By Stephanie LI Yingliang
Dec. 12, 2016, Hong Kong
When Huang Zhi-ming has to wake up at 7 o’clock, she knows that it is not her regular Saturday morning. She hurries to grasp her breakfast on the way to catch the tour bus that leaves at eight. After a three-hour trip, Huang and her friends finally arrive at the border, ready to wait in the long line before entering Hong Kong. And it takes them another half an hour to get to a private medical clinic in Tuen Mun, a closest destination for mainland travelers.
The 29-year-old Guangzhou-based department store employee is one in the flock of mainland women who cross the border to receive vaccinations against HPV (human papillomavirus) in Hong Kong. She has to go through the same routine three times, for the three doses strictly follows a six-mouth timetable.
HPV, the likely cause of cervical cancer, is a group of viruses that are extremely common worldwide. Among more than 100 variations, at least 13 types of HPV are cancer-causing (also known as high risk type), according to a fact sheet released by the World Health Organization (WHO).
The topic of cervical cancer and HPV vaccine came up from time to time in Huang’s dinner table discussions with her friends, mostly young, college-educated women. After some research and consultation, she is convinced of the necessity and urgency to pay extra, both time and money, to take measures against the fatal disease, especially when the vaccine has not yet been made available at home.
“I’m already a bit too old for that,” Huang laughs. She then explains that the most effective prevention should begin around the age of 11 or before the person becomes sexually active, “so far it’s the only way to get the treatment from Hong Kong.”
Yet it is far from the only explanation that proves the vaccination worthy of her troubles. “When it comes to health, I think it’s natural that we all want the best for us, and I simply don’t trust the safety of vaccines from the mainland,” Huang said.
To many Chinese, the deep distrust in public healthcare and food safety almost comes as an instinct. The scandal of faulty vaccines that broke out earlier this year in Shandong, an eastern province in China, threatened public faith in medical system, and it again echoes Huang’s decision. She says her cousin has never had her six-year-old son receive any vaccination at Chinese hospital. The obvious choice for the family is to go to Hong Kong, and the trip is relatively convenient for residents in Guangzhou.
The notoriously lengthy and difficult drug approval process in China only adds more obstacle to the promotion of female welfare, which drugs are required both to be approved in another country and to pass Chinese clinical trials, according to The Guardian at the 10-year anniversary of the first HPV vaccine released in Australia and the United States.
But during the past decade when women in about 50 countries have been commonly preventive to HPV-related diseases, cervical cancer has become the second most diagnosed cancers among females in China. The 2012 Chinese Cancer Registry reported an estimated 445,000 new cases with an overall incidence rate of 8.98 per 100,000, which accounts for 84% of the total number in the world. The Center for Health Protection in Hong Kong reported 503 new cases in 2013, standing at the rate of 13.0 per 100,000 females.
Despite a higher possibility of cervical cancer, skepticism remains to local taker of HPV vaccines. Low enthusiasm in the drug among young women in Hong Kong casts sharp contrast to their mainland peers. Two local female undergraduates in the Hong Kong Polytechnic University say they have never heard of HPV vaccination until college. In spite of a small promotional discount offered by the school’s clinic, they do not feel obliged to take any action.
A 26-year-old Ph.D. student in the University of Hong Kong says she thought it was necessary at first, but then had a change of heart after she asked for the advice from her mother and gynecologists. After being told that the vaccine was not infallible and would not replace the need of cervical smear screening, she decided not to go through the “fussy” inoculation.
A study conducted by the Department of Obstetrics and Gynecology in the same university confirms the existence of barriers to vaccination among Hongkongers, including high monetary cost, uncertain length of vaccine effectiveness, low perceived risk of HPV infection, anticipated family disapproval and fear of the pain of injection.
Gardasil, the newest 9-valent vaccine that covers HPV genotypes, costs HK$3,600 in private clinics. But the good news is, the government’s Community Care Fund offered free vaccines to young girls from low-income families under a HK$99 million scheme starting this September.
Yet perhaps the real reason buried underneath is the cultural association between receiving the vaccination and premarital sex. Mrs. Lai, mother of a 20-year-old girl, reveals her concern, “it looks like a green light for teenagers to feel safe to sleep around.”
Her worry is resonated by 35 local mothers with daughter between 9 and 17 years old in regard to vaccinating their daughters against HPV, according to a medical research by Hong Kong Baptist University. The sampled mothers did not have a positive perception of the drug due to misconceptions of the transmission of HPV, for they perceived the vaccination to be potentially harmful to health and would encourage their daughters to engage in sexual activity at an early age.
Controversy over the safety issue adds fuel to the doubt as Japan withdraws HPV vaccine recommendation since severe adverse reactions including long-term pain and numbness has been reported, according to the country’s newspaper The Asahi Shimbun. Dr. Ko Wing-man, Secretary for Food and Health in Hong Kong, said in response that multiple studies and medical expects remain reassured by the safety profile of the vaccine to be a safe and effective method against cancers inflicted by HPV.
The Global Advisory Committee on Vaccine Safety (GACVS), an independent, scientific advisory body to WHO, reviewed evidence related to autoimmune disease and the HPV from the U.S., Australia and Japan in 2013 and found no increase in risk of autoimmune diseases among girls who have received HPV vaccine compared to those who have not.
“Ring, ring, ring…” Calls to the reception desk keep flooding in, and this is just another busy Sunday afternoon in a private clinic in Tsin Sha Tsui, where Mandarin speakers fill the waiting room, most are to get vaccinated.
By breaking out of Chinese health system, Huang, like many of her compatriots, continues to seek a better chance of health from Hong Kong healthcare provider, “I’m afraid of dying. After all, it’s cancer. So with an affordable expense, I can sort of buy health, why not take action now?”