Male jab to reduce cervical cancer
By Nigel Hawkes
Times Online, UK
January 25, 2007
? Vaccinate both sexes, say experts
? Thousands of lives could be saved
Vaccinating boys as well as girls with a cervical cancer vaccine would greatly increase the number of lives saved, a study has found.
More than 90 per cent of cases of the disease caused by the four commonest strains of human papilloma virus (HPV) could be eliminated, instead of just over three quarters if only girls were vaccinated.
The study, carried out by three researchers from Merck Research Laboratories into the best strategy for using the cervical cancer vaccine Gardasil, shows that the greatest reductions are achieved if both boys and girls are targeted before the age of 12.
The reductions are achieved more quickly if “catch-up” programmes for teenagers and young adults up to the age of 24 also take place.
Professor Margaret Stanley, of the University of Cambridge, said that the results were exciting. “They not only demonstrate how effective a national vaccination programme for females could be, but also demonstrate that by vaccinating males as well, prevention of over 90 per cent of cervical cancer caused by the HPV types targeted by the vaccine could be achieved.”
Gardasil, which is developed by Merck and Sanofi Pasteur, is one of two HPV vaccines that are competing for the market. The other, Cervarix, is made by GlaxoSmithKline.
They target strains of HPV that are responsible for three quarters of the cases of cervical cancer, and are expected to offer protection against other strains. By preventing HPV infection, the vaccines remove the principal cause of cervical cancer and genital warts, as well as pre-cancerous lesions.
The model assumes that 70 per cent of 12-year-olds will be vaccinated before they become sexually active. Health authorities in the US have recommended the routine vaccination of girls aged 11 and 12, and a catch-up programme for those aged between 13 and 26.
In Britain, the Joint Committee on Vaccination and Immunisation is considering how the vaccine should be introduced. Ministers will then have to decide if it can be afforded. The cost is likely to be in the range £150 to £250 per person.
In clinical trials with more than 25,000 women, Gardasil proved 100 per cent effective against the HPV strains 6, 11, 16 and 18. The protection has remained for five years and is expected to be long-lasting.
Laboratory data suggests that Gardasil will also protect against HPV strains 31 and 45.
The results from the Merck team are published in the Emerging Infectious Diseases journal of the US Centres for Disease Control.
The team, led by Elamin Elbasha, assumed a gradual increase in vaccine take-up to a level of 70 per cent by the fifth year. If only girls were targeted, cervical cancer would be expected to fall by 78 per cent over 30-40 years. The fastest reduction in cases would be achieved by vaccinating both girls and boys before the age of 12, and providing a “catch-up” programme for both sexes up to the age of 24.
The cost-effectiveness of the different strategies varied. Although this comprehensive strategy was the most effective in reducing cases, the most cost-effective method was to target girls under 12.
Any scheme that included boys added greatly to costs.
Even the most comprehensive programme — including girls and boys at 11, plus a catch-up in both sexes — had a cost per year of life saved (£23,000) that falls within the target used in Britain by the National Institute for Health and Clinical Excellence of £30,000.
? A charity has accused the Government of “dragging its heels” in introducing a cervical cancer vaccination programme.
Pamela Morton, director of Jo’s Trust, said: “Three women die every day in the UK from cervical cancer. This is unacceptable, so I would like to ask the Government how many more have to die before it decides to make the HPV vaccine freely available on the NHS?”
A spokeswoman for the Department of Health said: “We are currently seeking expert advice from the Joint Committee on Vaccination and Immunisation on the efficacy, safety and benefits that new vaccines against human papilloma virus may offer.”
Senator Tom Coburn
Subcommittee on Federal Financial Management, Government Information, and International Security
340 Dirksen Senate Office Building Washington, DC 20510
Phone: 202-224-2254 Fax: 202-228-3796
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