February 17, 2011
Warts and All (Again, again)
Health secretary Andrew Lansley has famously promised ‘no decision about you without you’ and a strong focus on preventing sexually transmitted infections. As the Department of Health reviews its secretive and sexually unhealthy choice of cervical cancer vaccine, is he brave enough to go public about preventing genital warts?
The Eye has long campaigned for an NHS Human Papilloma Virus vaccine programme with Gardasil to protect women against both cervical cancer and genital warts (Eye 23.3.2007). Labour dithered for 18 months and then chose Cervarix, which protects against cancer only (Eye 16.7.2008). The UK has an excellent cervical screening programme that already prevents 80% of cancers, so although the uptake of the vaccine has been very good, there will be little benefit in terms of lives saved for some years yet. The benefit in preventing genital warts – which are very common, cause untold misery and are fiddly and expensive to treat – would have been much quicker, as other countries have found.
In Australia, 70% of women under 28 have been vaccinated with Gardasil. New cases of genital warts among young women started falling after 6 months and now, 3 years into the programme, they have fallen by nearly 75%1. Even cases among (unvaccinated) heterosexual men fell by one third, due to herd immunity. In contrast, since England’s school-based HPV vaccine programme began in 2008, there has been no significant change in numbers of genital warts with some 91,000 new cases diagnosed each year and a further 70,000 cases undergoing repeat treatments. The highest rates of diagnoses are among women aged 16-19 and men aged 20-24. If you doubt the unpleasantness of warts, these photos will set you straight2. Doctors are now facing the anger of women whose sex lives are destroyed because Labour chose the wrong vaccine.
It costs the NHS £31 million a year to treat genital warts, and preventing most of them would free up time for staff to prevent and treat HIV and other infections. In addition, Gardasil prevents 30% of minor smear abnormalities and a rarer but often fatal condition called recurrent respiratory papillomatosis, where babies develop florid warts on the vocal chords and in the throat. Those who survive face multiple and extremely unpleasant treatments, costing the NHS £4million annually. The downside of Gardasil is that its manufacturers, Sanofi Pasteur MSD, have stuck to a price of £240 for the three-shot course, whereas Glaxo SmithKline, makers of Cervarix, undercut their list price substantially in a secret contract with the Department of Health.
This contract is now up for renewal and the government must decide whether to pay more up front for broader protection, knowing that the money will be recouped much more quickly than by sticking to Cervarix. Or it could try to negotiate a lower price with Sanofi Pasteur MSD. Lansley must involve the public in the decision, publish details of the Cervarix deal and at least allow people to pay a top up for Gardasil. 5% of all cancers are caused by Human Papilloma Viruses (cervix, vagina, anus, penis, head and neck) and both vaccines should be available as cheaply as possible within the NHS to all women and men who might benefit, without incurring the extra costs of using a private clinic.
At present we have a two-tier schoolgirl vaccine programme. The well-off and well informed are paying for Gardasil, and everyone else gets Cervarix. A recent study by the British Association for Sexual Health and HIV found that over 90% of sexual health clinicians recommend Gardasil and 61% have paid for their own daughters to be vaccinated with it privately. MD did likewise, but it makes the day job harder. Many doctors are supporting the NHS vaccination programme for their patients whilst secretly taking their daughters out of it and giving them another vaccine. If Lansley is to be a credible Secretary of State for Public Health, he must offer all patients the same protection against disease as the daughters of doctors.
1. Fairley et al Rapid decline in presentations for genital warts after the implementation of a national quadrivalent human papillomavirus vaccination program for young women. 2010 Australasian Sexual Health Congress, Sydney 18-20 October 2010.