To the Editor: We appreciate the comments from Dr. Schneider1 and concur with her observations about the human papillomavirus vaccines. It seems that German health care providers are confronted with many of the same issues we face in the United States. Given the robust efficacy and excellent safety profile of these cancer prevention vaccines, we too are extremely frustrated by the poor rates of vaccination that are documented in many parts of the world. Furthermore, a high number of individuals do not complete the entire 3-dose series. There is great room for improvement to help reduce the morbidity and mortality associated with human papillomavirus infection. A mandatory HPV vaccination program is one means of ensuring maximum coverage and protection.2 All health care providers should encourage their patients to receive the vaccine. Dr Schneider's comments about making the vaccines widely available to all inhabitants of our globe are certainly appropriate. My response actually comes from our cervical cancer prevention clinic in Cusco, Peru (www.theincca.org, www.cervicusco.org) where we see women with cervical cancer too often. To think that we now have a vaccine to prevent the horrid suffering associated with cervical cancer is simply a wonderful gift to mankind. Although secondary cervical cancer prevention efforts with cervical cytology have reduced the rates of disease, particularly in developed countries, the developing world does not have the capacity to derive the same benefits. Yet, I believe this same gift of life-saving vaccination will be shared with all one day. In fact, Merck, Sharp and Dohme Corp. has been very generous in sharing their vaccine with the developing world. We are extremely grateful to them and hope that this effort can be expanded in the future.
