By Norma Erickson

9 August 2015, a citizen of South Africa (we’ll call her Sarah) sent the following questions about HPV vaccines to CANSA, the Cancer Association of South Africa. Sarah had no idea her questions would lead to a full-blown scientific debate.

Could you please let me know why CANSA is supporting the use of the hpv vaccines when these are now proven to be deadly? Several hundred young women have died because of this vaccine and thousands more are permanently disabled or battling with chronic health-problems. This vaccine has NEVER been proven to prevent cervical cancer. Many countries have banned these vaccines because they are not just useless, they are dangerous – why is South Africa using them? And why does your web page not list the potential side effects?

Sarah received a reply on August 13th referring her to Professor Michael Herbst, a clinical expert who would answer her questions. Professor Herbst sent Sarah copies of 5 abstracts from peer-reviewed scientific journal articles which stated the following. (CANSA Correspondence: Complete copy here, begins on page 3)

…trials have proven its (HPV vaccine) efficacy in preventing cervical intraepithelial neoplasia (CIN) beyond doubt and its effectiveness in preventing cervical cancer though presumptive is reasonably certain as per mathematical modelling. It also prevents other HPV related anogenital and oropharyngeal malignancies in both sexes.

The HPVs vaccine prevents infection with certain species of HPVs associated with the development of cervical cancer, genital warts, and some less common cancers.

The cost-effectiveness of human papillomavirus (HPV) 16/18 vaccination of 12 year-old girls was calculated for 28 countries, under the assumption that vaccination prevents 70% of all cervical cancer cases and that cervical cancer and all-cause mortality rates are stable without vaccination. At three-dose vaccination costs of I$ 100 per vaccinated girl (currency 2005 international dollars), HPV16/18 vaccination was very cost-effective in 25 out of 28 countries…

Human papillomavirus (HPV) infection is a central and necessary, although not sufficient, cause of cervical cancer. Besides HPV, the additional multiple risk factors related with the onset of cervical cancer are early-age sexual activities; high number of sexual partners, which is the most salient risk factor; suppression and alteration of the immune status; long-term use of oral contraceptives; and other hormonal influences.

Our analysis (of 24 Hispanic mothers/28 daughters) found several themes that affect whether Hispanic girls get the HPV vaccine: gaps in knowledge; fears and concerns about the vaccine; sociocultural communication practices; and decision-making about HPV vaccination. Both mothers and girls had limited knowledge about cervical cancer, HPV, and the vaccine.

As you can clearly see, Professor Herbst’s reply did not address any of the questions Sarah had asked. Undaunted, she replied to him on August 16th as follows (excerpts):

Dear Prof Herbst Thank you for the document containing various abstracts to papers on the subject of HPV. With all due respect, these are obviously of zero value in terms of answering the questions that I put to CANSA. My specific questions are:- Why is CANSA supporting the use of the HPV vaccines when these are now proven to be deadly and when they have NEVER been proven to prevent cervical cancer? Both India and Japan have stopped giving this vaccine because of the severe side effects – why is South Africa ignoring the glut of data that shows this vaccine is dangerous? (Followed by multiple reference documents) What we do need to do is look at the reported adverse events and to ask the pertinent questions regarding the safety of this vaccine. No manufacturer is going to admit (unless forced to by a court of law) that their product is either defective or deadly. If anyone purports to be a caring physician and who wishes to help the community defend itself against deadly diseases, then surely that person needs to look at both sides of the argument? It is completely unacceptable simply to point towards the manufacturer and trust that their data is 100% accurate. Attached is a document that lists many of the criminal activities of (and fines handed down to) various pharmaceutical companies. These are the reasons why a good proportion of the general public does not trust the pharmaceutical industry. Patients have a right to know the risks and benefits of any medical treatment offered to them. Attached is a document that gives pertinent information for South Africans, including the issue of informed consent. This information should be made known to the patient BEFORE the administration of this vaccine. I therefore respectfully ask that you go through the above information and then kindly answer my questions.

