Guest Blogger: Amanda Eastwood
While suggested or even mandatory Human Papilloma Virus (HPV) vaccines for young girls in the United States has been a highly controversial topic over the past few years, the risk of HPV among females in developing countries is a topic of equally important value but receives little publicity within the United States. While I don’t argue that the HPV vaccine should be mandatory for all young females anywhere, I do believe that it should be made available at little to no cost to young females, not only in the United States and other developed countries, but also in developing countries where cervical cancer screening is less common and often less effective.
The World Health Organization holds a similar stance to my own on the topic by recommending that:
“…routine HPV vaccination should be included in national immunization programmes, provided that: prevention of cervical cancer or other HPV-related diseases, or both, constitutes a public health priority; vaccine introduction is programmatically feasible; sustainable financing can be secured; and the cost effectiveness of vaccination strategies in the country or region is considered1.”
Further emphasizing that all young women should have affordable access to the HPV vaccine, Part Two of the 25th Article of the Universal Declaration of Human Rights states that, “Motherhood and childhood are entitled to special care and assistance. All children, whether born in or out of wedlock, shall enjoy the same social protection2.” As an upcoming public health professional with a deep-rooted desire for advocating for women’s reproductive health, I believe that cervical cancer is a threat to the livelihood of women, families, and entire communities and that access to the HPV vaccine can help to protect this right.
Cervical cancer, caused by HPV in almost all cases, is the leading cause of cancer deaths among women worldwide. Often referred to as a disease of the poor, of the roughly 500,000 annual cervical cancer deaths worldwide, approximately 80 percent are in developing countries where it should be most considered a public health priority meeting one of the criterion of the WHO stance on including it as part of a country’s vaccination programme3. One positive aspect of cervical cancer is that it is extremely slow to progress allowing time to detect it in its early stages. When un-detected in its most preventable states, it often presents during a woman’s years of greatest productivity from her 30s to 50s. The good news is that cervical cancer can be prevented quite feasibly and easily through the prevention of HPV and through the early detection of pre-cancerous cells through cervical cancer screening3. The downside is that in many low-resource settings adequate screening and treatment services are generally sub-par which is why so many women in these settings perish at such a young age to a preventable cancer.
GlaxoSmithKline’s (GSK’s) Cervarix® and Merck’s Gardasil® are the two leading HPV vaccines consisting of a three-series shot administered to prevent the four main cancer causing strands of HPV. The vaccine, consisting of a series of three doses, averages $10 to $25 U.S. dollars per shot to all recipients unless their country of residence is considered an “extremely poor” country by the standards of the pharmaceutical company. Protection rates are highest (90 to 100 percent in clinical trials) after the administration of all three doses but the vaccine still shows high rates of efficacy after as little as one dose1. The cost is a seemingly small amount by American standards, however, an impossibly large sum to many poor women in country’s not considered to be “poor enough”. The problem is that many developing countries are comprised of a large, very poor population with a very small middle class and an even smaller but very rich upper class. Therefore, the economic status of such countries is skewed by the small population with extreme wealth and not considered “poor enough” to receive discounted vaccines.
There are several avenues one could take to approaching the issue of availability due to prohibitive pricing. One would be to demand that pharmaceutical companies consider vaccine rates on a more region or community specific level as opposed to a country-wide assessment. A second option is to tap into external sources that provide funding for vaccines in low-resource countries. Frankly, I would prefer to see the pharmaceutical companies reevaluate their current system of assigning countries an economic category or even consider the donation of vaccines to extremely impoverished settings. However, I don’t see this as extremely likely so will err toward the option that is already in place and functioning.
The GAVI Alliance is a source of external funding for vaccines in countries with a Gross National Income of less than $1,000 U.S. dollars per capita. Approximately 54 percent of cervical cancer cases are found in qualifying countries which could indicate huge strides in lowering both cervical cancer rates and deaths! Achieving success, however, will require some work on behalf of qualifying countries. Countries must apply to the GAVI Alliance and the Alliance does reserve the right to approve or deny applications. Nevertheless, once approved, countries are asked to contribute a maximum of 30 cents U.S. per vaccine depending on the Gross National Income of the country, and the GAVI Alliance will cover the rest4. Not only does this option reduce the financial burden to vaccine recipients, it also meets the WHO criterion of the security of sustainable funding. When looking at this from a cost-benefit approach, spending 30 cents U.S. now to prevent cervical cancer is a great deal less than the costs associated with trying to treat a very lethal cancer thereby making the vaccine a good long-term investment. I will not address the WHO criterion regarding the feasibility of programme introduction within this reaction but do want to acknowledge the importance it.
The fact that cervical cancer is the leading cancer killer among women worldwide should indicate its status as a public health priority. What’s more is that there is a known method which demonstrates high levels of efficacy in the prevention of HPV. As public health professionals, there is a level of accountability in making it available to women worldwide but particularly in low-resource settings where incidence rates of cervical cancer are highest. As many as 500,000 women worldwide die each year; each of them mothers, daughters, sisters, friends, wives, and companions in the peak of their lives3. The prevention of HPV among young women of this generation paired with effective cervical cancer screening among all women makes the fight against cervical cancer is one that we can win.
*Amanda Eastwood is a graduate student in the Maternal and Child Health Program at the University of Minnesota
- (April 10, 2009). Human Papillomavirus Vaccine WHO Position Paper. Weekly Epidemiological Record. No. 15, 2009, 84, 117–132. Retrieved from http://www.rho.org/file /WHO_WER_HPV_vaccine_position_paper_2009.pdf.
- (December 10, 1948). Universal Declaration of Human Rights. Article 25, Part 2. Retrieved on February 12, 2011 from: http://www.un.org/en/documents/udhr/index.shtml.(2007).
- Cervical Cancer, Human Papillomavirus (HPV), and HPV Vaccines; Key Points for Policy-makers and Health Professionals. WHO Press. Ref WHO/RHR/08.14. Retrieved from http://whqlibdoc.who.int/hq/2008/WHO_RHR_08.14_eng.pdf.(2007).
- Making Cervical Cancer Vaccines Widely Available In Developing Countries: Cost and Financing Issues. Retrieved from http://screening.iarc.fr/doc/IAVI_PATH_HPV_financing_brief.pdf