By Poly Pantelides
THE CYPRUS paediatric society is trying to secure a price reduction for a very expensive vaccine against cervical cancer as it tries to get more girls and women vaccinated.
Only about 15 per cent of girls and women in Cyprus have been vaccinated, the head of the paediatric society Michalis Iasonides said, citing data made available by the two companies offering two competing versions of the vaccine.
“The reason is that it is expensive,” Iasonides said.
Cervical cancer, the second most common cancer among women worldwide after breast cancer, is also the only cancer for which there’s a vaccine. The vaccine was first made available in 2006.
The paediatric society has recently announced a pro-vaccine campaign backed by the Health Ministry to raise awareness among parents and women. Parallel to the campaign, Iasonides said they were trying to get at least a 30 per cent to 40 per cent drop in prices to encourage vaccination. Three doses are needed and each one costs between €130 and €150, a significant expense for households.
The cost is currently preventing the debt-ridden state from including the HPV vaccine in its free vaccination programmes. So far, 21 European countries, within and outside the EU, have introduced the HPV vaccine in their immunisation programmes, according to the World Health Organisation (WHO). Of these, seven (Denmark, Italy, Luxembourg, Portugal, Spain, Switzerland and the United Kingdom) have achieved coverage rates of 80 per cent or more, the WHO said earlier this year.
Most countries, such as the UK and Greece, fully finance the vaccine via their national health authorities, while others such as France and Belgium part-finance vaccination, incurring most of the cost.
“A parent can easily vaccinate their daughter. It is a gift,” Iasonides said.
Cervical cancer is caused by certain “high risk” genotypes of the human papillomavirus (HPV) which are sexually transmitted. Two HPV vaccines, given in three doses over a period of six months, protect against two of the genotypes causing 70 per cent of all cervical cancers. One of the vaccines additionally offers protection against two genotypes causing genital wards, which affect 30 million people around the world every year.
About half a million women get cervical cancer every year, and over 250,000 die from it annually.
Just under 30 women will get cervical cancer in Cyprus every year, and about eight will die from it, according to data from the health ministry’s cancer registry.
Health authorities in Cyprus have a comprehensive free immunisation programme available to all children and adults for free, based on WHO recommendations and covering the major public health hazards such as polio, measles, mumps and rubella and diphtheria, tetanus and whooping cough. School and pre-school age children are vaccinated against diseases considered to be a major threat for public health and adults may get free boosters on all of those. The immunisation programme was last updated last year, but the debt crisis has prevented authorities from including the HPV vaccine in their programme, a health ministry official said.
The vaccine has not been without controversy. Some health officials fear that it will encourage reckless sexual behaviour because of a false sense of security, even though condoms do not actually prevent HPV. Others still question the need for a vaccine, since no vaccine offers complete protection against cervical cancer and so women continue needing to take regular screening tests. Those in favour point out that the vaccine does increase protection and greatly reduces likelihood of getting cervical cancer. And no screening test is foolproof.
Because HPV is highly transmissible, especially soon after the beginning of sexual activity and can be passed on through skin-to-skin contact, the sooner girls get the vaccine, the better. Recommended age is 12 years, before the beginning of sexual activity. Ideally, both boys and girls should be vaccinated to ensure full coverage but because of the seriousness of cervical cancer and the associated costs, girls are a priority, Iasonides said.
Dinos Mavromoustakis, a board member of the gynaecological society and the head of the Pancyprian colposcopy and cervical pathology company, recommends the HPV vaccine to women and men up to the age of 26 but said there was data to suggest it would be useful still for women up to the age of 45 because repeat rates of cervical cancer survivors might be lower among those who were vaccinated.
The vaccine may also reduce incidence of other cancers according to WHO which says that 90 per cent of anal cancers were caused by the HPV, which also accounted for 40 per cent of cancers of the penis, vagina and the vulva and to a lesser extent, for some cancers in the head and neck area.
So although normally associated as a female health issue, Mavromoustakis said the HPV vaccine is relevant to boys and men.
The UK’s National Health Service, which includes the HPV vaccine in its immunisation programme, says the vaccine has an “excellent safety profile” while a recently-published study of almost a million girls in Denmark and Sweden, did not find links to short- or long-term health problems.
But because the first vaccine was only approved in 2006, there are those who are still sceptical over any long-term side effects. Mavromoustakis said although the vaccine was made available in Cyprus very soon after approval, there were those – colleagues included – who did not see the need to rush to be “the first to do it”. Mavromoustakis felt that the drug test trials themselves and the drug’s approval indicated the vaccine was safe and the fact it protected against “a serious disease” was plenty of recommendation. Cervical cancer is a nasty thing, he said and “it doesn’t end well”.
One Cyprus-based doctor who would rather remain anonymous said that she hasn’t had her two daughters vaccinated. Though the literature that comes out says the vaccine’s efficacy and safety profile are excellent, the vaccine has not been around for that long and she wonders if there would be anything down the line, she said. But she added that doctors she trusts and the scientific community concur the vaccine is safe.
“The longer time passes the more interested I am [in the vaccine],” she said but with some safety concerns from some countries including Japan that took it off the list of mandatory vaccines this year, she was still “holding back”.
For Mavromoustakis, getting the HPV vaccine along with regular PAP tests screening for pre-cancerous changes in cells means no woman in Cyprus has to get cervical cancer.
“Don’t get your child an iPhone and get them vaccinated instead,” he said.