Now that I am vaccinated, then what?...

The expressed opinion in this post are made entirely based upon the author's own impression and knowledge. They are not influenced in any way, nor the author being given remunerations in any form by any party.
In the effort to reduce the incidence of Cervical Cancer, multiple awareness campaigns held by pharmaceutical company isn't suffice. It may serve the purpose to remind the public the presence of this disease, and that the vaccine against it is available. But I doubt the public knows the degree of seriousness this disease and it's impact upon the lives of patients and caretakers.
Personally, as a medical practitioner, I felt the need to be more proactive and reach out to the public since the community is unaware of the impact cervical cancer has.
Public perception is the single most important factor in the effort to lower the prevalence of cancer.
No doubt, cervical cancer vaccine receives its share of bad reputation from media. Those 12,000 reported adverse effects are mainly against Gardasil, not Cervarix.
Naturally, first and foremost important task to achieve is to educate the public and to make available the true facts to dispel the negative impression the public had perceived.
Through campaigns, seminars, talks, public forums, internet, etc.. any form of mass media that enable to reach out the facts on this vaccine. However, the facts shouldn't be biased, and to reveal possible side effects, right from the trivial to the serious side effects.

My preference for GSK's Cervarix is based upon it's quality which I determine by :-

1. The spectrum of protection it provides

2. The duration of immunity the vaccine provides.

As the law states, any products which is of pharmaceutical grade is required to list it's possible side effect, even if its remote and rare.
GSK does just that in their brochure which is handed to the public.

Possible side effects are divided into very common,common, and rare

These brochures are distributed by the nurses to the patients, or displayed in strategic areas in clinics for patients to to read while awaiting their turn to consult the doctor.

For patient's convenience, these brochures come with a follow up card with columns to write the dates for vaccination.

This goes to show that GSK goes all the way not only to encourage, promote, but to remind patients of their date of the subsequent doses.

Does completion of vaccination prevents cervical cancer altogether? Absolutely not. Individuals who have had intercourse prior to vaccination are required to continue with their annual Pap smear.Cervical Cancer Vaccination DOES NOT replace annual Pap Smear for screening for pre malignant changes.

Pap Smear was discovered during World War II. Since then, it has reduced the mortality due to Cervical Cancer drastically by early detection of pre-malignant changes. If Cervical Cancer is diagnosed upon the first symptom, often the malignancy would have been in the advance stage.

It's a easy clinical procedure to collect sample from the cervix. Procedure is done with patient lying on their back.

A wooden spatula is used to collect sample from the surface of the cervix.

When the spatula is in contact with the cervix, it is then rotated 360 degrees to obtain the lining epithelium of the cervix.

The sample is then smeared on a glass slide, which is then chemically fixed with a cytofix.

As shown in the picture above, the sample is fixed onto the slide with the cytospray. It is then examined by histologist/cytologist to detect changes of the cellular make up. 

Despite the drastic reduction of mortality rate in cervical cancer , the incidence of "false negative" reports in Pap Smear is relatively high. (False negative is failure to detect early pre malignant changes,hence the sample is reported as normal) this gives the patient a false sense of security.
Pap smear is an effective way of screening for cancer, however, it's not diagnostic. Even when considered effective, there is still possibility of a false negative report. The percentage of false negatives ranges between 5%-50%, out of which 80% are true false negative, and the rest are due to mistakes done in the laboratory.
To date, there is yet to exist a "perfect" test to detect and diagnose cancer in terms of cost effectiveness and accuracy.

Even though our government provide free Pap Smear screening program at government hospital, sadly percentage of woman who actually did the test remains low. To my opinion, this is due to the attitudes toward cervical cancer and participation in early detection and screening services are well known to be profoundly affected by cultural beliefs and norms.
 Pap smear coverage in the country was a dismal figure of less than 2% in 1992, 3.5% in 1995 and 6.2% in 1996.Most woman have a wrong perception of Pap Smear.Many believe it to be  diagnostic rather than screening, hence do not see the necessity to get it done, until the presence of symptoms that prompts them to do so.