Several emails were exchanged over the next few days, culminating with this request to Sarah from Professor Herbst on August 20th:

Please forward to CANSA any scientific evidence (unbiased peer-reviewed research) / scientific reference that supports and proves that: HPV vaccines are deadly

That several hundred women have died as a direct result of the vaccine (please reference country / countries where women have died & number of women who have died)

That the HPV vaccine was directly responsible for the disability / disabilities that are claimed to result from HPV vaccine (include disability type, numbers affected and country)

That there is a direct link between HPV vaccine and the chronic health problems you refer to (specific chronic conditions, numbers affected and country) Please forward scientific information regarding the banning of HPV vaccine by different countries together with the scientific grounds on which the vaccine was banned – please also identify the countries by name. Find attached a few abstracts of peer-reviewed scientific research which categorically state that HPV vaccine prevents cervical cancer and Google ‘PubMed’ and then the key words “HPV vaccine Cervical Cancer Prevention” and read further scientific evidence supporting this.

Professor Herbst had been very careful in the wording of his request to Sarah. He knew, or should have known, exactly how difficult it would be to prove HPV vaccines have been the direct cause of any permanent disability or death. Sarah was not intimidated. She took on the challenge.

By 13 September 2015, she sent Professor Herbst an email with a 105-page document, complete with references from around the world to back up her personal concerns regarding HPV vaccines and vaccination programs. (Read Sarah’s CANSA Reply September 2015 here.)

As of November 15th Sarah had not received a reply from anyone at CANSA, so she sent a short email reminding them she was not going away. She stated she intended to pursue the matter and go public with the truth about how she had been treated with regard to the HPV vaccine matter.

17th November, Professor Herbst had CANSA’s Information Coordinator send Sarah a copy of the CANSA’s Fact Sheet on Human Papillomavirus Infection and Cancer. (Pages 19-32 of this document)

6th December, Sarah responded to the latest email stating:

Thank you for the email from Radiah but there was no response from you to my questions. Attached was a document that is merely standard information and which contains gross inaccuracies such as:- “Are the HPV vaccines safe and effective? Both the vaccines as said to be safe and effective. Both vaccines were tested in thousands of people around the world. These studies showed no serious side effects. Common, mild side effects included pain where the shot was given, fever, headache, and nausea. As with all vaccines, CDC and FDA continue to monitor the safety of these vaccines very carefully.” Clearly the above is not a response from you but is just a regurgitation from the manufacturer. Where is the scientific evidence behind “both the vaccines are said to be safe and effective”? Who said they are “safe and effective”? Where is the evidence to back up this claim?

Approximately two and a half hours later, Professor Herbst responds with the following message:

