Aussie Doctors Worry That Gardasil's Cost May Force Fewer Pap Smear Tests

[mhatrw]

http://www.smh.com.au/news/national/pap-smears-still-essential-say-specialists/2008/08/25/1219516370509.html

AUSTRALIA'S cervical cancer rate could start to rise again if a new generation of young women vaccinated against the disease is not encouraged to continue having Pap smears, says a group of specialist doctors who are calling on the Federal Government to clarify the screening program's future. The pathologists - who include the inventor of the cervical cancer vaccine, Professor Ian Frazer - met two weeks ago to develop a new policy on preventing the disease. The move comes amid concern that immunisation could give women a false sense of security and undermine Pap smear screening, credited with halving cervical cancer cases and deaths since its introduction in 1994. ...

Dr Medley, head of cancer pathology at Melbourne Pathology, said the high cost of the vaccine program - $436 million in its first three years - might pressure the Federal Government to economise on Pap screening, which cost $104 million in 2006. Annabelle Farnsworth, director of cancer pathology at Douglass Hanly Moir Pathology, said immunisation, offered to 12-year-olds in a school-based program and to women aged 18 to 26, only offered protection against virus strains most likely to lead to cancer. But other strains could also cause the disease. "What if the other ones become more prevalent?" said Adjunct Professor Farnsworth.

Government analysis had shown expected cancer risk was three times higher in vaccinated women who did not have Pap tests than among unimmunised women who had regular two-yearly smears, she said.

The doctors' comments come amid rising concern overseas that the value of immunisation may have been oversold. It was unknown whether vaccinating against some strains might adversely affect women's natural immune defences against others, wrote Dr Charlotte Haug last week in the influential New England Journal of Medicine. As well, it was possible protection against HPV might wane over time, leaving women vulnerable later in life. "With so many essential questions unanswered, there is good reason to be cautious about large-scale vaccination programs," Dr Haug wrote.

[mhatrw]

1. Merck spokesdoc: It's "unfair" to study Gardasil's long term effects.

http://www.thestandard.com.hk/news_detail.asp?we_cat=16&art_id=70702&sid=20332517&con_type=1&d_str=&fc=3

It is routine for vaccines to be used after five years of efficacy data and it would be unfair to patients keep the product off the market while researchers study its long-term effects, says Rick Haupt, Merck's executive director of Gardasil clinical research.

Furthermore, since it was also "unfair" to withhold such a great product from Merck's clinical control groups (all to whom Gardasil has been recommended and offered for free), it is also now impossible to conclusively study Gardasil's long term benefits or its long term risks.

In addition, the other vaccines that are "routinely" used after five years of efficacy data have actually shown their efficacy against their targeted conditions, not a limited subset of precursor conditions.

[Hannah Bell]

2. published in reputable source, medical professionals question

vaccination program cost/benefit calculus...

but australia's already put it in their childhood vaccine schedule...

[WillYourVoteBCounted]

3. " Sophies choice" - Gardasil vac would double cost of Vacs in N. Carolina. from $11 Mil to $21 Milli

We have seen medicaid dollars cut because the budget isn't there, and to
pay for a non essential possibly dangerous vaccine would double the $ needed to
give children their "routine" vaccinations for communicable diseases in North Carolina.

North Carolina, for instance, spends $11 million annually to provide every child with seven vaccines. Gardasil alone would probably cost at least another $10 million.

"Increasingly, states are asked to make a Sophie's choice about which diseases they will allow children to be hospitalized or killed by," said Dr. Paul Offit, director of infectious diseases at Children's Hospital of Philadelphia.
http://www.nytimes.com/2006/06/09/health/09vaccine.html?_r=1&oref=slogin

What services will have to be cut to pay to keep Merck's profits up?