HPV vaccine off to a good albeit jumpy, small start
This week the HSE started vaccinating first year students in 20 schools around the country with the HPV vaccine. The HPV vaccine is part of a national programme to prevent cervical cancer. Recommended by HIQA the introduction of this virus the minister oked it and then withdrew it and then reannounced it. So what’s happening… The Human Papilloma virus (HPV) vaccine was the first Health Technology Assessment (HTA) carried out by Health Information and Quality Authority (HIQA) for its clinical and cost effectiveness. HIQA has a remit to assess medicines, devices, diagnostics, and health promotion and then advise the Minister on whether they should be used or introduced in Ireland.
In February 2008, HIQA published their first recommendation to the Minister which suggested the introduction of the HPV vaccine along with a cervical cancer screening programme.
In August 2008, Minister Harney agreed it should happen but that the cervical screening should happen first and the HPV vaccine would be introduced in all schools by September 2009. But then in November 2008, the minister announced there was not enough money to make the vaccine happen. And then in January of this year she announced they had negotiated down the cost and it would happen this year.
The HPV vaccine, under the new scheme, is being given to all girls currently in first year and those who will be in first year in September 2010 about 60,000 girls in total. And this week, the programme started on 600 of 60,000 who are going to get it. It is being administered through school and it requires three doses. If you have your first one now, the second one is two months later and the third, 4 months later so at 0, 2 and 6 months.
It is given to 11/12 year olds as that is what’s considered most scientifically effective, it is most effective if introduced to girls before they are sexually active. HPV is a very common virus easily spread by skin to skin contact during sexual activity. It is possible to have it without knowing it and therefore pass it on. HIQA recommended a catch up programme for 13-15 year olds but this is not happening on the basis of cost. Other countries have much more generous catch up programmes eg UK’s catch up programme went to 18 years of age and the American programme has a catch up programme up for young women up to 22 years of age.
The HPV vaccine does not guarantee that all the girls who are vaccinated will not get cervical cancer. It is when the vaccine is combined with cervical screening that the vast majority of the cases can be prevented. But because of the length of time before the onset of the disease, we will not see the benefit of this for 20-30 years. So even if vaccinated, screening is still required. Ireland is about 20 years behind most other European countries in introducing free cervical screening which is one of the reasons we have such high figures for cervical cancer and cervical cancer deaths. In 2007, there were 286 new cervical cancer cases and 81 women died from the disease.
But now there is also a free cervical cancer screening programme in place. Any woman aged 25 to 60 who has not had a smear test for three years can register on line at cervicalcheck.ie or call a free phone no 1800 45 45 55 and register and cervical check will send you out a letter so that you can go your GP and get a free check. As one doctor said to me recently it is ½ an hour once every three years that could save your life. There is no need to register if you have had a smear test in last 3 years, they will come to you.
The HPV vaccine is available to all girls in sixth class and first year now. The 600 girls who are vaccinated now will go to a health centre during the summer for follow up doses and then they’ll get the remainder dose in school. After September the majority will be administered through schools. For those who are home schooled or in special schools, arrangements will be made. And for those who are in second year or above, they will have to pay for it privately.
To buy costs and therefore is more accessible to those with money than those without which is why this new universal programme is so important. Privately it costs between €360 – €600 for the three doses. In total HIQA said it would cost €9.7 million per annum for all first years. Minister Harney said she’d got the price down significantly by negotiating with the pharmaceutical companies. The HSE said today they do not know yet how much it will cost as they are still working out the administration costs.
Under the new scheme, it is the public health/community nurses who carry out the childhood immunisations. The HSE is in negotiation with nurses, managers and unions as to how best to make the HPV vaccinations work but there is some criticism that other normal work is getting set aside like hearing tests and early childhood immunisations or other immunisations like rubella and booster for diphtheria and tetanus.
Also there has been a back stage showdown between the HSE and Dept of Health with the HSE saying it was not possible to make the scheme happen until September but the minister determined to go ahead with it now – so just 600 of 30-60,000 students who require it this year are getting the first dose in advance of the summer break.
For more information on this check out the HSE website hpv.ie which has very extensive and easy to understand material on it plus all parents and students are being sent information packs and consent forms in advance of getting the vaccines.