Dear Ms XXX March 12, 2014 Global Advisory Committee on Vaccine Safety Statement on the continued safety of HPV vaccination as with all new vaccines, the Global Advisory Committee on Vaccine Safety has been reviewing the safety of HPV vaccines since they were first licensed in 2006. The World Health Organization (WHO) recommends the introduction of HPV vaccination into national immunization programmes where prevention of cervical cancer is a public health priority and the introduction is programmatically feasible [1]. While early detection of pre- and cancerous cells through screening programs has helped decrease incidence rates of cervical cancer in women aged 25-45 in the UK, for example [2], that decrease has plateaued in the past decade. While safety concerns about HPV vaccines have been raised, these have systematically been investigated: to date, the GACVS has not found any safety issue that would alter any of the current recommendations for the use of the vaccine. The purpose of this update is to summarize the work of GACVS over the past six years in reviewing the safety of HPV vaccines. It is important to highlight and reiterate this work because a number of national immunization programs have been facing real and potential public losses of confidence in their programs as a result of increased negative publicity, even from safety issues that have been addressed. To date, the GAVCS has reviewed evidence related to syncope, anaphylaxis, venous thromboembolism, adverse pregnancy outcomes, Guillain Barre Syndrome, and stroke [3]. It also examined concerns around the aluminium adjuvant used in HPV vaccines, with considerations around the toxicology of aluminium adjuvants and studies by investigators claiming that aluminium in the quantities used in vaccines are associated with adverse health outcomes [4]. Finally the Committee also reviewed the question of autoimmune disease, specifically around multiple sclerosis (MS), cerebral vasculitis, and an evolving concern over cases of complex regional pain syndrome (CRPS) and/or other chronic pain conditions following vaccination that have surfaced. With respect to aluminium, the GACVS has had occasion to review the safety of the adjuvant on several occasions, beginning in 1999. At that time, deltoid muscle biopsies performed in France on a number of patients with a variety of complaints revealed in a small number the presence of a minute inflammatory focus of macrophages with associated necrosis. These localized lesions, called macrophagic myofasciitis (MMF), have been shown to contain aluminium salts [5, 6]. Since the location of the lesions in the deltoid muscle coincides with the usual site of injection for vaccines, these microscopic lesions may appear to be related to immunization. The investigators from the “Groupe d’études et de recherche sur les maladies musculaires acquises et dysimmunitaires” (GERMAAD) have suggested that vaccination and localized MMF lesions might be associated with a multi-system disorder. The GACVS has reviewed evidence regarding MMF on several occasions since that time and continues to reaffirm that, while MMF is clearly linked to a vaccination “tattoo” among some patients who have received an aluminium containing vaccine, the associated systemic symptoms related to that finding have never been scientifically proven. Statements about MMF were published in 1999, 2002 and 2004 [4]. While there have never been any published reports of MMF in recipients of HPV vaccines, there is no plausible reason to suspect that any reports of MMF would be associated with systemic symptoms following aluminium containing HPV vaccines any more than the finding of the histological lesion of MMF following hepatitis B vaccine and clinical symptoms. In 2012, the GACVS reviewed two studies claiming an association between aluminium in vaccines and autism spectrum disorder [7, 8]. It found serious flaws in the two studies that limited their value even for hypothesis generation. In December 2013, the GACVS reviewed evidence related to HPV vaccine and autoimmune disease, specifically multiple sclerosis [3]. While there remain case reports in the literature, multiple epidemiologic studies have not demonstrated any increased risk of autoimmune diseases, including MS, in studies, some of which have included girls who have received HPV vaccine compared to those who had not [9, 10, 11, 12]. Several papers have also been published pertaining to the finding of HPV L1 gene DNA fragments in clinical specimens following HPV vaccination [13, 14]. These papers claimed an association with clinical events of an inflammatory nature, including cerebral vasculitis. While the GACVS has not formally reviewed this work, both the finding of DNA fragments in the HPV vaccine and their postulated relationship to clinical symptoms, have been reviewed by panels of experts. First, the presence of HPV DNA fragments has been addressed by vaccine regulatory authorities who have clearly outlined it as an expected finding given the manufacturing process, and not a safety concern [15]. Second, the case reports [13] of adverse events hypothesized to represent a causal association between the HPV L1 gene DNA fragments and death were flawed in both clinical and laboratory methodology [16]. The paper described 2 fatal cases of sudden death in young women following HPV vaccine, one after 10 days and one after 6 months, with no autopsy findings to support death as result of cerebral vasculitis or an inflammatory syndrome. Thus the hypotheses raised in these papers are not supported by what is understood about the residual DNA fragments left over following vaccine production [17]: given the extremely small quantities of residual HPV DNA in the vaccine, and no evidence of inflammation on autopsy, ascribing a diagnosis of cerebral vasculitis and suggesting it may have caused death is unfounded. In June 2013, the GACVS reviewed the concerns arising in Japan in regard to reports described as CRPS in a few cases, and other chronic pain conditions following HPV vaccine. At the time, GACVS found no evidence to suggest a causal link with the HPV vaccine, and recommended careful documentation of each case and definition of diagnostic criteria to guide management and causality assessment. The Committee has meanwhile continued to monitor the HPV vaccine and considered further issues during their meeting in December 2013 [3]. In Japan, an expert advisory committee has continued to meet and review the situation but has not yet reached a conclusion. It is acknowledged that the HPV vaccine may be a more painful injection, leading to frequent complaints of pain, which, in some settings, may trigger additional non-specific complaints [18, 19]. As to Complex Regional Pain Syndrome, this entity has been described following various forms of trauma, including injury, surgical procedures and injections. It is therefore plausible that CRPS could develop following the injection of any vaccine (however, such cases have been very rarely described in the literature [20]).In summary, the GACVS continues to closely monitor the safety of HPV vaccines and, based on a careful examination of the available evidence, continues to affirm that its benefit-risk profile remains favorable. The Committee is concerned, however, by the claims of harm that are being raised on the basis of anecdotal observations and reports in the absence of biological or epidemiological substantiation. While the reporting of adverse events following immunization by the public and health care providers should be encouraged and remains the cornerstone of safety surveillance, their interpretation requires due diligence and great care. As stated before, allegations of harm from vaccination based on weak evidence can lead to real harm when, as a result, safe and effective vaccines cease to be used. To date, there is no scientific evidence that aluminium-containing vaccines cause harm, that the presence of aluminium at the injection site (the MMF “tattoo”) is related to any autoimmune syndrome, and that HPV DNA fragments are responsible for inflammation, cerebral vasculitis or other immune-mediated phenomena.