Other main reasons for not doing the screening included lack of awareness of Pap smear indications and benefits, perceived low susceptibility to cervical cancer, and embarrassment. Other reasons for not being screened were related to fear of pain, misconceptions about cervical cancer, fatalistic attitude, and undervaluation of own health needs versus those of the family.

These are some of the many reason behind the drawbacks of Pap smear. As I had mentioned earlier, public perception and an awareness of the nature of disease is of utmost importance in the effort to decrease of its occurrence. 

Say ,somehow we managed to change the mindset of society towards annual screening, the next question would be the accuracy of Pap Smear. 

It's rather unfortunately that I've encountered quite a number of patient who's family member who previously goes for their annual Pap Smear religiously, was reported to  be normal, but 5-6 months later, succumbed... due to Cervical cancer. With total disbelieve, those family members would never have a closure to what has happened.

The inaccuracy of Pap Smear could be due to sampling where inadequate samples are collected. Based on head of histology and cytology department, Gribbles Laboratory(Malaysia), upon smearing the sample onto the surface of the glass slide, only 20% of the samples are deposited, while the other 80% are discarded along with the wooden spatula. 

.....which is of course naturally discarded into the waste bin.

....... Such a small and trivial avoidable mistake that cost someone's life....

All it takes for  a more thorough screen is all still on the surface of this spatula...
While Conventional Pap Smear is a good method to detect squamous cell carcinoma(85% of cervical cancer that arises from the ectocervix)......

...Ectocervix is part of the cervix that faces the vagina, while 15% of cervical malignancy is due to adenocarcinoma which often arise from the endocevix...

...Endocervix is the part of cervi that faces the uterus. Hence conventional Pap Smear is unable to detect adenocarcinoma.

...advance stage of Cervical cancer....
Though conventional Pap Smear reduced the number of mortality significantly, nevertheless, for those unlucky undetectable "adenocarcinoma" type, 15%,30%, or 50% doesn't mean anything to them. It simply doesn't make any difference.
Since 1996, an improvised version to counter the problem in sampling by Conventional Pap Smear was found.
Thin Prep Pap Smear.

This process differs and possesses several advantages over conventional Pap Smear.

Most importantly, the brush which is used to collect the sample is designed  in such a way to enable a thorough sampling from both ecto and endo cervix.

As you can see, the design of the brush is such a way that the centre bristles are longer than the surrounding ones. The longer bristles is able to reach deep into the endocervix, and collection of sample is done by rotating the the brush once it's inserted on the right place.

The sample taken from the brush has both endo and ecto cervix.

The brush is then rinsed by pushing the brush into the bottom of the sampling vial several times, forcing the bristles apart. Lastly, the brush is then swirled vigorously to further release the sample.

The name and the ID number of the patient is written of the surface of the container, and send to the lab for investigation.

The second advantage being that the sample are screen twice compared to only once in conventional Pap Smear, which then depends on the experience of the pathologist who writes the report.
While in Thin Prep, the first stage is screen by a computerized imaging device that screens and detects abnormal cellular picture, which then proceeds to the second stage where the abnormality is confirmed by the pathologist.
If at all there are presence of abnormal findings in the Thin Prep, the same sample can be sent for HPV DNA testing to determined the subtype of HPV, in addition to STDs, while in conventional Pap Smear would require a second sample to be taken.
Today, 90% of cervical cancer screening in the US is done via Thin Prep Pap Smear. The high sensitivity and specificity of this test is significantly more accurate than conventional Pap Smear.

It's rather alarming to know that not many general practitioners are aware of the availability of such test. Out of all the Pap Smear samples received by Gribbles Lab( Malaysia) only 30% are Thin Prep Pap Smear, and out of that, only 20% are sent by general practitioners.
Considering the awareness, or rather ignorance among doctor on the availability of such investigation, the public aren't the one to be blamed. How would the public know if it's not being brought up by the doctor?

