The HPV vaccine was created to prevent an infection that causes cancer. That is pretty exciting. After all, Terry Fox’s arduous marathon a day was to raise money for a cancer cure. Did he even imagine that we would have a vaccine to prevent cancer?

Given the power of HPV vaccine to prevent disease and death, a long Toronto Star article that appears to suggest that the HPV vaccine causes harm is troubling and disappointing. Although the article states in the fifth paragraph that “there is no conclusive evidence showing the vaccine caused a death or illness,” its litany of horror stories and its innuendo give the incorrect impression that the vaccine caused the harm.

Very unfortunately, this article may well lead readers to doubt both the scientific evidence and the recommendations of the Public Health Agency of Canada, the Society of Obstetricians and Gynecologists of Canada, the National Advisory Committee on Immunization, and the Canadian Cancer Society about vaccination.

The Star story states that some people became sick and even died after being vaccinated against HPV infection. Yet, after HPV vaccination, some people might have won a major scholarship or the lottery. Does this mean the vaccine caused the award or the win? Hardly.

The fact that one event follows another does not mean that the first event caused the second — in scientific terms, correlation is not causation.

For example, the number of shark attacks and ice cream sales rise when the weather is hot. The confusion of correlation and causation here is funny because, of course, the shark attacks don’t cause the ice cream sales increase. But in the case of the HPV vaccine, such confusion is not funny because HPV infection can have very serious consequences that the vaccine helps prevent.

HPV infection causes nearly all cervical cancers and cancers of the vulva, vagina, penis, anus and throat. Two strains (“types”) of HPV, called HPV16 and HPV18, are responsible for about 70 per cent of cervical cancers and an even higher proportion of the other HPV-associated cancers. Two other HPV types, HPV6 and HPV11, cause about 90 per cent of genital warts. The vaccine smeared by the Star’s article, Gardasil, prevents infection by these four strains of HPV.

In 2008, approximately 610,000 cases of cancer worldwide were attributable to HPV.

HPV infections in Canada annually result in 85,000 physician consultations for genital wart infections, 1,450 newly diagnosed cases of cervical cancer and 106,000 patients with cervical lesions that require expensive, painful treatment that can cause infertility and premature birth. In Canada, 380 women die from cervical cancer every year, many of them in the prime of life. HPV infections are a very real threat to the health of Canadians.

All of us must take very seriously the potential complications of any drug or vaccine. Gardasil was licensed only after its safety was studied in clinical trials with more than 29,000 people. After licensing, reported side effects are collected in a vaccine safety database. Researchers studied that database after more than half a million doses of Gardasil had been administered. The only — and very rare — serious side effect of HPV vaccines that they identified was allergic reactions. Public health officials who continue to study these databases have not found evidence of any other serious side effects.

The Star presented the stories of women who have suffered greatly. The article was engaging, dramatic and might have created fear. But study after study has shown that there is no causal link between the events the Star reported and the vaccine. About 169 million doses of the HPV vaccine have been administered worldwide. In any given large population, there will be illness and death. This is a statistical fact. To attribute rare devastating occurrences to a vaccine requires evidence of causation, of which the international scientific community and the Star article have none.

When such articles appear, we all lose. Those of us in a position to influence others have a responsibility to provide the best evidence about health-related issues. In this case, the evidence is very clear that the risks associated with HPV infection are much greater than the risks associated with vaccination.

We hope Star readers will continue to rely on evidence-based public health recommendations to protect all our children from cancer. Those recommendations save lives.

Juliet Guichon, of the University of Calgary, is the recipient of the Canadian Medical Association Medal of Honour for HPV vaccine related work. Dr. Rupert Kaul is a Professor in the Departments of Medicine and Immunology, and the Head of the Division of Infectious Diseases at the University of Toronto.

This response is endorsed by 63 specialists in infectious disease, public health or related sciences:

Isaac I. Bogoch, MD, MS, FRCPC, DTM&H, Consultant, Infectious Diseases and Internal Medicine, University Health Network, Toronto, Assistant Professor, Department of Medicine, University of Toronto

Donald A. Branch, PhD, Professor, Department of Medicine, University of Toronto

Vivien Brown, MDCM, CCFP, FCFP, NCMP, Professor, Department of Family and Community Medicine, University of Toronto, Board Member, Immunize Canada

John H. Brumell, PhD, Pitblado Chair in Cell Biology; Senior Scientist, Cell Biology Program, The Hospital for Sick Children; Professor, Dept. of Molecular Genetics and Institute of Medical Science, University of Toronto

