The Department of Health has decided to change the vaccine it uses, Cervarix, to protect girls against cervical cancer. From next year it will use a jab, known as Gardasil, which also protects against genital warts. It would be mandatory to discuss the long-standing debate regarding HPV vaccinations to understand how the NHS is now forced to make a ‘U-turn’ in accepting Gardasil to have higher efficacies overall than Cervarix, which the Department of Health in England insisted before the latter came out on top ‘after a rigorous assessment’.
According to the US government’s National Cancer Institute, “Human papillomaviruses (HPVs) are a group of more than 150 related viruses. They are called papilloma viruses because certain types may cause warts, or papillomas, which are benign (non-cancerous) growths. Some types of HPV are associated with certain types of cancer. These are called “high-risk,” oncogenic, or carcinogenic HPVs. Of the more than 150 types of HPV, more than 40 types can be passed from one person to another through sexual contact. Transmission can occur in the genitals, anal, or oral regions. Although HPVs are usually transmitted sexually, doctors cannot say for certain when infection occurred. About 6 million new genital HPV infections occur each year in the United States. Most HPV infections occur without any symptoms and go away without any treatment over the course of a few years. However, HPV infections sometimes persist for many years, with or without causing detectable cell abnormalities. Infection with high-risk HPV is the major cause of cervical cancer. Almost all women will have an HPV infection at some point, but very few will develop cervical cancer. The immune system of most women will usually suppress or eliminate HPVs. Only HPV infections that are persistent (do not go away over many years) can lead to cervical cancer.”
HPV (Human Pappilloma Virus) is thought to be behind 99% of cervical cancer cases. Since September 2008 there has been a national programme to vaccinate girls aged 12 to 13 in the UK against the human papilloma virus (HPV). But there was an earlier controversy among sexual health experts regarding which vaccine to make available to the NHS to combat the various strains of HPV. Major uncertainties arose over efficacy and safety for these costly vaccines, with certain opinions suggesting the decision was made to benefit the drug giants, though it was deemed ‘scientifically and economically justifiable’.
In the UK, Cervarix is the vaccine of choice. It protects against the two strains of HPV (16 and 18) that cause cervical cancer in over 70% of women. The Cervarix jab has been given to more than a million girls in the UK to protect them from the virus that causes cervical cancer, with many more set to follow. Decision making regarding what drugs to make available in the NHS is not a simple process. An article from bad reputation summarises this complicated issue as:
Public health is a complex issue; there is a finite amount of money to be allocated and the long term cost/benefit analysis are by no means straight-forward. Organisations like NICE have to make some occasionally very tough decisions, and sometimes good treatments have to be left out of guidelines because they would deprive other areas of resources judged to have a greater beneficial impact. With that said, on to an issue of current importance, in which NHS guidelines may well be letting a lot of people down.
Bad reputation addresses the debate regarding HPV vaccinations in a lucid manner as: “The issue here is that there are two vaccines available, Gardasil from Merck and Cervarix from GlaxoSmithKline. Whilst both protect against strains 16 and 18, Cervarix does not provide any protection against the non-cancerous strains responsible for genital warts. Gardasil, by contrast, also protects against strains 6 and 11, which cause 90% of genital wart cases. Gardasil also has a rather high list price of £240 per person, available in the private sector, whereas the makers of Cervarix have significantly undercut their list price in an unreleased contract with the NHS.”
It is obvious that Cervarix was not a popular choice to start with, with lots of controversy about its selection over Gardasil. Some sexual experts suggest Gardasil would have been a better option because it targets four strains of HPV – two responsible for cervical cancer (type 16 and 18) and two causing the less serious condition of genital warts (type 6 and 11). Gardasil is used by the majority of vaccination programmes worldwide which are already up and running.
How safe is the vaccine?
According to Q&A on Cervical Cancer Vaccine, Fergus Walsh of BBC writes, “So far 1.4m doses of Cervarix have been given to people in the UK, and millions have received the jab around the world. It underwent extensive safety checks before its introduction, and so far its safety record has been good. A minority of people develop minor side-effects, such as sore arms, swelling at the site of injection and dizziness.”
Switch in vaccine
The recent high prevalence of genital warts in the UK seems to be the driving force towards the switch to Gardasil, as figures from the Health Protection Agency show that 75,000 people were diagnosed with genital warts in 2010.
Professor David Salisbury, the Government’s Director of Immunisation, said: “It’s not unusual for the NHS to change vaccines or other medicines – it can happen following competitive tendering exercises or when new research findings come to light.”