It's in the book. Just in case if my fellow doctor aren't aware on where to look for it, it's here...

Yes.. It's on page 13.

I would encourage my fellow doctors to constantly update ourselves through the internet or medical journal in regards to latest advancement, new regime of treatment, latest method of investigations..etc.. because decisions made by us determines the outcome of lives of others.
So, fellow, readers, after reading this particular post, the thing to remember is:-
1. Get vaccinated NOW!

You would be deluded to even consider contracting cervical cancer is being far fetched.
2.DO NOT DEFAULT in your vaccination.

3. Upon completion of vaccination, it doesn't mean you need not do your annual Pap Smear.

4.Request for Thin Prep Pap Smear instead of conventional Pap Smear.

5.Spread the news around. Discuss with your doctor today about Cervical Cancer. Inform your friends and ask them to come along if you feel hesitant on seeing the doctor by yourself.

Cervical cancer is the second cancer which is preventable by choice. So chose not to have cervical cancer. Get vaccinated at the clinic near you today!

Effort to reduce Prevelance of Cervical Cancer in Malaysia

GlaxoSmithKline, the pharmaceutical giant that manufactures Cervarix, is organizing another symposium to update and share ideas among doctors in the endless dedicated effort to lower the incidence of Cervical Cancer. GSK indeed is a pharmaceutical company with an unquestionable ethics, that produce excellent cutting edge and high quality health products in keeping up with global demands.
The lowered cost of Cervarix to enable accessibility by community from all walks of life, regular conventions,symposiums, and talks by world renowned experts to share and update on the latest development of their product, aggressive health campaigns to create public awareness, and round table discussion with experts who spearheads in their respective fields in the move to minimize the incidence of cervical cancer. While the incidence of Cervical cancer has drastically reduced with the discovery of Pap Smear during World War II, the genetically engineered vaccine totally revolutionize the approach to cancer by prevention. With Cervarix, the field of medicine has progressed by leaps and bounds with gargantuan significance that is forever immortalized in the history of mankind. Today, this is the second among so many form of cancers, that is preventable by man. The other being liver cancer.
It is rather disheartening to know the effort put into the research and finally the discovery of this near miraculous vaccine isn't just not being well accepted, but being opposed by certain groups of people who do not fully comprehend, nor open minded enough to even try to understand the benefits of this vaccine.

Ignorance is the main hindrance to progress of mankind. However being ignorant due to lack of information available is excusable, but expressing dissatisfaction and opposition by posting "warnings,'you vaccinate-you die' kind of articles, videos on YouTube, etc" without the fully understanding the facts about this vaccine is simply wrong. It is understandable that prior to subjecting yourself to a "controversial" vaccine, there are questions and doubts lingering in your mind.

I do encourage the public to inquire from the doctor the full facts on this vaccine.  Unfortunately, it is sad to admit that not all doctors are well versed in cervical cancer or the vaccine. Naturally, if you find the doctor's explanation isn't convincing enough, you'll search for information from the internet. That's when misinterpretation and misunderstanding of this vaccine begins. Most of the videos posted in YouTube are by individual who's opinion is formed from an inadequate knowledge.

I am really amazed at some individuals who actually thought this vaccine is a part of some government conspiracy to sterilize woman, and how these vaccines were related to  freemasons. Click here to have a good laugh. I sincerely cannot imagine the things that was going on in their mind while writing that. I had my share of good laugh after reading such post that is so ridiculous to a point where it becomes an entertainment.

US's FDA and UK's NHS do not approve a drug unless they had passed a set of criteria upon which only would their safety be established. US's FDA not only approved of it, but actually recommends it to protect girls and young woman from developing Cervical Cancer later in life. Click here for reference.
The death of a 14 year old Natalie Morton in UK on the 29 September 2009, hours after being vaccinated was found not to be caused by Cervarix, but instead was due to a undiagnosed huge malignant tumour in the lung and heart. Click here for reference.
As stated on the disclaimer on this blog, my choice of vaccine between the two available ones in the market is not being influenced by any party nor being given remunerations in any form by the pharmaceutical company that manufactures the vaccine.
So far, there are over 12000 reports of complications upon administration of HPV vaccine. As I had explained in detail about the validity of the reported side effects, and how the media play the role in amplifying the degree of "adverse effects", one should note that these reports weren't made against Cervarix. Click here to verify.

