Vaccination against human papillomavirus

Most developed countries have introduced human papillomavirus (HPV) vaccines as a public health measure. But there are continuing doubts about the “real-world” effectiveness of the vaccine and I and others have called for a slower, more cautious approach, so far to no avail (1-5).

Cervical cancer is predominantly a problem in under-developed countries and among poor and marginalized females in rich countries. The major burden of the disease is in poor countries (in Latin America, the Caribbean, and eastern Africa), and these countries can not only not afford the costs associated with a public campaign of HPV vaccinations, but lack the infrastructure to support both mass immunizations -- even with a reduced-price vaccine – and the Pap or other screening tests that are fundamental to a holistic cervical cancer prevention program.

Moreover, although marketing of the vaccines promises life-long protection from infection from the two viral types associated with about 70% of cases of cervical cancer, and “the beginning of the end of cervical cancer,” there are no published data to support these claims.

Putting aside all other concerns and unknowns about the vaccines I would propose now, as a bare minimum, that there be at least a contract between public payers in developed countries that have adopted the HPV vaccines and pharmaceutical industries which produce the vaccine that incorporates three commitments:

1. Pharmaceutical companies producing and selling the vaccines will donate (as vaccine or in dollars/euros) the equivalent to what is now charged for one dose to under-developed countries for each dose sold in developed countries. These donations will be devoted to programs for cervical cancer prevention (screening and/or vaccination to be determined by the recipients).

2. In case booster shots are needed because of shorter-than-promised protection, the pharmaceutical companies producing the vaccines will cover all the costs of re-immunizations, with preference to the resource-poor countries with a high prevalence of cervical cancer.

3. The companies producing and selling the vaccines will be responsible – collectively – for any costs arising from lack of effectiveness of vaccination of girls and women that emerge.

I offer these three proposals to start the necessary dialogue to ensure private profit is not at the expense of public health and well- being in the world.

References 1. Sawaya GF, Smith-McCune K. HPV vaccination: more answers more questions. N Engl J Med. 2007;356:1991-3. 2. Lippman A, Melnichuk R, Shimmin C, Boscope M. Human papilloma virus vaccines and women’s health: questions and cautions. CMAJ. 2007;177:484-7. 3. Gérvas J. La incierta prevención del cáncer de cuello de útero con la vacuna contra el virus del papiloma humano [Questions and doubts around cervical cancer prevention with vaccine against human papilloma virus]. Rev Port Clin Geral. 2007;23:547-55. 4. Lippman A, Boscoe M, Scurfield C. Do you approve of spending $300 on HPV vaccination? No. Can Family Phys. 2008;54:175-7. 5. Minnesota Department of Health. Human papillomavirus vaccine. Report to the Minnesota Legislature 2008. http://www.health.state.mn.us/divs/idepc/dtopics/vpds/hpv/hpvreport.pdf

Conflict of Interest:

None declared