Immunisation: Preventing unintended new risk through education and information dissemination

16 July, 2019

Dear all

In our Reading Group we came across some very interesting discussions about the potential for new risk after immunisation in some circumstances, because immunising against one condition might lead to complacency of the immunised individuals who then become even more exposed to other diseases that are not covered by the immunisation.

Courtesy of Luiza de Oliveira Rodrigues on, we share the discussion: it relates to immunisation against cervical cancer which has been shown to be effective using Cardasil vaccine against HPV infection which is contracted through sexual activity (’the invasive cervical cancer mortality and incidence is decreasing rapidly because we have pap screening. in the areas where there is no screening cervical cancer keeps killing women (not in the developed world) and remains one of the competing causes of premature death’).

BUT cardasil is not cheap, especially for LMICS. The discussion is about what happens if people vaccinated with cardasil, knowing that they are safe from HPV become complacent and engage in more risky sexual activity and so become more exposed to other sexually transmitted diseases (STDs) including HIV, etc, and the consequences that follow.

The 3 posers below call for wider discussion and consideration by policy makers, health workers and the population in general:

‘1) But, where we don’t have screening (for economic reasons, mostly) are we going to have effective vaccination? isn’t it even more expensive than screening?’

‘2) Can vaccination decrease safe-sex behavior? and expose to other serious STDs? like the chronicity of aids (through the “optimism” with HAART):

‘3) Isn’t it cheaper and a lot more effective to invest in safe-sex education than to use gardasil? specially in low income countries, where cervical cancer is prevalent.’

We look forward to reading members contribution on the debate. To us it appears the solution is to immunise and educate simultaneously: immunise against HPV, establish national screening programme for cervical cancer, and educate the population that the vaccine only prevents HPV infection and not other STDs and so that they must not lower their guard / practice about safe sex.

Joseph Ana


@Health Resources International (HRI) WA.

National Implementing Organisation: 12-Pillar Clinical Governance

National Implementing Organisation: PACK Nigeria Programme for PHC

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HIFA profile: Joseph Ana is the Lead Consultant and Trainer at the Africa Centre for Clinical Governance Research and Patient Safety in Calabar, Nigeria. In 2015 he won the NMA Award of Excellence for establishing 12-Pillar Clinical Governance, Quality and Safety initiative in Nigeria. He has been the pioneer Chairman of the Nigerian Medical Association (NMA) National Committee on Clinical Governance and Research since 2012. He is also Chairman of the Quality & Performance subcommittee of the Technical Working Group for the implementation of the Nigeria Health Act. He is a pioneer Trustee-Director of the NMF (Nigerian Medical Forum) which took the BMJ to West Africa in 1995. He is particularly interested in strengthening health systems for quality and safety in LMICs. He has written Five books on the 12-Pillar Clinical Governance for LMICs, including a TOOLS for Implementation. He established the Department of Clinical Governance, Servicom & e-health in the Cross River State Ministry of Health, Nigeria in 2007. Website: Joseph is a member of the HIFA Steering Group and the HIFA working group on Community Health Workers.

Email: jneana AT