In the scientific and medical community, the unwritten rule is US FDA is being regarded as the Gold Standard for many other countries to refer to. I am not sure whether my fellow Malaysians are aware at the fact that Malaysia do not posses a lab of our own to conduct scientific studies prior to approval of drugs. I am not sure what are the set of criteria our local "FDA" is based upon to establish it's safety.
However, one can be assured of the quality of drugs and its safety upon approval by FDA as it possess the reputation for protecting  public health and consumer safety.
The response towards cervical cancer vaccination is still very low, despite GSK's effort in multitude ways to create awareness campaigns, public forums, regular symposiums by inviting world renowned experts in various fields to update and share the latest information and development of new drugs, all this being done bearing society as the beneficiary. Unlike some company that I've come across, especially in the field of cosmetology, doctors need to pay,often amounting to thousands to attend courses and often as a token of "qualifications" upon completion of the course, these doctors are issued "certificates of attendance" that is hung on the wall of their consultation room, very often giving patients a false sense of confidence towards the doctor.Who benefits from this?
Base upon the regular visits from company representations, this unquestionably  proves GSK's commitment in supporting health care provider.

It was less than 3 weeks ago since the last symposium held in Le Meridien Hotel, Kuala Lumpur. Just a few days ago, the friendly company representative invited me to attend another symposium on this coming 20th April, in Hilton Hotel.

The topic for the symposium is Broadening The Protection Against Oncogenic HPV Types.
I am looking forward for this symposium as the guest speaker would be a leading European Virologist, Professor Tino F. Schwarz, Head of Virology Laboratory at Foundation Jusliusspital,Wurzburg,Germany. He has 19 publications in various field concerning vaccines, virology, pandemics, etc.

Looking at his resume, he is the best person to talk to when comes to issues such as safety profile of HPV vaccines. But most of his research are based on Cervarix, which has the least if not non adverse effect compared to the other available vaccine in the market. A leading virologist in Europe who has traveled all around the globe to speak in symposiums attended by many well known doctors in various fields. It would be quite an experience to
have the opportunity to meet him.

This goes to show the degree of commitment of GSK in it's contribution in public health and consumer safety by regularly organizing symposiums as such, in addition to the regular visitation by the company representation to doctors to share the results of the latest studies.
I was excited and looking forward to attend the symposium on the 20th, but I was ESTATIC when I received this!

A round table discussion with Professor Tino himself. This invitation is limited to only 30 doctors all over Malaysia. I felt honoured, yet nervous since it's only limited to only 30 doctors, obviously, those 30 doctors would be intellectuals, professors from various teaching hospitals, researchers, consultants Gynaecologist with fancy titles like Datuk, then it dawned upon me, GOSH! How is it possible that I got invited in this event?

Out of curiosity, I requested for the list of doctor who are invited to attend the event.
Thank God there's no Datuk, nor anyone in the list who is a professor, but out of the 40 names listed, only 3, including me, are general practitioners, while the rest are gynaecologist.

I was having a mix feelings of excitement and nervousness at the same time.

The round table discussion will be held on the 19th April, at One World Hotel. That's tomorrow!Yikes! I was all excited and REALLY looking forward for the RTD, until I received a SMS from the pharmaceutical company representative,

Arrrrggghhhhh!!!!!!!!!!!

The cheapest cost for Cervarix in Malaysia?

Guaranteed the lowest price of Cervarix in Malaysia. Call now to inquire on it's price at 62722678

My rationale for vaccination vrs against those who opposed of it...

