Mass immunization with cervical cancer vaccine switched to a more effective variety

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Cervarix, a vaccine that protects cervical cancer, will be replaced by Gardasil which also prevents up to 90 per cent of genital warts.

Campaigners have argued that the wrong vaccine Cervarix is being used in the routine immunization programme for young girls, which is estimated to prevent 400 deaths a year. Cervarix is cheaper than rival Gardasil, but fails to protect against genital warts. Surveys suggested doctors were choosing Gardasil for private vaccination of their own daughters.

Cervarix is currently offered to girls aged 12 and 13 years to protect against strains of the sexually transmitted human papillomavirus (HPV), which causes most cases of cancer of the cervix, the neck of the womb. Cervarix was picked by the Labour government for the first four-year phase of the NHS programme in 2008 because it offered ‘best overall value’ and more than five million doses have been given.

The vaccine, made by GlaxoSmithKline, beat off its rival Gardasil, made by Sanofi Pasteur MSD, for the lucrative contract worth at least £100 million, while a two-year catch-up programme for older girls was expected to cost a further £20 million. Both vaccines are 70 per cent effective against HPV strains 16 and 18, but Gardasil also protects against two other strains responsible for 90 per cent of genital warts.

With 100,000 new cases of genital warts in England each year and condoms only reducing transmission by up to 50 per cent, doctors argue that the safer option is to vaccinate with Gardasil. Data from the Health Protection Agency says genital warts cost the NHS £17 million a year, some of which could be saved by vaccinating against them. Doctors at the British Association for Sexual Health, which has campaigned for Gardasil, said it expected genital warts to be eradicated within 20 years among heterosexual boys and girls, as long as over 70 per cent of 12 to 13 year-old girls continue to have the full course.

The Department of Health (DH) last night confirmed that Gardasil had been chosen for the next four-year programme starting in September 2012 covering the whole country. The cost of the contract was ‘commercially confidential’ but updated information about the clinical benefits and pricing had been taken into account.

Professor David Salisbury, DH director of immunization, denied the original choice of vaccine had been wrong, saying it was a clear decision based on criteria at the time – which had now changed. Latest Department of Health figures show at least three-quarters of girls aged between 12 and 15 have received all three doses. Professor Salisbury said, “From next September, Gardasil will be the vaccine that we offer to girls to protect them against the HPV infection. It’s not unusual for the NHS to change vaccines or other medicines – it can happen following competitive tendering exercises or when new research findings come to light.”

“Young women and girls who have already been vaccinated or who are due to be vaccinated before September, do not need to be vaccinated again. They have done exactly the right thing and they can be assured that they are protected against types of HPV virus that cause over 70 per cent of cervical cancer,” he added.

Peter Greenhouse, spokesperson for the British Association of Sexual Health and HIV, said, “All of us at BASHH are delighted by the news that the next generation of teenage girls will receive a multi-purpose HPV vaccine which will protect them against cervical cancer AND genital warts. The UK-wide school cervical cancer vaccination campaign has produced higher rates of coverage than achieved in any other country - if we can keep this up we should expect to see genital wart infections start to reduce in teenage girls within five years, and slightly later in boys.”

Latest official figures show that 77% of 12- and 13-year-olds, and 84% of 14- and 15-year-olds, have voluntarily received the full course of three HPV jabs, either at school or at their GP's surgery – the highest uptake in the world.

Cervarix makers GSK said it had decided against bidding for the latest contract because the Government’s priorities had shifted towards protecting against genital warts even though there was evidence that Cervarix was better at reducing cancer death. Simon Jose, General Manager, GlaxoSmithKline UK, said, “This was a difficult decision for us to make but the criteria for the tender were changed. We are proud to have played our part in the success of the UK’s first HPV immunization programme which has uptake among the best in the world.  Latest figures show that more than 84 per cent of girls aged 13 to 14 have helped to protect themselves against cervical cancer by getting all three doses of GSK’s vaccine.”

The Aids charity the Terrence Higgins Trust also welcomed the decision because “it makes sense in terms of improving women's health and will also save the NHS millions.” But the charity called on ministers to offer the vaccine to all boys to protect them against some male cancers.

A British Medical Association spokeswomen said, “The latest evidence shows that Gardasil has superior public health benefits and is more cost effective.”

Dr Tony Falconer, the president of the Royal College of Obstetricians and Gynecologists, said, “The quadrivalent vaccine will also protect against the strains of HPV that cause genital warts, which are unpleasant and the cause of much psychological distress for sufferers.”

The Health Protection Agency said, “Warts are a common sexually transmitted infection in the UK, and as a result of this decision we expect to see a reduction in the number of diagnoses over time…We understand that the choice of the quadrivalent vaccine [Gardasil] in the UK followed a competitive tender. This tender was informed by a detailed scientific study comparing the two available vaccines against a range of criteria, including scientific qualities and cost effectiveness.”

Dr. Ananya Mandal

Written by

Dr. Ananya Mandal

Dr. Ananya Mandal is a doctor by profession, lecturer by vocation and a medical writer by passion. She specialized in Clinical Pharmacology after her bachelor's (MBBS). For her, health communication is not just writing complicated reviews for professionals but making medical knowledge understandable and available to the general public as well.


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