By J. P. Anderson:
The Government has abandoned a plan announced just three months ago to have all 12-year-old girls vaccinated against a virus that causes cervical cancer, citing “very scarce” health resources.
Minister for Health Mary Harney this evening said the economic situation had “rapidly and seriously” deteriorated since the plan was announced in August. The vaccination scheme would have cost an estimated €9.7 million annually.
The decision was immediately criticised by the Opposition and by the Irish Cancer Society, which asked Ms Harney to make a clear commitment to restore the vaccination scheme "at the earliest possible opportunity".
In a statement, Ms Harney said: “Public resources, including those for health, are very scarce indeed and will remain so.
“I have decided that the best that can be achieved in these circumstances is to prioritise funding for the development of the cervical screening programme and treatment services at the eight designated cancer centres, which includes the challenge of funding very expensive cancer drugs.
“I will not therefore be proceeding with the introduction of a HPV vaccination programme.”
Between 70 and 80 women with cervical cancer die in Ireland each year and some 200 new cases are diagnosed.
Ms Harney announced on August 5th she had asked the Health Service Executive (HSE) to prepare a plan for the introduction of a human papillomavirus (HPV) vaccination programme for 12-year-old girls to commence in September 2009.
Her decision was based on a report by the Health Information and Quality Authority (HIQA) which recommended that the vaccine be given to 12-year-olds, along with a catch-up vaccination programme for 13-15 year olds.
The report said the annual cost of vaccinating 12 year olds would be €9.7 million, while the catch-up programme for 13-15 year-old girls would be €29.2 million. It estimated the cost per child would be just under €400.
The vaccine, consisting of three injections over a six-month period, was to be given free in primary schools.
Ms Harney was criticised by some experts for the decision, for budgetary reasons, not to implement the once-off catch-up vaccine programme for 13- to 15-year-olds.
Parents here who elect to vaccinate their older daughters privately now face costs in the region of €600.
The Irish Cancer Society expressed "serious disappointment" with the decision to vaccinate young girls against the virus which is "one of the biggest risks in developing cervical cancer".
Head of advocacy Kathleen O’Meara asked the Minister to make "a clear commitment to the restoration of the vaccination programme at the earliest possible opportunity".
Fine Gael health spokesman Dr James Reilly said the decision was "a slap in the face to people who believe in prevention being better than cure".
"For a miserly sum, they are now going to expose our children, our young women, to cervical cancer."
Dr Reilly said he would not be surprised to see women who contract cervical cancer in the future "suing the State" over the failure to implement a vaccination plan.
Ms Harney said in tonight the continuation and expansion of the Cancer Control Programme under Prof Tom Keane “remains a priority” and that funding of €15 million had been made available for this programme.
The Minister said the Government was currently rolling out the National Cervical Screening Programme, Cervical Check.
“The programme will provide free smear tests through primary care settings to the 1.1 million women living in Ireland aged between 25 and 60 years. A successful national programme has the potential to cut mortality rates from cervical cancer by up to 80 per cent,” she said.
There are more than 200 strains of HPV, which is sexually transmitted. Just a small number are associated with cancer of the cervix, the neck of the womb.
HPV types 16 and 18 are found in almost 70 per cent of cervical cancers, while another five sub-types are responsible for a further 20 per cent of cases. HPV infection is found in 99 per cent of women with cervical cancer.
Up to 2,000 women in Ireland each year are diagnosed with changes to the cells of the cervix that, while not cancerous, have the potential to become cancerous over a long period of time if they are not treated.
If caught in the early stages, cervical cancer has a five-year survival rate of 80 per cent or greater.
Dr Muiris Houston Medical Correspondent
Q&A:
The pros and cons of vaccination for girls against HPV, and the link between HPV and cervical cancer
What is HPV?
HPV stands for human papilloma virus – a sexually transmitted infection. It is estimated that almost 80 per cent of sexually active people have been infected with at least one type of the virus.
What is the link between HPV and cervical cancer?
Although there are in excess of 200 HPV strains, just a small number are associated with the development of cancer of the cervix (neck of the womb). HPV types 16 and 18 are found in almost 70 per cent of cervical cancers, while another five sub-types are responsible for a further 20 per cent of cases. HPV infection is found in 99 per cent of women with cervical cancer.
How common is cervical cancer?
Cancer of the neck of the womb is diagnosed in almost 200 women here every year. Some 70 women die from the disease annually. Cervical cancer usually develops quite slowly, passing through a number of pre-invasive stages (carcinoma in situ – CIN) before becoming an invasive cancer that spreads. If caught in the early stages, cervical cancer has a five-year survival rate of 80 per cent or greater.
Why might HPV vaccine help?
