The HPV vaccine is more cost effective than it first seems

Since its initial licensing in 2006, the move to introduce an HPV vaccine for school-age girls has been contentious. Firstly, there was the cost implication, then doubts over effectiveness, worries about encouraging promiscuity… the list continues. Despite these concerns, in September 2008 the vaccine was introduced in schools across the UK with the plan to vaccinate all girls aged 12-13, with a “catch-up” programme covering girls up to the age of 18. The aim is to vaccinate girls before they are exposed to HPV. Well, that’s all fine and dandy, but what about the rest of us?
Cervical cancer kills 1000 women every year in the UK and is the second most prevalent cancer in the world. By the age of 24, two fifths of women are infected with the strains of the Human Papilloma Virus which can cause cervical cancer. In the UK, cervical screening is only available to women over the age of 25. So, what is the best course of action for those sandwiched in the 19-24 gap – the gap into which most university students fall?
Presently, there are two vaccines available which combat HPV: Cervarix and Gardasil. Both protect against strains 16 and 18 of the virus – the strains responsible for 70% of cervical cancers. Gardasil also protects against strains 6 and 11, which are responsible for most cases of genital warts.  The UK government has opted for the slightly cheaper Cervarix, however, both vaccines are available privately in this country to those outside the immunisation programme. When a course can cost up to £450 privately, it is not an option open to most students, however much they value their health.
Should the vaccination programme be extended? Research published in the Journal of Infectious Diseases indicates that Gardasil provides a degree of protection to women already infected with strains 16/18 of HPV. Over three years, the efficacy of the vaccine at preventing pre-cancerous or cancerous cervical cell changes in those already infected with HPV was 91%. Likewise, a study published in the Lancet Medical Journal asserted that older women are increasingly exposed to HPV infection: “Changes in sexual behaviour during the past 30 years, characterized by rising age at first marriage and an increase in divorce rates, have led to more widespread premarital sexual intercourse and acquisition of new sexual partners around middle age, respectively,” – thus, older women could seriously benefit from a prophylactic HPV vaccine. As yet, the Gardasil vaccine is only licensed in the UK for women up to the age of 26. Conversely, Cervarix is licensed to be administered to women up to the age of 55, although only those aged 18 and under may be vaccinated on the NHS.
The main aim of the HPV vaccine is to guard against cervical cancer. It may be a surprise that there has been demand for the vaccine amongst men. Whilst HPV causes more life-threatening cancers in women, men can be carriers of the virus too, often having no knowledge or symptoms of the infection. Thus, men can unknowingly pass on HPV to their partner.
It would be unreasonable to suggest men should be vaccinated for the purely altruistic reason of preventing the spread of the infection to women. Surely, however, an approach which sought to completely eradicate the infection would be desirable in the long term.  A little known fact is the relation between HPV infection and various male genital cancers. Whilst these cancers are rare, there is an annual incidence of around 1200 cases of HPV-related male genital cancer in the UK, with around 400 cases proving fatal. Reducing the prevalence of HPV in men would not only induce a state of greater immunity across the population, it could also save lives in the case of these rare cancers.
Thus far, I have avoided the wholly unpleasant matter of genital warts. A favourite topic of discussion at SHAG week, genital warts may seem a somewhat embarrassing and even humorous complaint talked about by eager Welfare Reps across the colleges. In reality, it is a particularly grim condition, which is often difficult and painful to cure. Genital warts are the most commonly diagnosed sexually transmitted infection in the UK. In 2003, there were an estimated 76,457 initial and 55,657 persistent cases of genital warts dealt with at a cost of £22.4 million. Suddenly, this uncomfortable disease and the possibility of its prevention seem a less laughable prospect.
I have previously defended the National Institute of Clinical Excellence as an essential agency which “balances the books in a country where any drug deemed effective and necessary is available to the individual”. In the case of HPV vaccinations, the books have been balanced against men, older women and in opposition to the prevention of genital warts.
Expense is a key issue in the debate; the vaccination programme is already costing up to £100m a year and the “catch-up” could cost up to £400m over two years. This approach may however, be deemed short-sighted considering the advantages of so called “herd immunity” in the long term. Perhaps NICE has made the right (or most cost-effective) decision. However, there is still room for debate. Meanwhile, perhaps the only option for cash-strapped student is to take advantage of the free condoms doled out by the Welfare Reps.