Deborah Maine Asks, "Does the HPV Vaccine Make Sense?"

On Wednesday, May 16th, the Maternal Health Task Force at the Women and Health Initiative hosted Deborah Maine for a seminar on cervical cancer at Harvard School of Public Health. The seminar was titled, “HPV Vaccine: Does it make sense?”

Deborah Maine, an epidemiologist with a background in anthropology and over 30 years of experience working on reproductive health programs in developing countries, developed the three delays framework for understanding maternal mortality—a framework that continues to guide the work of maternal health program implementers and researchers alike.

In recent years, Maine has been working extensively on the issue of cervical cancer. Her May 16th presentation focused on the controversy around priority setting for cervical cancer prevention, screening, and treatment in developing countries.

Maine explains the controversy:
“Even a successful vaccine program won’t help women already sexually active. Focusing only on the vaccine means writing off 2 generations of women who have already been sexually active and have already been exposed but will not benefit from this. And I wonder: Would anybody even propose a child health intervention that would take effect in 20 years? I don’t think so. I think this is something that happens preferentially with women. And I think it is a human rights issue. I really do.”

A few of Maine’s recommendations:

• Retire the pap smear. “It is like a horse and buggy. It was great when that was all we had.”
• Visual inspection and DNA tests are both more sensitive, cost less, and have lower loss to follow up.
• Increase coverage of screening in both developed and developing countries.
• Focus on neglected groups.
• Focus on women over 30.
• Avoid over screening.

Dr. Maine wrapped up her presentation by reminding the crowded room of public health students, researchers, and implementers of a very important point: “I would just like to remind everyone that 5 million women who have already been infected with HPV will die before the vaccine can have effect. Improving screening programs is the first priority in both developed and developing countries.”

The presentation was followed by a lively Q&A session.

Watch the video of the presentation here.

Click here to read a recent paper by Maine and colleagues, Cervical Cancer Prevention in the 21st Century: Cost Is Not the Only Issue.

Learn more about Deborah Maine here.