THE ROW: Minister excludes girls from free vaccinations

Mary Harney, the beleaguered health minister, has cited budgetary constraints for her decision to omit teenage girls from a programme to vaccinate young women against cervical cancer. Harney said last week that the cancer jab would be confined to 12-year-old girls when it is introduced in September 2009. The minister can save €29.2m for the cash-strapped government by excluding girls aged 13 to 15. It will only cost €9.7m to vaccinate 12-year-old girls. The Health Information and Quality Authority, the health watchdog, recommended two months ago that older teenage girls receive the vaccine as a one-off catch-up measure. Harney said competing health programmes, such as the rollout of breast cancer screening, had to take priority.

THE ISSUE: Putting money before lives lost to cancer

Following the announcement, Fine Gael accused Harney of putting “money before lives”. About 200 women were diagnosed with cervical cancer in 2004 and 90 died from the disease. The Gardasil vaccine is designed to combat strains of the human papilloma virus (HPV), the main cause of cervical cancer. The vaccine can prevent the development of 70% of the cancers if it is given to girls before they become sexually active. The vaccination could lead to a halving of related deaths in the long term. A 2007 study found that a third of 16-year-old schoolchildren were sexually active and that one in 10 Irish schools did not give any sex education to first- and second-year students.

THE REAL ISSUE: Widening the two-tier health service

The decision to limit access to the vaccine could increase the relative incidence of cervical cancer among girls from poorer families. Wealthier parents, now aware of the cancer jab amid widespread media coverage of the controversy, can pay to have their children inoculated. The vaccine costs an estimated €130 per jab, with three vaccinations required over six months. This is likely to heighten the outcry about the republic’s two-tier healthcare system. One saving grave is the nationwide cervical screening programme that the National Cancer Screening Service is preparing. This will provide free smear tests to the 1.1m Irish women aged between 25 and 60. It aims to reduce deaths from cervical cancer by detecting and treating cervical abnormalities.

THE BIGGER PICTURE: Promoting sexual activity?

The vaccine is controversial, with some parents in the US

and Britain refusing to give it to their daughters in case it encourages them to become sexually active, or because they question its safety. HPV is mostly transmitted through sexual contact. Thousands of complaints have been made about Gardasil’s side effects since it was approved by the US Food and Drug Administration (FDA) two years ago. Twenty deaths have been reported to the FDA, but there has been no proven link to the vaccine. Merck, the company that makes Gardasil, said the FDA had found issues that prevented the vaccine being effective for women over the age of 27. But the company said the FDA warning did not affect females aged from 9 to 26.

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