The Daily Mail has followed yesterday's article (about the death of a young girl following vaccination against HPV) with one today from Dr Richard Halvorsen. Halvorsen's article is headlined "Dr Richard Halvorsen: I'm not opposed to jabs but there are serious worries."

What are these serious worries? Well, Halvorsen apparently believes that "the sudden death of Coventry schoolgirl Natalie Morton after a jab against cervical cancer highlights the reality that vaccination programmes are not without their risks". It seems to me that a sudden death that has not yet been explained - and certainly has not been confirmed to be linked to the vaccination - should not be characterised as a "serious worry" about vaccines. Nor does this case "highlight the reality that vaccination programmes are not without their risks".

I do not doubt that there are risks involved in vaccination, but it would surely be better to rely on incidents that have been shown to be linked to vaccination, rather than speculating about a case in which the facts are not yet in our possession, in order to highlight this point?

In fact, a preliminary post mortem has found that the girl in this case had a "serious underlying medical condition" and the Guardian has reported that: "Although local health authorities stressed that further tests needed to be carried out to establish how Natalie Morton died, they said the human papillomavirus (HPV) vaccine was "most unlikely" to have been the cause of her death."

While I agree with the sentiment expressed by Dr Halvorsen when he argues that we need to know whether vaccines "do more harm than good", Halvorsen goes on to contrast the sad death of Natalie Morton with the 911 deaths from cervical cancer in 2005. I find it odd that Halvorsen seemingly believes that the sad death of a young girl (that has not even been linked with the vaccination she received) means that the vaccination against HPV is of serious concern, but not that the deaths of nine hundred and eleven women is of serious concern. The exact words used by Halvorsen are as follows:

"In 2005, just 911 women died of the disease. Though every death was obviously a terrible blow to the victim's family and friends, this figure pales beside the 12,000 who died from lung cancer or the 11,000 who succumbed to breast cancer."

Just 911 women? Halvorsen's piece could be read as arguing that as there were 'only' 911 deaths from cervical cancer in 2005, it is not worth vaccinating against HPV. That more people die of other causes is not a good argument against trying to reduce hundreds of preventable deaths each year.

While Halvorsen compares the number of deaths from cervical cancer to those of lung and breast cancer, it would surely be more relevant to compare (a) the number of deaths (and complications) of cervical cancer caused by the strains of HPV that Cervarix vaccinates against with (b) the number of deaths (and complications) that have actually been linked to the vaccine.

We should not be considering whether lung cancer is deadlier than cervical cancer here - we should be considering whether not vaccinating against HPV is riskier than vaccinating against HPV. We have a vaccine available. The debate should be about the risks and benefits of the vaccine and should be informed by evidence.*

Dr Halvorsen then goes on to remind us that pharmaceutical companies are businesses, who have marketing departments and make profits. I mention this only because I was interested to note that Halvorsen writes that pharmaceutical companies "have a vested interest in deliberately whipping up public anxieties". Dr Halvorsen, who (as he reminds us in his latest article) runs "an immunisation clinic which offers a wide range of vaccines as a protection against various diseases", has previously written articles on the dangers of the MMR vaccine - and recommended vaccination with the single measles vaccine in this article. It could be argued that Dr Richard Halvorsen and the Daily Mail are themselves guilty of the charge of "whipping up public anxieties", which makes his criticism of pharmaceutical companies (not to mention the Daily Mail's decision to publish this criticism) seem perhaps a little hypocritical.

Dr Halvorsen's next tactic is to argue that the decline in deaths from diseases such as measles is due to social factors and the discovery of antibiotics rather than vaccination. This is an argument he makes against the effectiveness of vaccination. Halvorsen compares:

"...the late Victorian age, when tens of thousands of children died of tuberculosis, measles and whooping cough" with the situation today, where "such fatalities are almost non-existent."

It seems to me that in order to discuss the effectiveness of a particular vaccine it would be better to compare a period of time immediately prior to the introduction of a vaccine with the same period of time immediately following the introduction of a vaccine. I did this here, in a blog post on measles and vaccination. From this post:

"The 10 years prior to the introduction of the single measles vaccine (1958-1967) brought 863 deaths (and 4,120,936 notifications) and in the 10 years following the introduction (1968-1977) there were 292 deaths (a fall of 571 deaths – or 66%) – and 1,600,979 notifications (a fall of 2,519,957, or 61%)."

It seems clear that the introduction of the vaccine against measles saved hundreds of lives in the following decade. Reducing the number of deaths by two-thirds and saving over fifty lives a year seems a worthwhile endeavour. If you also consider that the number of notifications fell by over two and a half million in the same period of time and take into account the rate of complications in those infected, it is also clear that a number of people avoided serious complications from measles infection through the introduction of the vaccine. For example: the NHS factsheet "MMR The Facts" gives a rate of 1 in 1,000 people with measles suffering from meningitis/encephalitis, while 1 in 8,000 children under 2 years old are at risk of Subacute sclerosing panencephalitis (SSPE) - a rare, degenerative neurological condition that causes brain damage and death. The factsheet is available as a PDF here: link.

Halvorsen's article can be found here: link.

*I note that Halvorsen's article does not cite evidence in support of his opinions. Given the lack of references in other Daily Mail articles on health, I assume that it is Daily Mail policy not to reference research rather than an omission on Dr Halvorsen's part. For those who would like to read further on HPV vaccination, I provide this link as a starting point: HPV vaccination: the beginning of the end of cervical cancer? - A Review. There is discussion of the efficacy and safety of prophylactic HPV vaccines.