Prof Michael C Herbst Health Specialist [D Litt et Phil (Health Studies); D N Ed; M Art et Scien; B A Cur; Dip Occupational Health] Cancer Association of South Africa – Head Office

Address: 26 Concorde Road West, Bedfordview, 2008

Postal: PO Box 2121, Bedfordview, 2008

December 7th, excerpts from Sarah’s response:

It greatly concerns me that CANSA appears to have no thoughts of its own and instead relies on statements from organisations who have a vested interest in pursuing vaccination programs and maintaining “public confidence”. Upon reading the GACVS statement, anyone who had not investigated this matter would think that this vaccine is perfectly safe, yet the truth is far from that as can be seen by the various protest groups, lawsuits, representations to governments and other actions being taken by victims of the HPV vaccines. If the vaccine was perfectly safe, why are SO many victims stepping forward and why are many, many doctors, scientists and health professionals trying to get their message heard about the dangers of these vaccines? So in other words, the manufacturers are relying on voluntary reports to reveal adverse reactions ‘post marketing’.

To which Professor Herbst responds on December 8th with:

Dear Ms XXXXX Thank you for your response. I wish to inform you that I am ending our discussion on HPV vaccination. If you have issues around HPV vaccination, I would like to suggest that you take it up with the National Department of Health, and not with the Cancer Association of South Africa. Kind Regards, Prof Michael C Herbst Health Specialist

Sarah responds almost immediately with (page 39):

I am saddened and appalled at your response. I am a cancer survivor myself (malignant melanoma) and I am shocked that CANSA refuses to answer genuine concerns about a pharmaceutical product that is supposed to protect against cancer. The general public is led to believe that organisations like CANSA have the best interests of the public at heart but clearly this is not the case. I therefore wish to place on record the following conclusions that I have drawn from the lack of response by CANSA: CANSA has no interest in protecting the lives of females (or males, as young males are now also being drawn into the HPV vaccination program) in South Africa CANSA is unwilling to properly investigate the flood of reports, scientific studies and documented evidence of the dangers of HPV vaccines CANSA is not providing balanced information to the general public of the dangers of HPV vaccines and therefore has no interest in ensuring full informed consent CANSA refuses to answer my concerns and questions CANSA is putting the lives of all young South Africans at risk by failing to properly investigate the devastating serious adverse effects that are being reported all over the world

As much as Professor Herbst would have liked this to be the end of his conversation about HPV vaccines, it was not meant to be. During the course of Sarah’s communications with the director of CANSA, one of the scientists whose work was criticized in Professor Herbst’s Dec 6th email had an opportunity to read what the professor had stated. Consequently, Dr. Sin Hang Lee responded directly to Professor Herbst via email (complete email with references here.) on December 11th as follows:

