Changing vaccines: a ‘foolish decision’

As I mentioned before, there are two vaccines for the ‘cervical cancer’ virus, HPV – Cervarix and Gardasil. But why do some countries choose one over the other? And how do these decisions get made?

As you can see from this cervical cancer research timeline, studies about a possible HPV vaccine started in the 1990s.

In the UK, once the vaccines were proven safe and effective, the Joint Committee on Vaccination and Immunisation looked at the evidence and made its recommendation to the Department of Health in 2008. As a result, the government decided to use Cervarix in their screening programme. But following a debate on whether the NHS should replace Cervarix with Gardasil, it seems that the committee might have to go through the whole long-winded procedure all over again.

To find out more about what should happen next, I spoke to Dr Anne Szarewski – a clinical consultant at Cancer Research UK’s Centre for Epidemiology, Mathematics and Statistics at the Wolfson Institute of Preventive Medicine.

You can listen to our conversation below – but these are the main issues that Dr Szarewski raised:

Given that the vaccination programme is only just being rolled out, switching now would prevent us from comparing the effectiveness of each of the vaccines. Therefore, “the government would be foolish to change at this point”.

Similarly, a country needs to decide whether it is more important to prevent cervical cancer with a greater protection or to prevent genital warts and cervical cancer with less protection for the latter. “Cervarix offers much greater protection against cervical cancer than Gardasil does because it has a lot of cross-protection against other high-risk HPV types that are actually not included in the vaccine,” says the expert.

There are countries where culture and religion affect this decision. As Dr Szarewski says, “what’s going to work for example in a Muslim society is not likely to be the same in ours.”

Therefore, she believes Cervarix tends to be more popular in conservative countries. Vaccinating a woman against a sexually transmitted disease in those countries is “alien”, says the expert. Why would you vaccinate women against genital warts when they are supposed to have one sex partner their entire life?

Additionally, a country’s infrastructure determines the effectiveness of a vaccination programme. Without good transport and call-recall systems, which ensure that girls are given the jabs at the right time, women will not be looked after appropriately.

And finally, “the pharma industry of course is involved but ultimately it is the Department of Health that has to make the decision.”


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