On the 5th of August of this year, Mary Harney announced that she would be rolling out the HPV vaccination programme for twelve year-old girls, beginning in September 2009. However, due to recent budget cuts, she did a u-turn on the vaccination programme, saying that funds would be prioritised for the development of the National Cervical Screening Programme instead.
She justified her position by stating that “screening has the capacity to reduce cervical cancer by over eighty percent, in terms of the population, and in an individual case by ninety-five percent”. Her decision provoked outcry, with Donegal TD Dr. Jim McDaid refusing to vote with his party on the issue. He told the Dáil that he could not support a decision that withheld a life-saving vaccine from young girls, as it was against his Hippocratic oath.
The vaccine in question was the Human Papilloma Virus vaccine. HPV is the main cause of cervical cancer, the eighth most frequently diagnosed cancer in women in Ireland. The new vaccines protect against the two most deadly strains of the virus, which account for seventy percent of cervical cancer cases.
Thus, by vaccinating twelve year-old girls, seven out of every ten cancers of the cervix would be avoided. Screening would detect the further three out of ten patients, and also the older women who have not been vaccinated.
At the request of the Minister in July 2007, the Board of the National Cancer Screening Service undertook a review of the role of HPV vaccines in the prevention and control of cervical cancer. The board examined the cost-effectiveness of a combined national HPV vaccination and cervical cancer-screening programme, compared to a cervical cancer-screening programme alone. The board recommended the rollout of the vaccine programme.
In August, Mary Harney had also announced the decision not to put in place a catch-up programme for thirteen to fifteen year-olds in the first year of vaccination.
Did this receive any attention in the media? was it the subject of a Dáil motion? I’m afraid the answer to both questions is no. Belgium, France and the UK all have catch-up programmes for girls up to fifteen, up to twenty-three and from fourteen to eighteen years of age respectively.
The implications of both not rolling out the catch-up programme, and reversing the decision to vaccinate twelve year-olds, will result in parents and young women being forced to pay for private medicine. Charter Medical offers the vaccine for €610, a price well above what many parents can afford.
The HSE’s counterpart over the border and across the water, the NHS, has already made available cervical cancer vaccines to twelve year-old schoolgirls in the UK. They expect an uptake rate of seventy percent. Fine Gael’s health spokesperson, Dr. James Reilly, pointed out the ludicrous nature of a situation where the vaccine was available “fifty miles up the road in Newry, and we cannot have it down here for our children.” The disparity between the health services on the same island is further underlined by the fact that a national screening programme has been in place in the UK since 1989.
According to Mary Harney, the axing of the vaccination programme will only save €10 million in a budget worth €1.6 billion. This projected €10 million cost wasn’t even accurate. The Health Information and Quality Authority’s €9.7 million estimate had been adjusted upwardly to the tune of twenty percent by the HSE. As the Labour Party health spokesperson Jan O’ Sullivan rightly pointed out, the government’s costing of €600 per schoolgirl was “well wide of the mark. The cost of three doses required for the vaccination is actually €345, which if a procurement process were to be put in place, could probably be driven down even further, bringing the annual cost down to somewhere in the region of €7 million.”
There were, of course, alternatives to the Minister’s u-turn. Both companies potentially involved in supplying the vaccines were willing to forego payment until next year. With this deferred payment of the vaccines, the HSE would have been left an administrative bill of just €900,000.
To compound matters, the Minister hasn’t even given a provisional date for introduction of the vaccine. It has been put off indefinitely. We must remain content with her pledge to implement the cervical cancer programme as soon as possible, whenever that may be.
From a purely political point of view, this vaccine didn’t offer short-term benefits and this probably shaped the opinions of the Minister of Health when she decided to scrap it. Political expediency isn’t based on long-term benefits to be realised twenty to thirty years from now, when the number of cases of cervical cancer will be greatly reduced. One wonders what Dr. Harald zur Hausen, the man responsible for discovering the link between HPV and cervical cancer and a recipient of this year’s Nobel Prize for Medicine, would think of the u-turn. He spoke on Irish radio recently, saying that in each case, prevention is better than cure. He believes that vaccinations and screenings are should be used in tandem. The vaccination is clearly superior in preventing all those lesions and avoiding the therapeutic types of interference, but sceening is also important.
Failure to go ahead with such a vaccination will inevitably lead to deaths in years to come. Mary Harney has a real opportunity to regain credibility and respect by standing up to Brian Cowen and demanding the reinstatement of the HPV vaccine programme.
I would like to remind the Minister that in 2004, two hundred women were diagnosed with cervical cancer, ninety of whom died of the disease. Of those two hundred cases, it has been estimated that over one hundred of the diagnosed cases, and fifty-two of the deaths, could have been avoided by using the vaccine. How then, in good conscience, can it be denied to our country’s children?