Dear Professor Herbst: Based on your 06 December 2015 letter addressed to Ms XXXX on behalf of the Cancer Association of South Africa, you are obviously not a scientist, but are trying to dismiss a very important scientific issue which has affected the health of many teenagers worldwide. Since you are masquerading as a health specialist, acting as a spokesman in a cancer association and trying to discredit my scientific work on the finding of HPV L1 gene DNA in the vaccine Gardasil® while using your position to influence health policy decision making according to your agenda, your letter must not be allowed to pass without challenge. The first exposure of your lack of understanding of the science involved in this matter is contained in your statement “Several papers have also been published pertaining to the finding of HPV L1 gene DNA fragments in clinical specimens following HPV vaccination [13, 14]. These papers claimed an association with clinical events of an inflammatory nature, including cerebral vasculitis.” You quoted as reference #13 a paper published by “Tomljenovic L, Shaw CA. Death after Quadrivalent Human Papillomavirus (HPV) Vaccination: Causal or Coincidental? Pharmaceut Reg Affairs 2012, S12:001”. If you had understood what HPV L1 gene DNA fragments mean, you would not have made such an erroneous statement as you did because in their entire paper, Tomljenovic and Shaw never mentioned “HPV L1 gene DNA fragments” even once. These authors demonstrated HPV-16L1 VLPs, not DNA fragments in the blood vessel walls. You obviously do not understand the difference between HPV L1 VLPs and HPV L1 gene DNA fragments. You quoted as reference #14 a paper published by “Lee, SH. Detection of human papillomavirus L1 gene DNA fragments in postmortem blood and spleen after Gardasil® vaccination— A case report. Advances in Bioscience and Biotechnology, 2012, 3, 1214-1224”. You are basically putting your words into the author’s mouth because I know the author did not claim cerebral vasculitis in this case report. In an attempt to boost your credibility, your also wrote “….the case reports [13] of adverse events hypothesized to represent a causal association between the HPV L1 gene DNA fragments and death were flawed in both clinical and laboratory methodology [16].” For reference 16, you cited a CISA Technical report from a U.S. CDC webpage. However, in this CDC technical report, the unnamed authors of the document only questioned the HPV-16L1 particles, never HPV L1 gene DNA fragments. Therefore, it further confirms the fact that you really do not understand these two important and distinct chemicals in the HPV vaccine at all. And there is a Disclaimer following this document, stating: The information and conclusions in this report are those of the work group participants addressing this issue and do not necessarily represent the official position of CDC. So you blindly misquoted a technical report written by a team of ghost writers to dismiss a potential causal association between the HPV L1 gene DNA fragments and death. You were unable to find a scientific publication published in a peer-reviewed journal to challenge the plausible mechanism leading to potential harm induced by residual HPV DNA left in the vaccine Gardasil®. So you had to use a blog written by a Dr Helen Petousis-Harris who knows even less than you do on this subject to support your opinion. In her blog (your reference #17), Dr Helen Petousis-Harris did not even cited a single publication of mine, and used some social media articles published on the Internet to attack me by character assassination. Although she had no personal experience on viral DNA research, she was brave enough to declare that the quantity of residual HPV DNA left in the vaccine Gardasil® has no health impacts on the vaccinees. It is unfortunate for the teenagers of this world to have people like you and Dr Helen Petousis-Harris to rely on selling your biased opinions without any scientific evidence of your own to influence health policy decision making. Neither of you has done any work to support your opinions. Neither of you knows what you are talking about. If you want to prove me wrong, please show me a report of the amount of HPV L1 gene DNA fragments (type 16, 11, 18 and 6) which are bound to the aluminum adjuvant, as found in the vaccine Gardasil® that has been shown to be of no short-term or long-term risk to humans. Since you have quoted in your reference #12, a paper published by Slade BA, Leidel L, Vellozzi C, Woo EJ, Hua W, et al. Postlicensure safety surveillance for quadrivalent human papillomavirus recombinant vaccine. JAMA. 2009 Aug 19; 302(7):750-7. Let me point out to you that this CDC study shows that among 12,424 reported adverse events following Gardasil® vaccination from