Simply go to Youtube, and key in the word "side effects of cervical cancer vaccine",  the page that appears is full of videos clips of claims of its hazardous side effect, death, complication, whether or not a person should be vaccinated or not.. it's just simply overwhelming.

I thought to myself for a while, and I guess the best way to change the mindset of public perception on this vaccine would be to publish a mail which I've received today, and the reply that I wrote.

I am from India and am 42yrs old.
I had my daughter of 18yrs vaccinated with the first course of Gardacil on 10th April 2010.

I was very worried when i read articles is the local newspapers doubting the efficacy of the vaccine and its side-effects. I was in mental torture after watching the youtube videos against the HPV vaccine.

Please kindly advice about the side-effects and dangerous risks(infertillity, blood clots etc) associated with the vaccine as mentioned online in reports.

Thank You very much,

Your help in the matter will be sincerely appreciated.

************

After reading his mail, I thought his worries are totally unnecessary. But who wouldn't after so much hype the public created? So, my reply was this:-

Dear respected Mr ***,
First and foremost, I would like to express my sincere thanks and appreciation for writing in to inquire regarding HPV vaccine. The sole purpose of me writing a blog on HPV vaccine is to reach out to the public, local or foreign to educate and to create an awareness regarding this vaccine.
I understand completely the psychological trauma you are bearing at the moment. With each YouTube video that you watch, it felt like the worries you already have kept on piling up. I am sure at a given time, you had wondered why isn't there any video on the positive side of these vaccine? I am a father to 2 daughters, and I can imagine being in your shoes. You are not alone,Mr*** . I am glad you write in to inquire concerning the efficacy and potential side effects of this vaccine. I sincerely wish more people would be as inquisitive as you,Mr ***.
First and foremost, Mr ***, i would like you to know that as a medical practitioner, I personally feel the duty of a doctor is beyond treating the sick.In addition to that, we are responsible to create an awareness and to dispel any form of misinterpretation and misunderstandings on a certain disease or drugs stemming from rumours, friends, personal experiences, etc. I will speak to you as friend, rather than a doctor-patient relationship.
I sincerely hope you will be assured and have a better understanding about this vaccine after reading this mail.
Since the launch of the first anti cervical cancer vaccine, Gardasil in 2006, it was was received with much controversies. Some believed that this vaccine gives the false sense of security and encourage sexual promiscuity among the recipients. Personally, I felt this is a unjustified and unwarranted, as it is entirely depends upon the upbringing of the individual, and not the vaccine. A well brought up individual would know for themselves the impact and consequences of health and morality issues on promiscuous sex, irrespective of being vaccinated or not.
The total amount of reported "side effects" that was more than 12,000 cases so far is rather far fetched and exaggerated.
The side effects such as pain, muscle weakness, fitting episodes, convulsions,epilepsy, Bell's palsy, lost of sight, dizziness, blood clots, infertility, auto immune diseases, etc are being highlighted and repeatedly being portrayed as "definitely hazardous" by many.
But Mr ***, as in other given vaccines that provide protection against viral diseases, it acts by stimulating our immune system, thus creating antibody against the disease. I am sure you are aware on the fact that in our lifetime, we never get flu from the same virus twice.
Initially when our body is being infiltrated by pathogens,eg bacteria and virus.. our immediate immune response would be non specific characterized by fever, nasal congestion, running nose,  basically the feature that you see when you fall sick.
To understand that these claims of so called "dangers" or "hazards", you would need to understand a little about immune response.
Initial body response to infiltration of pathogens would be a non specific response to deter the propagation of the pathogen. What at the features? Lets look at them one by one.
1.Fever. Mechanism of Fever and why?
Our normal body temperature is 37.4 degree Celsius. Incidentally, it happens to be the optimum temperature of which bacteria and virus flourish. So, as a pre programed immediate response, our temperature control centre located in the brain would reprogram itself to increase the norm from 37.4 to a higher temperature, say 38.5C. So now, 38.5C is perceived as normal in sick patients.
2.Running nose, sorethroat,
This are due to inflammation of the mucosa of the lining epithelium(the cellular layer than lines that inner surface of body) and vasodilatation(widening of blood vessel to increase blood flow to the effected area).
The inflammation response is a result of cascade of chemical reactions characterized by increased local temperature, redness, tenderness, swelling. This in fact do increase the blood flow to the infected or affected area as white blood cell(our body defense "soldier" that defends against bacteria) contained in the blood would be channeled to the site.
