked the second oldest of three HPV vaccines on the market, Cervarix, which protects against HPV strains 16 and 18, which account for 70 per cent of cervical cancers.

The Ministry of Health (MOH) told The Straits Times that Cervarix was selected based on factors such as efficacy, price and stock availability.

Its spokesman added: "MOH is evaluating Gardasil 9 to compare it to the other two HPV vaccines. If found to be cost-effective in the local setting compared to Cervarix or Gardasil, MOH will consider offering Gardasil 9."

* Boosting HPV vaccination coverage

We thank Dr Tay Eng Hseon for his support for the school-based human papilloma virus (HPV) vaccination programme (Offering best protection for S'pore girls, March 13).

The move to offer free vaccination to all Secondary 1 girls in national schools, including madrasahs, is part of the Ministry of Health's (MOH) efforts to increase the coverage of this vaccine which prevents cervical cancer.

While all three HPV vaccines that are available in Singapore – Cervarix, Gardasil, and Gardasil 9 – were considered for the school-based programme, Cervarix was selected following an assessment which included considerations of efficacy, price and stock availability.

Cervarix and the vaccine Gardasil are recommended under the national immunisation schedules, and have been assessed by MOH to be safe and effective in preventing cervical cancer.

The current evidence indicates that both these vaccines provide comparable protection against two of the most common cervical cancer-causing HPV types - HPV types 16 and 18.

They account for 70 per cent of all cervical cancer cases.

While Gardasil extends protection against HPV types 6 and 11, these HPV types generally do not cause cervical cancer.

A third vaccine, Gardasil 9, is relatively new in Singapore and is not included in the national immunisation schedules.

But MOH may offer Gardasil 9 in the school programme in future if it is cost-effective.

The Health Promotion Board will provide parents with educational material on HPV vaccination, the type of vaccines available in Singapore and what will be administered to the girls in schools to encourage parents to opt in for the programme.

Lim Siok Peng (Ms)
Director, Corporate Communications Division
Ministry of Health
ST Forum, 21 Mar 2019

MOH, experts debunk rumours about cervical cancer vaccine
Some parents hesitant about vaccination as hoaxes, misinformation are circulated on social media
By Yuen Sin and Rei Kurohi, The Sunday Times, 24 Mar 2019

Many parents cheered a Ministry of Health (MOH) announcement that Secondary 1 girls in national schools will be offered free vaccination against cervical cancer - but some were disturbed by the move.

The scheme kicks off next month and will be offered on an opt-in basis. The vaccine protects against common human papilloma virus (HPV) strains, which primarily cause cervical cancer but can also cause vulva, vaginal and anal cancers.

Ms Koh (not her real name), 43, along with a few other Facebook users from Singapore, voiced her doubts online. The mother of two girls aged two and five has seen videos and articles circulated in a WhatsApp group made up of Singaporean mothers - some based overseas - that highlighted the allegedly negative effects of the vaccine.

This has made her and some friends hesitant about opting for the vaccine, she told The Sunday Times.

The videos include claims that there were reports of girls who could not talk and walk after being vaccinated. Another website said that Japanese government officials have stopped recommending the Gardasil cervical cancer vaccine due to reported side effects, including seizures, brain damage, blindness and paralysis.

Ms Koh, who runs a business in the finance industry, said: "We did our own research, but what scares us is that there seems to be conflicting information on both sides. And once you've been vaccinated, you cannot reverse the process." She requested to remain anonymous for fear of backlash from other parents.

Others said on Facebook that "girls' fertility may be affected by this vaccine", or shared links to articles claiming that the vaccine causes nervous and immune system disorders.

These rumours about the HPV vaccine here have emerged on the back of a growing anti-vaccination movement abroad that has led to a drop in immunisation rates for measles and other diseases, and has caused the World Health Organisation (WHO) to name "vaccine hesitancy" as one of this year's top global health threats.

An MOH spokesman told The Sunday Times that the vaccination has been shown to be safe and effective in preventing cervical cancer. "The consensus among leading health agencies, including the WHO, is that the benefits of HPV vaccination outweigh any potential risk of side effects," the spokesman said.

Associate Professor Chong Chia Yin, director of clinical quality and patient safety at the KK Women's and Children's Hospital's division of medicine, said possible side effects like nausea and muscle ache are generally mild and resolve spontaneously.

