Table 5 Human papillomavirus vaccine for cervical cancer

Case study

Human papillomovirus (HPV) vaccine can be used to protect adolescent girls against cervical cancer. Current calls to introduce an immunisation programme reflect the cumulation of evidence from aetiological epidemiology, which has identified HPV as a necessary cause of most cervical cancers, and translational medicine, which has produced a vaccine and shown it to be safe and effective in randomised controlled trials. The linear model of translation suggests that all that remains is for an immunisation programme to be implemented in primary care.

However, the UK experience of other recent translational activities in this field illustrates how these may have queered the pitch for new vaccines. The findings of one single, small and unreplicated study [37] were interpreted as showing that the measles, mumps and rubella (MMR) vaccine may cause autism and were deliberately released into the public realm where they were amplified and disseminated by the mass media, resulting in a marked decrease in MMR coverage to a low of 79% in England in 2003 [26]. This unintentional translational process was much more effective in changing population health-related behaviour (vaccine uptake) than was the subsequent systematic synthesis of epidemiological evidence [27]. It also directly produced a change in professional practice (the introduction of single-vaccine clinics) without this ever being recommended in clinical guidelines. The successful translation of the potential offered by the HPV vaccine into actual population health improvement will therefore depend, among other things, on winning the argument in the public realm that the benefits of routine immunisation outweigh the harms, and in particular that it is appropriate to immunise girls against a sexually transmitted infection before they become sexually active. Meanwhile, parents' attitudes and reactions to information about vaccines remains an active area of research that could be described as 'basic science' – in the sense that it investigates the causes of health-related behaviour – but is also clearly crucial to the effective translation of future advances in this field [28–31].