All these response are non specific and does not last. They are pre- programed with the intention of providing an initial defense before a more specific response takes place. Remember that I mentioned that early non specific response is mainly inflammation as a result of cascades of chemicals being released into the blood circulations particularly histamine,bradykinin, serotonin, leukotreines, and prostaglandins.
These non specific defense response takes place before a more specific target orientated long term response develops, upon completion which renders the patient having the long term protection against the same pathogen in future, by which the patient becomes immune toward a second attack from the same pathogen,.
As the initial response is non specific, it involves the entire body system. Some exaggerated immune response would result in allergies. Similar to asthma.
It is this non specific inflammatory response that attribute to the so called complication upon administration of vaccine into an individual. As these vaccines are made up of protein from the capsid of the virus, is doesn't contain virus DNA hence IT DOESN'T CAUSE HPV INFECTION. So by this, it dispels the argument that the vaccine is the cause of HPV infection as highlighted in this YouTube presentation.
The report of patient develop epilepsy, seizures, convulsions upon the administration of HPV vaccine, to my humble opinion isn't valid. No one "develops" epilepsy. It's not a disease that one contracts. It's either a person is born with abnormality is the brain's electrical pathway, E.g damaged pathway in Cerebral Palsy, head injury involving the brain, tumour.etc.  Judging from the way these articles are written, one can easily identify the author as non medical background. Fitting, seizure, convulsion. These terms describes the same condition. It it written in such a manner that is easily misinterpreted by the public as if these three words are different entities altogether. One may develop seizure, but not necessarily be an epileptic, but all epileptics have seizures.
Epilepsy is the condition, while seizure is the clinical presentation.
One needs to remember that a person who is epileptic may get a seizure which can be triggered by various factors, including flashes of bright lights, not enough sleep, restlessness, anxiety, stress, missed medication, etc. Whether or not these reported seizure post vaccination were epileptic to begin with isn't being reported, as while awaiting for their turn for vaccination and pain induced by the intramuscular injection may trigger it off. Hence, by that, one cannot attribute the seizure as the result of the vaccine.
Non specific inflammation response towards introduction of pathogen or any particle that is recognized as  being foreign is a pre programed response developed within the physiology of the human body as a result of million of years of evolution that involves a gradual slow process of adaptation towards becoming a perfect being within the surrounding environment. As the definite, long term, and specific defense mechanism(immunity) which is a characteristic of  creature of higher level of evolution takes time, hence the immediate response towards detection of pathogen would be generalized and often systemic. As I had mentioned earlier, inflammatory response is a main feature in a non specific response.
When inflammation involves the nervous systems, where it interferes with the transmission of electrical signal along the nerve, the motor and sensory response would obviously be affected. Hence this accounts for the reported cases of Bell's Palsy,hemiparesis, numbness or hypersensitivity of the extremities, muscle weakness, temporary loss of sight, temporary paralysis, transient loss of hearing.
As for autoimmune disease, I believe the susceptibility of a person to develop autoimmune disease is pre determined by gene. Very often viral infection or vaccines that triggers an immune respond may trigger an acute episode in these individuals, which can be controlled by steroids. However, the report of vaccine causing an auto immune disease has not been  reported. It may trigger an acute attack on patient who are known and already being diagnosed earlier, or may trigger a first clinical attack on genetically susceptible individuals. However, one should understand that this is being observed on various auto immune disease like Systemic Lupus Erythematosus, Guillain -Barre Syndrome, Multiple Sclerosis, myopaties, vasculitis, rheumatoid arthritis,etc.. where its been observed that  vaccine have a different spectrum of susceptibility in triggering attacks on each of the listed auto immune disease. Some are not related, while some may trigger the attack but the degree of correlation between vaccine triggering attacks is inconsistent to be listed as a contraindication. In cases of Guillain Barre Syndrome, one needs to be careful and observe for an acute attack, but not in any way, a contraindication. Click here for reference. Instead of jumping into the bandwagon in the effort to protest against vaccination for HPV, these correlations of "complications" post vaccination doesn't apply to HPV vaccine alone, but also for Hepatitis B, Hepatitis A, and the various Influenza vaccines in the market.