Paul Bunce, MD, FRCPC, Infectious Disease Consultant, University Health Network/Mount Sinai Hospital; Assistant Professor, Department of Medicine, University of Toronto

Sumon Chakrabarti, MD, FRCPC, Consultant, Infectious diseases and internal medicine, Trillium health partners; Lecturer, Department of Medicine, University of Toronto

W. David Colby, MSc, MD, FRCPC, Professor Microbiology/Immunology, Schulich School of Medicine and Dentistry, Western U and MOH Chatham-Kent

Bryan Coburn, MD, PhD, Infectious Diseases Specialist, Toronto

Rohan D’Souza, MD, MSc, MRCOG, FCPS, DNB, DGO, DFP, Maternal-Fetal Medicine Physician, Mount Sinai Hospital; Assistant Professor, Obstetrics and Gynaecology, University of Toronto

Nick Daneman, MD, FRCPC, MSc; Scientist, Evaluative Clinical Sciences, Sunnybrook Research Institute; Assistant Professor, Department of Medicine, University of Toronto

Aled Edwards, PhD, Banbury Chair of Medical Research at the University of Toronto; Professor, Department of Medical Biophysics, University of Toronto

Alex W. Ensminger, PhD, Assistant Professor , Department of Molecular Genetics, University of Toronto

Gerald Evans, MD, FRCPC, Chair, Division of Infectious Diseases and Professor, Departments of Medicine, Biomedical and Molecular Sciences, and Pathology and Molecular Medicine at Queen’s University

I. George Fantus, Associate Dean Research, Faculty of Medicine; Professor, Departments of Medicine and Physiology, University of Toronto

David Fisman, MD, MPH, FRCPC, Professor, Dalla Lana School of Public Health, University of Toronto

Deborah B. Foster, PhD, Professor and Director, Graduate Program in Molecular Science, Ryerson University

Lori D. Frappier, PhD, Professor, Department of Molecular Genetics, University of Toronto; Canada Research Chair in Molecular Virology

Gary Garber, MD FRCPC FACP FIDSA CCPE, Professor of Medicine, University of Ottawa

Ian M. Gemmill, MD, CCFP, FCFP, FRCPC, Medical Officer of Health, Kingston, Frontenac Lennox and Addington Public Health Unit, Ontario

Jennifer L. Gommerman, PhD, Associate Professor and Associate Chair, Graduate Studies, Department of Immunology

Kevin Gough MD, FRCPC, MEd, Head, Division of Infectious Diseases, Medical Director, HIV Service St. Michael’s Hospital, University of Toronto

Scott Gray-Owen, PhD, Professor, Department of Molecular Genetics, University of Toronto

Sergio Grinstein, PhD, Senior Scientist, Program in Cell Biology, Hospital for Sick Children; Professor of Biochemistry, University of Toronto

David S. Guttman, PhD, Director, Centre for the Analysis of Genome Evolution and Function; Professor and Associate Chair, Research, Department of Cell and Systems Biology, University of Toronto

Monica Hau, MD, FRCPC, Associate Medical Officer of Health, Peel Region

Walid A. Houry, PhD, Professor, Department of Biochemistry, University of Toronto

Jennie Johnstone, MD, FRCPC, PhD, Infectious Disease Consultant, St. Joseph’s Healthcare, Toronto; Assistant Professor, Department of Medicine, University of Toronto

Kevin Kain, MD, FRCPC, Director, SAR Laboratories, Sandra Rotman Centre for Global Health, UHN-Toronto General Hospital, Professor of Medicine, University of Toronto

Kevin Katz, MD, CM, MSc, FRCPC, Medical Director, Infection Prevention and Control, North York General Hospital; Associate Professor, Department of Laboratory Medicine and Pathobiology, University of Toronto

Jerome Leis, MD, FRCPC, MSc, Associate scientist, Evaluative Clinical Sciences, Sunnybrook Research Institute; Assistant Professor, Department of medicine, University of Toronto

Jun Liu, PhD, Professor, Department of Molecular Genetics, University of Toronto

Mark Loeb, MD, FRCPC, MSc, Division Director, Infectious Diseases, Professor Departments of Pathology and Molecular Medicine, McMaster University

Christopher Mackie, MD, MHSc, CCFP, FRCPC, Medical Officer of Health and CEO, Middlesex-London Health Unit Ontario; Assistant Professor, Department of Epidemiology and Biostatistics, McMaster University

Ann K. Malinowski, MD, MSc, FRCSC, Maternal-Fetal Medicine Physician, Mt. Sinai Hospital; Assistant Professor, University of Toronto

