EULALEE THOMPSON
THE BREAKTHROUGH vaccine against the germ that causes cervical cancer (the second leading form of cancer among women in Jamaica) is now internationally available, but it won't be on the Government's menu of vaccines for girls here any time soon.
A proper cost-benefit analysis of introducing the new vaccine, Gardasil, will have to be done and compared with continuing the current screening test for cervical cancer, the Pap smear, according to Dr. Karen Lewis-Bell, director, Health Ministry's Family Health Services. This is one factor that could delay the vaccine's availability here.
"We have to look at the figures. Will it be economical to continue Pap smears?" she asked. "Some countries may decide to continue doing Pap smears."
However, Professor Horace Fletcher, a leading obstetrician/gynaecologist with research interest in this topic, said that the vaccine's introduction "is not supposed to be controversial; it should be straightforward.
"The only area of concern is that it is a sexually-transmitted disease and a lot of people don't want to admit that their children are sexually active ... Church groups, and schools may also resist it because of the sexual connotations," said Prof. Fletcher, who is head of the University of the West Indies' Department of Obstetrics, Gynaecology and Childhealth.
APPROVED FOR YOUNG GIRLS
Fairly recent discovery by scientists that cervical cancer is caused by a sexually-transmitted germ, the human papillomavirus (HPV), has led to the creation of this vaccine against the germ. As reported in this column last October, Gardasil, the vaccine created by pharmaceutical giants Merck & Co. Inc., in clinical trials completely prevented early-stage cervical cancer and precancerous lesions. The vaccine targets HPV subtypes 16 and 18 and genital warts.
The vaccine was approved by the U.S. Food and Drug Administration (FDA) in June and last week the (U.S.) Advisory Committee on Immunisation Practices recommended that 11- and 12-year-old girls be routinely vaccinated against the HPV. (Gardasil is expected to compete with GlaxoSmithKline Plc's, Cervarix, cervical cancer vaccine.)
Prof. Fletcher said that cervical cancer is very common and the screening system here (Pap smears), unlike in some other countries, is notoriously weak; most women do not have regular Pap smears. The HPV, he said, is the most common sexually-transmitted infection with rates running up to 60 to 70 per cent in some age groups. Only 10 per cent of people with the virus will show lesions; 90 per cent will show no outward signs of infection.
"Because the virus is so common, it is important for young women to get the vaccine before sexual exposure ... All the studies show that there is almost a 100 per cent efficacy of the vaccine. Women in the younger age groups are more susceptible to HPV. It's very high in women just starting sexual activity, but there is a fall-off as women become older. It's not clear why, it's not necessarily that younger women are more sexually active, but we believe that the explanation lies in their bodies' immune system ability to get rid of the virus," he said.
VACCINE PROTOCOL
The first vaccine is expected to be given at age 12 with a booster shot at age 20. Professor Fletcher said that older women can be given the vaccine, although the studies by the drug companies focused on younger women. He also said that 12-year-old boys can also be given the vaccine, but cancer of the penis (caused by the HPV) is much less common and therefore vaccinating boys would not be cost-effective.
While the Health Ministry appeared lukewarm about the introduction of the vaccine, Dr. Lewis-Bell said that she will be attending, within the next two weeks, a Pan-American Health Organisation meeting in Guatemala, where the 'cervical cancer vaccine' and other new vaccines, such as the one against the rotavirus, will be discussed. Also, a series of regional meetings extending into year end will discuss vaccine protocol.
"So it is on the agenda, but we will not be able to give more definitive information on the vaccine use here before next January," she said.
Dr. Lewis-Bell said that a number of issues will have to be reviewed before the introduction of vaccines, such as prevalance, epidemiology, cost, logistics and deaths per year.
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