The process of manufacturing and mechanism in development of immunity is the same for all these vaccines, but it doesn't make sense as to why is HPV being a topic or a much heated argument and controversies?
Very often, Mr ****, man by nature are psychologically creature of convenience. What seemed acceptable to them despite all the risk involved is received without much debate, while another with similar risk, when an opinion has been formed in the minds of people, every trivial temporary effects will be highlighted.
In the beginning when Gardasil was first launch, besides being expensive, medical practitioners have difficulties to even introduce the vaccine to parents of potential recipients, as cervical carcinoma is often being associated with multiple sex partners. Patient often felt offended when a doctor suggest this vaccine to them as they have the impression that they are thought to sexually promiscuous.
The protest against vaccination  as it gives a false sense of security and promotes sexual promiscuity is an excuse, rather than a reason. What has promiscuity got to do with medicine? It's psychological rather than a medical condition. The following are based upon my own observation, and not in any given time have I claim to be an expert in psychology. My opinion are not to be taken as facts, but rather perceived as an opinion from an individual.
I observed that 90-95% of the so called reported side effects comes from developed countries such as US, UK, and certain European countries. The epidemiology of cervical cancer indicated that its occurrence is significantly higher in developing and third world countries.
Once, a well known Consultant gynaecologist and obstetrician, Professor Dr B.K Lim, quoted in a symposium held by a giant pharmaceutical company, that the incidence of cervical cancer is so low in UK that training hospitals for future Gynaecologist have a hard time obtaining cases for training purposes. I would rationalized that since it has such a low incidence rate, the community do not see the degree of importance and significance of these vaccines to them compared to us who are from developing countries where cervical cancer is ranked top three among death due to malignancy, where the benefits of the vaccine far outweighs the potential side effect.
In the US, the incidence back in 2009 was just over 11,000 with mortality just over 4000 cases, compared to Asian countries where more than half of the overall global cases are from us.
The low incidence of cervical cancer in UK and US is attributed to the availability of an advance screening method, where more than 90% of screening done in US today is through Thin Prep Pap Smear.
Why only HPV vaccine be the much heated and controversial subject today? Why not Influenza Vaccine be the topic of debate when the method of manufacturing these vaccines are the same? While some says that efficacy of HPV vaccine is "questionable" as it hasn't been through the test of time.
Then, for the same reason, H1N1 vaccine was developed and it wasn't being subjected to the similar "test of time" nor its long term complications is known, but everyone is rushing to the nearest clinic to get themselves vaccinated? As a matter of fact, H1N1 vaccine was developed urgently and has not being subjected to sufficient test to established it's safety, but why wasn't it being debated upon? Why the discrimination?
It's because H1N1 that originated from Mexico City spread at an exponential rate to countries irrespective of whether it's developed, developing, or third world. Then, the UK and US general public demanded the vaccine despite it being at its infancy. News reports with photos showing people queuing up all the way out of the hospital premises still remain fresh in my mind. Why weren't there any debate? Because to them, the benefits far outweighs the potential side effects.
Based on this Mr ***, I see an element of discrimination and bias over the report and controversies involving this vaccine. The potential side effects are exaggerated and repeatedly highlighted.
Suddenly so called "experts" started popping out everywhere voicing their "human rights NOT to  subject their children to unnecessary life threatening risk" which I find it rather hypocritical just because they don't face the same degree of incidence as other countries.
 In my opinion, the so called side effects of this vaccine seemed more high risk simply because of media and public perception. Most of the doctors who have a bad impression of these vaccines are individual opinion.
FDA of US and UK's NHS will not approved these vaccine if the safety aren't being established. If the vaccine is at all that hazardous as it is being portrayed, then why would the health authority of these countries approved of it then? These countries are:-
Australia,Brazil,Canada,Denmark,Finland,France,Hungary,Germany,Iceland,Ireland,Italy,Japan,Korea,Luxembourg,Norway,New Zealand, Sweden,Switzerland,UK,US,Uruguay,India, Malaysia.....the list goes on.
I hope this would give you some assurance, Mr ****. Have a good day.