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Lionel Mandell, MD, FRCPC, FRCP, Professor Emeritus, Division of Infectious Diseases, Department of Medicine, McMaster University

Janine McCready, MD, FRCPC, Infectious Diseases Consultant, Toronto East General Hospital

Shelly McNeil, MD, FRCPC, Clinician Scientist, Canadian Center for Vaccinology, IWK Health Centre and Capital Health, Halifax; Professor of Medicine, Dalhousie University

Sharmistha Mishra, MD, FRCPC, PhD, Infections Disease Physician and Epidemiologist, St. Michael’s Hospital, University of Toronto; Assistant Professor, Department of Medicine, University of Toronto

Tara Moriarty, PhD, Assistant Professor, Faculty of Dentistry, University of Toronto

Andrew Morris, MD SM FRCPC, Director, Antimicrobial Stewardship Program, Mount Sinai Hospital | University Health Network; Associate Professor, Department of Medicine, University of Toronto

Samira Mubareka, MD, FRCPC, PhD, Microbiologist, Sunnybrook Health Sciences Centre; Assistant Professor, Department of Medicine, University of Toronto

Matthew Muller, MD, FRCPC, PhD, Medical Director , Infection Prevention and Control, St. Michael’s Hospital; Assistant Professor, Department of Medicine, University of Toronto

Kellie Murphy, MD, FRCSC, Maternal-Fetal Medicine Specialist, Mount Sinai Hospital, Toronto; Associate Professor, Department of Obstetrics and Gynecology, University of Toronto

William W. Navarre, PhD, Associate Professor Associate Chair and Undergraduate Coordinator, Department of Molecular Genetics, University of Toronto

Justin R. Nodwell, PhD, Professor and Chair, Department of Biochemistry, University of Toronto

Nanette Okun, MD, FRCSC, Division Head, Maternal-Fetal Medicine, University of Toronto; Associate Professor, Department of Obstetrics and Gynecology, University of Toronto

Mario Ostrowski, MD, FRCPC, Professor, Department of Medicine, University of Toronto; Infectious disease consultant, St. Michael’s Hospital

Dana Philpott, PhD, Associate Professor, Department of Immunology, University of Toronto

Jeff Powis, MD, MSc, FRCPC, Director, Antimicrobial Stewardship Program, Toronto East General Hospital

Anita Rachlis, MD, FRCPC, Infectious Disease Consultant, Sunnybrook Health Sciences Centre; Professor, Department of Medicine, University of Toronto

Susan Richardson, MD, FRCPC, Head, Microbiology, Hospital for Sick Children; Associate Professor, Department of Laboratory Medicine and Pathobiology, University of Toronto

Stefania Ronzoni, MD, Department of Obstetrics, Mount Sinai Hospital University of Toronto

Paul Roumeliotis, MD, CM, MPH, Medical Officer of Health and CEO, Eastern Ontario Health Unit, Ontario

Valerie Sales, MD, FRCPC, Pediatrician and Infectious Disease Specialist, Markham Stouffville Hospital; Division of infectious diseases, University Health Network

Abdu Sharkawy, MD, FRCPC, Infectious Disease Consultant, University Health Network; Assistant Professor, Department of Medicine, University of Toronto

Alison Shea, MD, PhD, Senior Resident, Department of Obstetrics and Gynecology, University of Toronto

Andrew Simor, MD, FRCPC, Microbiologist in Chief, Sunnybrook Health Sciences Centre; Professor, Department of Laboratory Medicine and Pathobiology, University of Toronto

Rachel Spitzer, MD, MPH, FRCSC, Obstetrician, Mount Sinai Hospital; Assistant Professor, Obstetrics and Gynaecology, University of Toronto

Linda Taggart, MD, FRCPC, MPH, Infectious Diseases Physician, St. Michael’s Hospital, University of Toronto

Mary Vearncombe, MD, FRCPC, Medical Director , Infection Prevention and Control, Sunnybrook Health Sciences Centre; Associate Professor, Department of Laboratory Medicine and Pathobiology, University of Toronto

Tania H. Watts, PhD, Sanofi Pasteur Chair in Human Immunology, University of Toronto

Barbara Yaffe, MD, MHSc, FRCPC, Director, Communicable Disease Control, Toronto Public Health

Yvonne Yau, MD, FRCPC, Medical Microbiologist, Hospital for Sick Children; Assistant Professor, Department of Laboratory Medicine and Pathobiology, University of Toronto