More severe side effects, such as an allergic reaction to the vaccine or vaccine component, are extremely rare and can occur immediately after the vaccination, said Prof Chong, who chairs the Expert Committee on Immunisation. The committee includes MOH officials and experts on communicable diseases.

Dr Ida Ismail-Pratt, a consultant at the gynaecologic oncology division at the National University Cancer Institute, Singapore, said there is "no evidence of causation with any of the claims" cited by Ms Koh and others from Singapore. She noted that a study from the American Academy of Pediatrics last year based on a sample of 199,078 female patients found that the HPV vaccine did not lead to a statistically significant higher risk of primary ovarian insufficiency, a form of infertility.

A Facebook spokesman told The Sunday Times that the social media site is unable to comment on whether it has received complaints about anti-HPV vaccine information from Singapore.

However, its vice-president of global policy management, Ms Monika Bickert, said Facebook is working to reduce vaccine misinformation, while providing people with authoritative information.

For instance, if verifiable vaccine hoaxes that have been identified by global bodies such as the WHO are posted in a group or by a page administrator, the entire group or page will be excluded from Facebook's recommendations, said Ms Bickert.

Facebook is also exploring ways to share educational information about vaccines when people come across misinformation, she said.

Institute of Policy Studies senior research fellow Carol Soon said people may believe false information about vaccinations as they are backed by "expert sources" and made-up evidence. These "authoritative" sources can confuse people about whom they should believe.

Cognitive biases may also be a factor, she said. For instance, some parents who are concerned about sending the wrong signal to their young daughters that it is all right to engage in sex may choose to believe that cervical cancer vaccinations have harmful effects, given that HPV is generally transmitted during sex.

"To educate the public and dispel myths, we need to leverage trusted local expert sources, present information simply and succinctly and acknowledge people's concerns and address them," Dr Soon noted.

MOH said parents are encouraged to check reliable and verifiable sources of information such as the HealthHub, WHO and European Medicines Agency websites. "Parents are also encouraged to speak with their doctor, who would be best placed to advise and provide accurate information," said the spokesman.

Tutor Vanessa Teo, 40, has no qualms about allowing her 11-year-old daughter to get the HPV vaccine when she is in Secondary 1.

"Our authorities keep to stringent guidelines, and if it's been tested and proven to be safe, why not get additional protection?"

**  Parliament: 25 schools offered HPV vaccine with 93% of Sec 1 girls opting for free cervical cancer vaccine: Amy Khor
By Linette Lai, Political Correspondent, The Straits Times, 8 May 2019

A total of 25 schools, as of April 26, have offered their Secondary 1 female students cervical cancer vaccines as part of the national school-based vaccination programme, said Senior Minister of State for Health Amy Khor yesterday.

She added that 93 per cent of the students opted to take the free vaccination.

In March, the Health Ministry announced that all Secondary 1 girls in national schools, including madrasahs, will be offered free vaccination against the human papilloma virus (HPV) from April to protect them against cervical cancer.

Around 200 women in Singapore get the cancer each year and 70 die from it.

Dr Khor, in her response to Mr Alex Yam (Marsiling-Yew Tee GRC), said most parents who opted out did so as their daughters already had been vaccinated, or because they preferred to take them for the vaccination on their own.

Fewer than 1 per cent were concerned with the vaccine's safety and side effects, she added.

"When parents do not give their consent, we contact them to provide them with information of the benefits and importance so that they can make an informed decision," she said.

She stressed that it is important for parents to refer to "reliable and verifiable sources of information" on the vaccine. These include websites such as her ministry's HealthHub, the World Health Organisation (WHO), the United States Centres for Disease Control and Prevention, and the European Medicines Agency. The vaccine is recommended by the WHO and other leading health agencies for the prevention of cervical cancer.

Dr Khor added: "Of course, parents ought to... speak to the doctors who will be best placed to give them advice and provide accurate information."

Mr Yam also said some parents have raised concerns that the HPV vaccine may lead to promiscuous behaviour.

The vaccine is typically recommended for women who have not yet had sex, as sexually active women may have been exposed to virus strains targeted by the vaccine.

Dr Khor said there is no evidence that women who have got the vaccine started having sex earlier or have more partners than women who have not been vaccinated.

She said her ministry and the Health Promotion Board will continue to highlight the benefits, importance and safety of the vaccination to parents and students.

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