Perhaps it was the jet lag. Or the attractive mother in the television ad,
kissing the top of her child’s head as I sat watching in an American hotel
room, thousands of miles away from my own daughter.
Apart from an appeal for an abandoned donkey sanctuary that I happened to
catch when I was feeling a little hormonal, no advertisement had ever acted
quite so effectively on my conscience.
“I chose to get my daughter vaccinated because I wanted her to be one less
woman affected by cervical cancer,” the woman said gravely, before giving a
little hug to her suspiciously cheerful teenager.
The ad was for a revolutionary human papilloma virus (HPV) vaccine,
manufactured by the American pharmaceutical giant Merck, and ended with the
message: “You have the power to choose. Ask your daughter’s doctor about
Gardasil.” So I dutifully did my research and discovered that as the jab
wasn’t yet available on the NHS, the vaccination would have to be done
privately at a cost of £250.
Small price to pay, I figured, if my daughter Ellie was to become “one less”
girl who had to worry about the second biggest cancer killer of women.
Ellie, then aged 14, simply shrugged when I told her she was going to have a
jab that would protect her against cervical cancer. There was no
soul-searching conversation; no demand to know why I wanted her to be
vaccinated at such a young age against a sexually transmitted virus. In any
case, I was pretty sure she knew about HPV.
Courtesy of teen mags and sex education lessons at school, Ellie and her
friends are pretty much up to speed on all the perils of underage sex.
(Children know far more than we think they do: at seven, Ellie once asked if
I knew what being gay meant. When I attempted a fumbling
Janet-and-Janet-style explanation of homosexuality, she snapped, “I know
what it is – I just wanted to know if you did.”) So Ellie readily agreed to
be given Gardasil in a series of three injections over the space of six
months, and suffered no adverse reactions. She was, if you like, a pioneer.
This September, every schoolgirl aged 12, 13, 17 and 18 – there are around
650,000 of them – will be given a letter inviting her to take part in the
most expensive mass vaccination programme ever undertaken by a British
government. (At a later date, the jab will also be offered to all girls aged
14-16 as well.)
The HPV vaccine was licensed for use in Britain more than a year ago, and last
month it was announced the lucrative government contract had been awarded to
Merck’s main rival Glaxo Smith Kline (GSK), which makes a vaccine called
Cervarix.
Some time between the licence being granted and GSK getting the contract, I
started investigating the story behind the vaccine for Channel 4’s
Dispatches. Even before Britain had taken the decision to buy it, I
discovered parents were starting to clamour for it – as one Glasgow GP
confirmed. “It came with a great degree of hype about it,” she said dryly.
I soon started to wonder whether I had done the right thing by my daughter.
Had my judgment been swayed by clever mar-keting? Had I inadvertently become
caught up in “AstroTurfing” – the term used when companies are accused of
creating a fake grassroots demand for a new product?
I also discovered that the path to herd immunity may not be as simple as the
government is hoping it will be. Many parents were uncomfortable about the
speed with which the vaccine had been introduced to this country. In
Manchester, where Cervarix had been trialled for the past year, only seven
out of 10 had agreed to their daughters taking part.
The reasons for this were varied. First and foremost, though, many were
understandably reticent to sign up for the jab until they had a cast-iron
guarantee that it was safe. The controversy over the MMR vaccine has put
paid to the days when parents unquestioningly followed public health advice.
However, Margaret Stanley, a leading cervical cancer expert based at Cambridge
University, assured me that unlike MMR the HPV vaccine is not live and is
therefore biologically safe. However, it stops only two strains of HPV – so
her main concern is that girls who are vaccinated should be given the strong
message that they must still go to the doctor’s for smear tests from the age
of 25.
Safety issues aside, some parents – particularly those from faith communities
– are uncomfortable with what they see as the moral issues surrounding the
vaccine. Two Catholic schools had opted out of the Manchester trial –
chiefly because many parents felt that 12-year-olds were far too young to be
told about a sexually transmitted virus. Indeed, some people believe that
the vaccination programme may actually encourage promiscuity.
Dr Majid Katme of the Islamic Medical Association said: “My humble message to
my Muslim community? Stick to your own religious moral code – you don’t need
the vaccine. There are a lot of young girls who’ll say, ‘Oh, we’re
protected, I have vaccine, I can go now and pick up these boys and sleep
around’.”
I felt my hackles rising. If we were all told we could suddenly murder with
impunity, I told him, that wouldn’t make us want to kill someone, would it?