June 1, 2006 through December 31, 2008, there were 32 deaths with a mean age of 18 years old, who died 2 to 405 days after the last Gardasil® injection. Medical records and autopsy reports on 20 of the 32 deaths were available for review and confirmed there were 4 unexplained deaths and 6 cardiac-related deaths. This same report also stated that syncope is the most common adverse reaction after Gardasil® injections and “The reporting rates per100 000 qHPV doses distributed were 8.2 for syncope;” Syncope is defined as temporary loss of consciousness and posture, described as “fainting” or “passing out.” It’s usually related to temporary insufficient blood flow to the brain. It most often occurs when the blood pressure is too low (hypotension) and the heart doesn’t pump a normal supply of oxygen to the brain. In view of the high incidence of syncope developed among Gardasil® vaccinees, the FDA Prescribing Information for Gardasil® (qHPV) contains the following Warnings and Precautions: “Because vaccinees may develop syncope, sometimes resulting in falling with injury, observation for 15 minutes after administration is recommended. Syncope, sometimes associated with tonic-clonic movements and other seizure-like activity, has been reported following vaccination with GARDASIL®. When syncope is associated with tonic-clonic movements, the activity is usually transient and typically responds to restoring cerebral perfusion by maintaining a supine or Trendelenburg position.” So why do Gardasil® vaccinees have a higher rate of syncope as compared to other vaccinees? The ugly truth that you and those agencies you have quoted to support your biased opinions would not like to face may be in the HPV L1 gene DNA fragments when the viral DNA fragments combine with the aluminum adjuvants in the vaccines. To understand this, you really have to spend time to study the history on the science of aluminum adjuvants in vaccination. Aluminum salts have been used as adjuvants in vaccination empirically to boost immune responses of the host to the protein antigens for many decades. However, the mechanism of the adjuvant effects of aluminum salts has only been recently investigated at the molecular level. It is now generally agreed in the scientific community that aluminum salts used as adjuvants are toxic and always damage the cells of the host at the site of injection, causing a localized inflammation at the vaccination site. This initial cell damage by the aluminum salt is an essential and necessary step to initiate its adjuvant effects because the free host DNA molecules released from the aluminum salt-damaged host cells act as mediators to trigger augmented immune responses of the host [1, 2]. The free DNA molecules of the dying host cells, also referred to as damage-associated molecular patterns (DAMPs) [3] bind the aluminum salt adjuvant at the site of injection, and the resulting DNA/aluminum complexes are phagocytized by the antigen-presenting cells (APCs) and macrophages. It was known as early as 2003, that when bound to aluminum salts as nanoparticles, free DNA molecules undergo dramatic conformational changes and can be introduced into mammalian cells as a means of gene transfection [4]. In vaccination with aluminum adjuvants, the transfected host DNA activates the pathways that would increase their ability to interact productively with antigen-specific CD4 T cells to boost host immune responses [1, 2]. In plain language, free DNA derived from the dying host cells is needed to be carried by aluminum adjuvants into the APCs or macrophages to function as mediators for boosting immune responses in vaccination. However, the presence of recombinant HPV L1-specific DNA fragments in the vaccine Gardasil® has disrupted this expected normal immunity response platform in vaccination. The HPV DNA molecules, being of a viral origin, are “non-self” microbial products, also referred to as pathogen-associated molecular patterns (PAMPs). The human body’s defense system can distinguish the PAMPs from the DAMPs in order to mount an appropriate immune response to either the presence of a pathogen or a tissue damage [3]. The amorphous aluminum hydroxyphosphate sulfate (AAHS) nanoparticles which are expected to bind the free host DNA at the site of vaccine injection can also bind the fragments of HPV L1 gene DNA present in the vaccine Gardasil® [5] through a ligand exchange process between the phosphate groups of the DNA molecule and the hydroxyl groups on the aluminum adjuvant surface, similar to a reaction between phospholipids and AAHS in the recombinant hepatitis B vaccine [6]. In other words, Gardasil® has been furnished with a set of ready-made instant DNA immune “mediators” already in the adjuvant, in the form of a viral DNA/aluminum chemical