Understanding policy over vaccination

The fight against cervical cancer can begin as early as the age of 12.

In September 2008, the UK National Health Service (NHS) started a national programme to vaccinate girls aged 12 to 13 against the human papillomavirus (HPV).

But the UK is just one example of how the discovery of a vaccine leads to a national vaccination programme. In fact, not all countries have invested in one. Those who did, may not have chosen the same vaccine. And also the way vaccination programmes are designed can differ – concerning the age vaccines are taken, the price paid by the governments and whether all those covered by the programme actually have access to the vaccine.

There are two vaccines that can protect against cervical cancer: Gardasil and Cervarix.

The Gardasil vaccine was created by German pharma company Merck, and was first approved by the US Food and Drug Administration (FDA) in 2006. Although it does not prevent all types of cervical cancer, Gardasil protects against four types of HPV: two of them (16 and 18) cause most of cervical cancer cases; the other two (6 and 11) are responsible for 90 per cent of genital warts cases. It is given as three injections over six months (if starting in January, the second would be given in March and the third in June).

The Cervarix vaccine was created by the UK’s GlaxoSmithKline (GSK) and licensed by the European Medicines Agency (EMEA) for use in the UK in 2007. Cervarix protects against HPV types 16 and 18. Like Gardasil, it is given as three injections over six months, but in different times (if starting in January, the second and third ones would be given in February and June respectively).

Nevertheless, this brief description of both vaccines is not enough to judge the effectiveness of each one nor the reasons that lead certain countries to choose one or the other. Some issues should be considered when comparing both vaccines:

– HPV is not only responsible for cervical cancer, but also for other types of cancer (such as neck, anal, penal, head) as well as genital warts;

– Being a sexually transmitted virus, HPV is a taboo in rather conservative countries;

– A vaccination programme is only effective with an effective calling system (i.e every person covered by the programme receives an invitation) to ensure that the three vaccine doses are taken appropriately;

– Vaccinating girls will affect how often they need cervical screening later in life, so the information given to both children and parents needs to be clear and accurate;

–  Although the evidence on vaccinating young girls is relatively clear-cut, research has not yet shown whether the uptake of the vaccine by young adults is effective, appropriate, cost-effective – or even harmful.

You can find more information on HPV vaccines here.

Cancer experts have kindly agreed to talk to me about some of these issues and I will soon be sharing their thoughts here. In the meantime, please feel free to share your experiences and doubts. The same experts might be able to answer your questions. How much is known about the vaccination of cervical cancer in your country?


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