Equally, girls who refrain from having sex don’t do so because they fear
they’ll get cervical cancer. They do so because they have high self-esteem
and a strict moral code. The vaccine doesn’t change that.
However, the age of 12 does seem especially young. The idea, I was told, was
to target every girl before she becomes sexually active; and, like it or
not, there are some already having intercourse by then.
Another contentious issue is whether, at a cost well in excess of £100m a
year, the vaccine is the best use of public money – or whether the money
might save more lives if spent elsewhere.
Dr Angela Raffle, a public health consultant, explained the figures this way:
“Take a million population: 14 women a year will die from cervix cancer. In
that same population, 200 will die of lung cancer and 1,500 will die of
heart disease. Cervarix is an expensive vaccine that, at very best, will
make a small extra inroad into a disease that is already very uncommon. It’s
probably not the best use of NHS resources.”
But David Salisbury, head of the vaccine programme for the Department of
Health, is convinced that the vaccine is efficacious and worth the cost. “In
an ordinary year of vaccination we would expect to save 400 lives,” he said.
“Now multiply that up over 10 years, and that’s at least 4,000 lives
[saved]. These are big numbers.”
Big numbers indeed, with a likely bill to taxpayers of close to £500m over the
next few years.
Understandably, the competition to secure the government contract was fierce.
So why did it choose to go for Cervarix? Merck’s Gardasil is the market
leader and protects against four main types of HPV and 90% of genital warts.
So it struck me as a curious decision to give the British contract to GSK’s
Cervarix, which protects against just two nasty types of HPV – strains 16
and 18.
Earlier this month the British Medical Journal online published a paper that
claims the government stands to make savings of £18.6m a year by choosing
Cervarix over Gardasil. This has prompted a US public health expert to say
that the health department decision implies it was willing to forgo health
benefits to save money for other health projects.
Prior to licensing, both Merck and GSK ran powerful campaigns in the UK.
Raffle told me that letters from both companies “started to come in thick
and fast to primary care trusts, infectious disease specialists, individual
practices, nurses, managers, everybody”.
She added: “This is a tried and tested technique that’s used a lot. The
pharmaceutical industry creates the impression that there’s massive
grassroots pressure for something – which works very well in a democracy
because ministers respond to grassroots pressure. They don’t see it as
self-interested lobbying by someone who has got a vested interest – the
technical term for which is AstroTurfing.”
When I put this to Dr Pim Kon of GSK, she told me: “I certainly wouldn’t call
it an AstroTurf or fake campaign. It is important that when you have
innovative breakthroughs, such as vaccines that prevent cancer, that people
are aware of them.”
On reflection my decision to vaccinate Ellie was undoubtedly swayed by a
clever US television ad and by the “wonder drug” stories I’d read in the
British media. So now that I know a little more about the vaccine would I
still go ahead with that decision? Absolutely. And I’ll sign my
four-year-old up for the free jab when she’s 12 too.
The clincher for me was meeting 22-year-old Claire Walker from Washing-ton in
Tyne and Wear, who was diagnosed with advanced cervical cancer a year ago
and was recently told that her condition is terminal. She has a two-year-old
son, Alex.
As well as being in great pain, she’s had to come to terms with the fact that
her life would have been saved if the vaccine had been available when she
was 12. Her mother Lynn has this advice for other parents: “I wouldn’t
hesitate. Even if it just saves one girl from going through what Claire is
going through, then it’s worth it, isn’t it?” To my mind, it’s hard to argue
with that.
Dispatches: The Jab That Can Stop Cancer is on Channel 4 at 8pm tomorrow
THE FACTS ABOUT THE HPV VACCINE
- Cervarix has been tested for 6½ years on more than 40,000 women. No deaths
have been reported. The most common side effects are headaches, muscle pain,
tiredness and swelling at the site of injection.
- The HPV virus is passed through sexual contact, but rarely causes serious
illness in boys, so only girls are being offered the vaccine.
- The list price of the HPV vaccine is about £250 for a three-shot course.
Although the NHS will pay less, it still costs about eight times as much as
the hepatitis A vaccine, 13 times as much as the meningitis C vaccine and 40
times as much as the MMR.
- A survey of 2,000 teenagers found that one in five 14-year-old girls had had
sex – with an average of three partners. Almost two-thirds of those had had
unprotected sex and more than half had had a one-night stand.