Because of the very strong link between HPV and cervical cancer, giving a vaccine to a woman before she becomes infected with the virus has the potential to hugely reduce the number of women at risk of cervical cancer.
Clinical trials have shown that HPV vaccination prevents advanced forms of non-invasive cervical cancer. However, because published data on the vaccine does not yet extend beyond a five-year follow-up period, it has yet to be scientifically proven that HPV vaccine prevents invasive cancer of the cervix.
When and how often is the HPV vaccine administered?
HPV vaccines, of which there are two on the market (Gardasil and Cervarix), must be given before the recipient becomes sexually active and contracts the virus. This means administering a comprehensive vaccination programme to girls aged 11 to 13. A full response requires three separate injections over six months. Because information is so far limited to a five-year follow-up period, it is not yet clear whether a booster vaccine will be needed. If it is, it is likely to mean a once-off additional injection.
How safe is the vaccine?
As with most vaccines, a local reaction at the injection site is quite common. Headache, fatigue and tummy upset have been reported following HPV immunisation. Fainting has occurred after vaccination, a common occurrence when immunising adolescents.
In the US, a possible association between HPV vaccination and Guillian-Barré Syndrome (a rare but acute neurological condition) is being investigated. In the US, three deaths were closely related in time to immunisation with a HPV vaccine, but no link could be found between the girls’ deaths and vaccine administration. It is estimated that some 1.5 million people have been vaccinated with one of the commercially available vaccines in Europe.
Why has it been decided to target 12-year-old girls?
The Minister for Health has been advised on HPV vaccination by the National Immunisation Advisory Committee of the Royal College of Physicians of Ireland (RCPI) and by the Health Information and Quality Authority (Hiqa). The expert advice was to target those aged between 11 and 13, with a once-off catch-up immunisation programme for 13- to 15-year-old girls. A key element of the decision was to ensure immunisation took place before sexual activity, because once a girl has been exposed to the virus vaccination is ineffective.
But why not target girls up to the age of 18?
Although the expert advice, here and in the UK, was to immunise 12-year-olds annually and carry out a catch-up programme up to the age of 15, a political decision was made by the UK health secretary to have a catch-up programme for those up to 18. Minister for Health Mary Harney could have replicated that decision here, but for financial and resource reasons has confined the programme to an annual primary school-based programme aimed at 12-year-old girls.
Research suggests the average age at which Irish women become sexually active is between 17 and 23, although one survey found that 22 per cent of 18- to 24-year-olds reported sexual activity before the age of 17.
So, what choice do parents of 13- to 18-year-old girls have?
Following the announcement yesterday, there is no prospect of these adolescents receiving a free HPV vaccine from the State. Their only choice is to pay for the three-part vaccination and have it administered by their GP. The estimated cost of a course of private HPV vaccination is around €600.
UPDATE:
THE Government was “cynical in the extreme” to announce plans to abandon a vaccination programme for cervical cancer on the same day as the US election, the opposition said.
Fine Gael leader Enda Kenny contrasted the “euphoria” in the US with the “pessimism and cynicism” here and said the excitement around the election was used by the Government to “bury bad news”.
During Leader’s Questions in the Dáil, Mr Kenny said vaccinating 12-year-old girls against the HPV virus, would have cost the State just €10 million.
“Why is there an intention to have pay increases of approximately €263m next year when frontline services like this, which are so important for young girls, are being cut?” he asked.
“Why was yesterday (Tuesday) chosen as the day to make the announcement when the HSE and the Minister for Health and Children knew — or perhaps expected — that people might not notice it?” he asked the Taoiseach.
The vaccination programme was announced three months ago and was due to be rolled out next September. Health Minister Mary Harney announced on Tuesday night that it would not go ahead because resources were “very scarce”.
Brian Cowen told the Dáil that resources are being concentrated on providing free smear tests to screen 25 to 60-year-old women for cervical cancer rather than vaccinating young girls.
“Health is one of the areas in which the Government has increased expenditure. The same public service pay pause, which, as matters stand has been negotiated with the social partners until October next year, applies to the health service,” said Mr Cowen.
The Taoiseach was also asked why a report on cancer misdiagnosis in the north-east was published on Tuesday evening when attention was focused on the US election.
Mr Kenny said the timing was designed to ensure “minimum scrutiny of the Government’s action”.
Nine patients had their lung cancer diagnosis delayed between August 2006 and August 2007 because of errors made by a locum consultant radiologist. Eight of these people died.
Mr Cowen said Ms Harney informed the cabinet of the report on Tuesday morning. Explaining delays in publishing the report, he said: “Protocols and guidance were not in place around the thresholds and methodology for reviews of this nature when concerns were first raised about delayed diagnosis. The HSE… faced logistical difficulties.”
