[Ip-health] TIME Magazine on cost and availability of new cervical cancer vaccine

[Mike Palmedo]

http://www.time.com/time/magazine/article/0,9171,1202935,00.html

A Shot Against Cancer

By CHRISTINE GORMAN
Time Magazine
June 11, 2006

You'd think that if they invented a vaccine that protects you from
cancer, everyone would want it. But last week's approval by the U.S.
Food and Drug Administration of Gardasil, a vaccine against cervical
cancer, raises about as many questions as it does hopes. At the top of
the list: Who will get the vaccine, who will benefit most, and who will
pay for it?

Before we tackle those issues, however, a short biology lesson is in
order. Almost all cervical cancers are caused by a few strains of a
sexually transmitted microbe called human papillomavirus, or HPV. Most
of the time, a woman's body can deal with an HPV infection without any
trouble--which is a good thing since a majority of sexually active women
are believed to develop one at some point in their lives. In a small
percentage of cases, the virus persists in the body, and in an even
smaller percentage of those cases, the infection triggers a complex
process that leads to cervical cancer.

Gardasil offers nearly 100% protection against the two most common
cancer-causing HPV strains, as well as two others that cause genital
warts. But at $360 for three shots given over six months, the vaccine,
which was developed by Merck, is among the most expensive on the market.
The price tag alone probably puts it out of reach for many uninsured
women in the U.S. (as well as those whose insurance companies balk at
the cost), not to mention millions of poor women in the developing
world, where cervical cancer is a leading cause of death. The Gates
Foundation announced last week that it will spend $28 million over the
next five years to determine whether a cervical-cancer vaccine can be
made more widely available.

But even those with adequate medical coverage will have to wait a while
to get the vaccine. "Doctors probably aren't willing to stock it until
they are sure insurers are going to pay for it," says Dr. Cynthia Rand,
a pediatrician at the Golisano Children's Hospital at the University of
Rochester in New York. The next step is for an advisory committee of the
Centers for Disease Control and Prevention (CDC) to decide whether to
make the vaccine mandatory for girls in the U.S. and, if so, for which
age groups. Research suggests the vaccine is most effective when given
before sexual activity begins, so the initial target group is likely to
be girls ages 11 through 12. On the basis of the CDC's decision and
recommendations from other professional organizations, the Vaccines for
Children Program--which provides free shots for eligible children--and
private insurers are likely to follow suit.

Tests are also under way to see whether vaccinating boys against HPV is
a good idea. Although they obviously don't get cervical cancer, they are
at risk of contracting warts as well as penile and anal cancers that may
be linked to HPV. Plus, vaccinating boys against HPV should, in the long
run, help protect girls and women.

Eventually, if enough children are vaccinated, the number of cervical
biopsies and other invasive procedures should begin to drop. But since
the vaccine doesn't cover every cancer-causing strain of HPV, women will
still need to undergo Pap smears and other preventive tests for the
foreseeable future.