Human Papilloma Virus
HPV Vaccine Eyed as Part of Cervical Cancer Strategy

Health officials from 21 Pan American Health Organization (PAHO) Member States pledged to work to make newly available human papilloma virus (HPV) vaccines affordable "so that all the countries in the region can introduce the vaccine in their national immunization programs as soon as possible."

The pledge was made in May in Mexico City at a conference sponsored by the Pan American Health Organization/World Health Organization (PAHO/WHO), the Sabin Vaccine Institute, and the U.S. Centers for Disease Control. It featured presentations and discussions on the toll of cervical cancer, the costs of new HPV vaccines, and the need to focus on both prevention and treatment.

Presenters noted that, in Mexico alone, one woman dies every two hours of cervical cancer. She is most likely poor, from an indigenous rural area, and with little or no access to health services. In Latin America and the Caribbean as a whole, 33,000 women die annually of the disease. These deaths often leave children motherless and can result in the impoverishment of entire families.Yet the vast majority of these deaths could be prevented with vaccination and screening.

Presenters said it should now be possible to cut the number of cervical cancer deaths in half. Newly available HPV vaccines are 100 percent effective against 70 percent of the viruses that cause cervical cancer. In addition, new screening methods give faster, more accurate diagnoses of precancerous lesions. With up to 30 percent of the region's youngest women currently infected with HPV, implementing a comprehensive regionwide strategy now could prevent the death toll from rising to 77,000 by 2030.

The major obstacle is the high cost of the vaccines. GlaxoSmithKline, maker of Cervarix, and Merck, maker of Gardasil, are selling the vaccines at $120 per dose,with three required doses.This puts the vaccine out of reach of the majority of females ages 9 to 26 (the target group) in the Americas.

Jon Andrus, PAHO's lead technical advisor on immunization, said that PAHO's Revolving Fund for Vaccine Procurement could take a lead role in helping to lower the prices. The fund facilitates bulk vaccine purchases by member countries and has nearly 30 years' experience negotiating affordable prices on a range of vaccines.

Data were presented showing that even if the HPV vaccine were available at $5 per dose, this would still represent a major budgetary challenge for the region's countries. But similar research showed that even with HPV vaccines priced at $10–20 per dose, paying for prevention is more cost-effective than the status quo.

Andrus said that accessing the HPV vaccine will ultimately require a process that includes negotiations on price, advocacy to build political commitment, and financial creativity to find new "fiscal space."

"We have to have steady demand for the vaccine through the revolving fund, and countries have to find new ways to finance the vaccines so that we're not taking from Peter to give to Paul in terms of other health expenditures," he said. "But financing vaccines is essential if we are to fulfill our commitments to the Millennium Development Goals."

Andrus and other experts emphasized that, regardless of the new vaccines, screening and treatment programs remain crucial. The new vaccines target only the two most prevalent strains of cancer-causing HPV, 16 and 18, yet a handful of other strains cause some 30 percent of cases. A comprehensive approach must include vaccinating young women before they start having sex, screening women throughout their lifetime for cervical cancer caused by strains not covered by the vaccine, and treating women who do develop the disease.

In the conference's final declaration, participants pledged to reinvigorate the fight against cervical cancer by integrating immunization, prevention, control, and adolescent and reproductive health programs, and by strengthening sexual education, health worker training, and screening, diagnostics, and treatment.

Ciro de Quadros, former head of PAHO's immunization program and a key player in the regional eradication of polio, said the new HPV vaccine and other recent developments have brought together experts who rarely talk otherwise. "It's energizing everybody," he said. "You cannot underestimate the impact, because it's enormous."

The Mexico City conference drew some 250 participants including government health officials, oncologists, epidemiologists, biologists, and experts on reproductive health, adolescent health, family health, and behavior, among others.