Warmest regards,  
So, guys, now you tell me, what is your opinion on this vaccine now?

Cervarix.What else can be done?

With the amount of effort I've put in creating awareness among woman in Malaysia concerning Cervical Cancer, I wouldn't say I am at all passive about it.
Right from decreasing the price to the extent where some people begin to doubt the genuineness of the vaccine(yes, I know doctors who started injecting normal saline when their vaccine ran out of stock) 

...to placing pamphlet on Cervical Cancer awareness on every corner of my clinic...

like this placed right on the drug collection and payment counter, NOBODY could miss it. And if that's not enough, i got this piece of huge sticker pasted on the counter itself...

There.. wait, there's some more!..

This is placed right at the registration counter. Well, all these are placed in the clinic, what about outside the clinic where people walk by?

First I've got this pasted on the glass entrance of the clinic, in addition to this...

Well, after all of these, if it still couldn't draw the patient's attention, I think I would be right to assume that they simply don't care.
There are times when I felt what's the point of all this effort when they chose not to respond? You could prepare a mouth watering meal, but it takes the person to reach out, grab the food, and place them into their mouth.
After a while, it came to my senses that perhaps the crowd aren't paying the due attention as they simply aren't aware of the degree of the disease and how it affects not only the patient, but the caretaker as well.
So, i begin to write post on cervical cancer, it's discovery, the significance and importance of getting vaccinated, to inform the general public on the more accurate method of screening for early signs of cervical cancer in this blog. So, a lot of those who sent me mail to inquire on the vaccine would someone get to know me on a personal level, which can be both good and bad.

Later i realized that letting the public know too much on my personal side isn't always a good thing. So, I created another blog purely to post write ups on cervical cancer vaccine of my choice.

The URL of this blog is www.cervarix.blogspot.com. All my previous post are transferred from my personal blog to this new blog site.

Well, I received quite an encouraging number of people writing in to inquire on the whereabouts of my clinic. However, hardly anyone turn up.
Again, for a while, I thought to myself, that's how far I'm able to go.But after a short period of time, my inner self told me "don't falter, you need to get off the boat to walk on water."
Don't get why I am trying to say? Well, that's what happens when you listen to too much of U2. It means not to be discouraged. Put more effort, take some risk, you wouldn't know what would the result be in the end which could lead to something unexpected.
So, last week, I thought my old poster wasn't attracting any attention as it's written in monochrome.The new one is this

It's written the price for each dose, along with a logo of a camera for passerby to snap the URL in case feeling reluctant on seeing me. And to convince that I am using the genuine product, I even pasted a photo of the product. My previous post tells you ways to make sure the doctor whom you are seeing is giving you the genuine stuff.
I pasted two of this, one on each side of door.
As I was watching the CCTV from my consultation room, i was feeling despair seeing this!

Notice the screen on the upper right?

In case if you fail to notice the picture, non of these people who walked past the poster even stopped to give a look at it!
I went out to take a picture of the poster when I spot 2 ladies who walked by....

Sorry, photo is blur as I had not time to focus. Yup, like the rest, didn't stop to look at the poster at all.
This reaffirms my belief that generally,people here are rather ignorant when comes to health.
Sincerely, I don't know what else can i do.