compound, specifically an HPV L1 gene DNA/AAHS complex. The downstream events after transfection into the human macrophages of these viral DNA fragments which are rarely found in the human genome [7] are quite different from those after the DNA of the dying host cells is introduced into the macrophages. Despite similarities between DNA molecules, mammalian cells have the remarkable ability to distinguish viral DNA from their own DNA. The human macrophages are able to recognize the HPV L1 gene DNA as a ‘stranger’ and a ‘danger’ signal, and in response produce many antiviral immune molecules, collectively referred to as type I interferons and pro-inflammatory cytokines [8-10]. Massive systemic production of these type I interferons and pro-inflammatory cytokines induces an antiviral state and protects the host, but it also can contribute to endotoxin lethality and autoimmune diseases [9]. Many of these cytokines are myocardial depressants. The two cytokines that show the greatest cardiovascular effects in animals and humans are tumor necrosis factor (TNF)-α and IL-1β [11]. Administration of recombinant TNF-α in animal models is known to cause hemodynamic changes and even death [11]. Injection of Gardasil® into animals has been shown to induce unusually early strong innate immune responses with quick releases of a variety of cytokines from the macrophages [12]. Injection of HPV DNA/AAHS complexes into the host is also known to induce a strong immune reaction and a strong CD8 T cell response [13]. Based on experiments with other viral DNA molecules, the recombinant HPV L1 gene DNA fragments transfected into human macrophages would also be recognized as “stranger” and “danger” signal, and invariably activate the macrophages to release numerous antiviral cytokines. Many of these cytokines, including TNF-α and IL-1β, are recognized myocardial depressants [14-18]. Hypotensive shock induced by TNF-α has been well documented among animals [19, 20] and humans [21, 22]. This brief review of literature shows that there is a known molecular mechanism to explain why syncope occurs more often in people injected with Gardasil® than with other vaccines, and why certain predisposed vaccinees may suffer a sudden unexpected death as the result of Gardasil® vaccination. You and those who blindly dismiss the potential toxicity of aluminum adjuvant and in particular the toxicity of the newly created HPV L1 gene DNA/AAHS compound for marketing an HPV vaccine should be held responsible for intentionally ignoring the scientific evidence at the expense of public interest. It is of interest that you mentioned that in June 2013, the GACVS reviewed the concerns arising in Japan in regard to reports described as CRPS in a few cases, and other chronic pain conditions following HPV vaccine. But you apparently purposely avoided mentioning the facts that the Japanese government has suspended its HPV vaccine recommendation since 2014 and that a December 10, 2014 Symposium held by the Japan Medical Association and the Japanese Association of Medical Sciences concluded that HPV vaccines should be promoted only after issues regarding vaccine safety are settled. In summary, to protect the health of the young children there is an urgent need for open debate of the risks versus benefits of HPV vaccination being recommended or forced onto the 12-year old school girls and boys. A simple declaration of vaccine safety made by some armchair professor like you does not serve the interest of the public. Sin Hang Lee, MD, F.R.C.P. (C), FCAP Director, Milford Molecular Diagnostics Laboratory 2044 Bridgeport Avenue, Milford, CT 06460 USA

The following is an excerpt from Professor Herbst’s email (link to entire email) reply to Dr. Lee which was sent on December 11th:

I wish to thank you for the information provided by you. I undertake to include your counter arguments and other relevant information supplied by you in an updated version of CANSA’s Fact Sheet on Human Papilloma Virus Infection and Cancer when our offices re-open on 4 January 2016 and will forward a copy of the updated document to you. I will also google your other research contributions in this regard.

There you have it – one single individual putting forth honest questions and demanding honest, documented answers can make a difference!

If Professor Michael Herbst lives up to his word and alters the CANSA fact sheet on HPV infection and cancer to reflect Dr. Lee’s concerns, the women of South Africa will be able to understand the potential risks of HPV vaccines as well as the potential benefits prior to making a decision as to whether or not HPV vaccines are a good addition to their cervical cancer prevention program.

The women of South Africa will be able to exercise their right to informed consent, thanks to Sarah.