In 2006, the world witnessed a medical milestone: the introduction of the HPV vaccine, hailed as a potential “cancer-prevention wonder.” Promising to protect against human papillomavirus (HPV), a virus linked to cervical and other cancers, the vaccine was rapidly adopted globally, including in Nepal, which launched its program in February 2025. Yet, as millions received the vaccine, a growing resistance started, questioning its safety, efficacy, and the transparency of its approval process. This article explores both the vaccine’s promise and the controversies swirling around it, drawing on the book The HPV Vaccine on Trial and recent data to ask: Is this vaccine a public health triumph – or a warning signal?
Nepal’s hope: A nationwide campaign
On February 4, 2025, Prime Minister KP Sharma Oli launched the campaign at Shivapuri Higher Secondary School in Kathmandu, distributing vaccines to health workers (R1). The drive, timed with World Cancer Day, aimed to immunize girls in grades 6–10 and out-of-school adolescents aged 10 – 14. Over 27,000 health workers and 54,000 female community health volunteers mobilized across 18,900 schools and 8,200 health facilities.
“This is a historic moment,” said Health Minister Pradeep Paudel, emphasizing the goal to vaccinate 90% of girls by 2030. Nepal’s campaign, supported by Gavi, WHO, and UNICEF, marks a bold step toward reducing cervical cancer rates, the leading cancer-related killer of Nepali women.
Cervical cancer claims four lives daily in Nepal (R2/1). The campaign, backed by 1.77 million doses supplied by Gavi, aimed to achieve WHO’s recommendation of a single-dose regimen, deemed as effective as multiple doses (R2/2).
Bollywood actress Manisha Koirala, a cancer survivor, joined as a goodwill ambassador, urging families to embrace the vaccine (R3).
The vaccine’s promise: Global success stories
Globally, the HPV vaccine has shown promise. Australia reported a 90% drop in genital warts and a 30% decline in high-grade cervical abnormalities within a decade of introducing the vaccine. WHO’s 2024 report highlighted “therapeutic” vaccines in development, offering hope for adult women in low-resource settings. Nepal’s campaign aligns with WHO’s 90-70-90 targets: vaccinating 90% of girls by age 15, screening 70% of women by 35 and 45, and treating 90% of cervical cancer cases (R4).
The Controversy: Voices from the Margins
The HPV Vaccine on Trial, authored by Mary Holland, Kim Mack Rosenberg, and Eileen Iorio, challenges the narrative of universal benefit. The book details harrowing personal stories:
- Christina Tarsell, a 21-year-old U.S. college student, died in her sleep 18 days after her third Gardasil dose. A federal court later ruled the vaccine likely caused her fatal arrhythmia.
- Alexis Wolf, a 13-year-old, developed seizures, cognitive decline, and chronic pain after vaccination, losing years to disability.
- Joel Gomez, a 14-year-old boy, died in his sleep hours after his second dose, with experts linking his death to vaccine-induced myocarditis.
These cases, among others, highlight a pattern of severe adverse events, including autoimmune disorders, neurological damage, and death. The book also argues that:
- Conflict of interest: U.S. agencies earn royalties from vaccine patents while regulating them.
- Data gaps: Long-term safety studies are very limited, and the vaccine’s impact on cancer rates remains unproven.
In Nepal, the government’s decision to adopt a single-dose regimen follows WHO’s 2022 recommendation, which concluded that one dose offers comparable protection to multiple doses. However, critics argue that long-term efficacy data is still limited.
Recent developments: Science or spin?
Recent studies add complexity:
- A 2023 Cochrane review confirmed the vaccine’s efficacy in reducing precancerous lesions but noted “low-certainty evidence” for long-term cancer prevention (RO1).
- Data from Denmark and Japan suggest a correlation between Gardasil and increased rates of postural orthostatic tachycardia syndrome (POTS) and complex regional pain syndrome (CRPS), though causality remains debated (RO2; RO3)
- the European Medicines Agency (EMA) reiterated the vaccine’s safety but acknowledged ongoing monitoring needs (RO4)
Critics like Dr. Yehuda Shoenfeld argue that aluminum adjuvants in the vaccine may trigger autoimmune reactions. This view of his resulted in his calls to resign as editor-in-chief of Israel Medical Association journals as well (RO5). While Dr. Sin Hang Lee’s research uncovered undisclosed HPV DNA fragments in vaccine vials, potentially acting as unapproved adjuvants (RO6). These findings, though contested by manufacturers, demand scrutiny.
Nepal’s crossroads: Proceed with caution
As Nepal rolls out its campaign, key questions loom:
- Safety monitoring: Nepal lacks robust systems to track adverse events. Post-vaccination surveillance is critical, especially given global reports of severe reactions in some cases.
- Informed consent: Parents must be briefed on potential risks. In India’s “demonstration projects,” alleged coercion and inadequate consent led to legal challenges (RO7). India rather took the route of developing it’s own version of vaccine (RO8).
- Equity vs. efficacy: Cervical cancer mortality in Nepal is 20.8 per 100,000 (WHO, 2023; R5). While the vaccine offers hope, critics argue that improving screening and addressing social determinants (e.g., nutrition) could yield greater impact.
Conclusion: Balancing hope and caution
The HPV vaccine represents a pivotal moment in Nepal’s public health journey. Its potential to save lives is undeniable, yet global controversies highlights the need for transparency and vigilance. As one parent in The HPV Vaccine on Trial shared in pain, “We were told this was safe. No one asked us to choose.”
For Nepal, the path forward must prioritize:
- Robust monitoring: Strengthen adverse event reporting systems.
- Community engagement: Educate parents on both benefits and risks.
- Equity: Ensure the vaccine reaches marginalized girls, while improving cervical screening.
As Prime Minister Oli stated at the campaign launch, “This is a historic step toward protecting our daughters.” But as the world watches, Nepal must ensure that every dose administered is a step toward health – not harm.
