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It is not always understood that cervical cancer is usually caused by a
sexually transmitted infection (STI). More than 70 per cent of cases are
triggered by the human papillomavirus (HPV), a pathogen passed on during
sex.
Last October, Gardasil, a vaccine against the four most damaging strains of
HPV, was licensed. It will transform the prevention of the disease, which
still kills 1,100 women a year in Britain despite a national screening
programme. New research this week showed that vaccinating 70 per cent of
girls would ultimately halve the incidence of cervical cancer. Further
benefits are possible given a more expansive programme.
Gardasil sounds like the sort of medical advance to which it is impossible to
object. But it has inspired surprising opposition, and not just from the
irrational anti-vaccine lobby, which regards all immunisation with grave
scepticism. As HPV is sexually transmitted, the vaccine needs to be given to
girls before they become sexually active to confer maximum protection. This
has alarmed some religious groups, which argue that vaccinating at an early
age will encourage teenage sex.
This objection is entirely specious. The HPV vaccine will protect against
neither pregnancy nor STIs such as chlamydia or HIV, which will always be a
more immediate concern. It is hard to imagine any 13-year-old deciding to
have sex purely because she has been immunised against cancer. This is a
campaign inspired by those who regard abstinence as the only acceptable
answer to STIs and teenage pregnancy.
At least parents do not seem to be buying it: a poll for Cancer Research UK
has found that 75 per cent of mothers want the vaccine for their daughters,
with only 12 per cent worried that it might make them more likely to have
sex.
Yet, while the US, Australia and several European countries have wasted no
time in including Gardasil in national immunisation plans, the Government
committee that will consider the issue here will not even meet until next
month. Even if it recommends it to ministers, it is touch and go whether
vaccinations could possibly begin during the next school year.
Such a delay would expose thousands of girls to unnecessary risk. While the
smear test programme has done much to prevent death from cervical cancer —
it is estimated to save 4,500 lives a year — there are signs that it is
becoming a victim of its own success. As the disease has become less
visible, some women are becoming more complacent about it. New figures
released on Monday showed that take-up rates among women aged 25 to 29 — the
most vulnerable group — have fallen from nearly 80 per cent in 1995 to 69
per cent last year. Vaccination will not replace the need for screening, but
it will ensure that fewer women slip through the safety net.
So, too, would another potentially controversial measure: giving the vaccine
to boys as well as to girls. While cervical cancer does not affect men, HPV
does, and they can pass it on to infect their partners. Immunising both
sexes would eliminate 91 per cent of HPV cancers, compared with 78 per cent
for girls alone. The logic is the same as vaccinating boys against rubella,
which causes birth defects if contracted during pregnancy. It reduces the
pool of individuals in whom the virus might be circulating, protecting women
who cannot be vaccinated.
Adding boys to the programme would make it much more expensive. The cost per
year of life saved would be £23,000, against £2,400 if only girls were
covered. Even the higher figure, however, is well below the NHS
cost-effectiveness threshold of £30,000. If there is room for sensible
debate about Gardasil, this is where it lies. The only question that the NHS
should be asking about this vaccine is not whether it should provide it, but
how.
Mark Henderson is the Science Editor of The Times
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