Cancer vaccines: who decides?

THIS AUTUMN, the Human Papilloma Virus Vaccine campaign is being rolled out. It is estimated this will save the lives of over 400 women a year in Britain. The government awarded the contract to GlaxoSmithKline (GSK) for their vaccine Cervarix, beating the competition from Sanofi Pasteur MSD and their vaccine Gardasil.

Liz Cowell

The Human Papilloma Virus (HPV) is contracted by direct sexual/skin to skin contact so condoms do not offer guaranteed protection - this is why the vaccine schedule is set to target young women before they become sexually active.

The HPV has over a hundred sub-types with about 30 affecting the genital area. 80% of sexually active people will be exposed to the virus HPV, however most people's immune systems deal with the virus and they don't go on to develop clinical problems.

However types 16 and 18 are responsible for 70% of cervical cancers and types 6 and 11 lead to 90% of genital warts infections.

Worldwide, cervical cancer is the second commonest cancer of women, causing 270,000 deaths annually. The cervical screening programme saw mortality rates in the UK drop by 60% between 1974 and 2004, but there is still a direct correlation between higher incidence of cervical cancer and mortality rates and socioeconomic deprivation. Just recently the government claimed to be addressing health inequalities.

Both vaccines in clinical trails were over 99% effective at preventing pre-cancerous lesions associated with HPV 16 & 18 in young women but only Gardasil was 99% effective at preventing genital warts associated with HPV 6 and 11 in young women.

We must question what was the government's rationale for choosing one over the other with genital warts being the most common viral sexually transmitted infection in the UK? 80,000 new cases of genital warts were diagnosed in Britain's GUM clinics in 2006 with the highest incidence in the under 24-year age group.

While it is not a terminal disease, it causes the sufferer discomfort and often psycho-social trauma. The chief executive of the Family Planning Association elucidates how "a huge opportunity to protect an entire generation of young women against genital warts [has been missed]", and she goes on to say "selecting the Gardasil vaccine would've been a huge preventative measure in terms of health and financial costs to the NHS.".

Criticisms also come from the Terence Higgins Trust, describing the government's choice as short-sighted, "they are saving pennies to spend pounds later."

The Financial Times predicted that the government would go with the Gardasil vaccine due to its broader protection, so the choice of Cervarix has left many scratching their heads. Both vaccines are said to cost £240 for the three-dose course.

The Department of Health maintain that decisions were made against a wide range of criteria, such as cost effectiveness and scientific qualities, with the vaccination programme always having been about cervical cancer protection.

But without this information being freely available, how are the public to believe this government's motives? That's another example of why we need a nationalised pharmaceutical industry as an integral part of the NHS.

AFTER GSK won the contract, its shares in GSK immediately increased by 22p to £11.02 (Financial Times 19/6/08). Meanwhile Gardasil is available from private clinics for £140-£159 a shot, with a course of three being required to offer protection. Health has certainly become quite clearly a commodity.