When it comes to making the shot against cervical cancer the national vaccine programme, which means girls between the ages of 12-18 will receive it free, price is the matter.
The debate over the price of the vaccine against Human Papillomavirus (HPV), a virus that causes cervical cancer, has become intense.
As cervical cancer has become one of the major national public health issues worldwide, governments in many countries fund HPV vaccinations for girls in the hope of lowering the number of cases in the long run. The Australian government, for instance, funds HPV vaccinations in the national vaccine programme for girls between the ages of 12-18, while the programme for boys has been already approved.
In Thailand, however, the Public Health Ministry’s plan to seek cabinet approval for HPV vaccination for all Prathom 6 (Grade 6) girls has become the subject of heated debate. The plan’s opponents cite the argue the vaccine cost per shot is too high.
“I am not against the availability of HPV vaccine,” said Nattaya Boonpakdee, secretary of Women’s Health Advocacy Foundation. “The availability of the vaccine means females can take advantage of today’s medical advancement that helps protect against the deadly disease in the future. But, the proposed price of 500 baht per shot (1,500 baht for a series of three shots) is unacceptable.”
Dr Yot Teerawattananon, director of the Public Health Ministry’s Health Intervention and Technology Assessment Programme (HITAP) recently told the Bangkok Post that the price of the HPV vaccine shouldn’t exceed 190 baht per shot, citing an HITAP study report on the price of the HPV vaccine. He notes that some African countries pay only 150 baht per shot. In his view, screening tests that include a Pap smear and visual inspection with acetic is the most effective way to detect cervical cancer.
To effectively protect against cervical cancer, meanwhile, Nattaya called for comprehensive protective measures, including stringent campaigns on cervical cancer and on the importance of pelvic examinations and screening tests to help raise awareness among women.
Many campaigns on cervical cancer used a fear strategy instead of creating awareness of the disease, she said.
Nattaya also urges the government to streamline the screening tests for the disease as the main tool to prevent cervical cancer. This activity can be achieved through an expansion of obstetrical and gynaecological services to cover all parts of the country and improvement of the standard of the services and facilities.
“A pelvic exam and a Pap smear are inevitable among females, even HPV-vaccinated women are also recommended to have a regular screening test for cervical cancer. So, why don’t we improve the standards of service and facilities?,” she said. Females are vulnerable. Offering services that make them feel comfortable is a must.
Nattaya stresses the HPV vaccine is not high on the agenda. The proposed price should be reviewed for reasonable rate.
Cervical cancer is the second most common cancer among Thai women, according to the National Cancer Institute (Thailand). It’s estimated that there are about 10,000 new cases each year and on average almost 14 women die from it each day.
Assist Prof Dr Manopchai Thamkhantho, of Siriraj Hospital’s Department of Obstetrics Gynecology, said most HPV infections have no symptoms. And the infections are sometimes harmless and go away on their own without treatment.
“But it’s important because infection of HPV virus can cause cervical cancer in women. It remains latent in the body for many years,” he said.
HPV infection is nothing to do with genetics, but it is a sexually transmitted disease. The infection can be found in both males and females. Needless to say, sleeping with someone who has many sex partners or those engaging in many sexual activities increase the chances of contracting the HPV virus.
“Condoms may be not the answer,” said the obstetrician and gynaecologist. It may lower the risk of HPV infection (if used all the time in the right way). But HPV virus can infect areas that are not covered by a condom.
There are more than 100 HPV virus types and over 30 types are transmitted sexually. Types 16 and 18, according to Dr Manopchai, accounted for 70% of cervical cancer in females. They can also bring on other types of cancer including vaginal cancer, vulvar cancer and penile cancer. In addition, HPV viruses are associated with several lesser known types of cancer. They are known as types 6 and 11 that cause about 90% of genital warts in both females and males. These less severe types can also result in low-grade cervix cell changes.
The HPV vaccine is designed to target HPV types of virus: 6, 11, 16 and 18. HPV types 16 and 18 are responsible for cervical cancer. Protection against HPV vaccine is expected to be long-lasting.
HPV vaccine is preventive, not curative, according to Dr Manopchai. Remember that the vaccine doesn’t protect against all HPV types that cause cervical cancer. So, vaccinated women still need a regular screening test.
Dr Manopchai notes the HPV vaccine is most effective when given to individuals, before there is any contact with the relevant HPV types through sexual activity. In fact, it’s ideal for sexually naive cases.
The women’s health expert says women with sexual experience and who have still have not been vaccinated may still benefit from the vaccine because they may not have been exposed to types of the virus covered by the vaccine.
However, being vaccinated can often be a double-edged sword.
According to Dr Manopchai, there are no known serious side effects from the HPV vaccine and minor complications can be found.
Vaccinated people may develop soreness and redness around the injection site. Fever, fatigue and headaches may be possible in some cases, the doctor said.
It’s advisable for individuals to be administered the HPV vaccine in three separate intramuscular injections and to adhere to the 0, 2 and 6 months vaccination schedule. Sexually active women who have never had a Pap test are recommended to have the test in order to detect any abnormalities of the cervix. If infection is detected, it needs to be treated and eradicated. Being vaccinated may be then considered.
“Get the facts and make your own choice whether its worthwhile to receive the HPV vaccination,” said Dr Manopchai.
The vaccine is now priced about 2,200-2,400 baht per shot if received at government hospitals.
Manatsakorn Junnuch, 39 is mother to a 12-year-old girl, and she has reservations about the safety of human papilloma virus (HPV) vaccines the government plans to provide to immunise schoolgirls against infection associated the development of cervical cancer, genital warts and some less common cancers in women.
Even after consultations and professional advice about their efficacy, she is not convinced.
“Information from doctors and from advertisement is overwhelming. Facts remain unclear, while some contradict each other,” said Manatsakorn. “I’m worried about the vaccines’ unwanted effects in the long term. Personally, I think being vaccinated do carry risks, even though many people have said HPV vaccines are harmless.”
She wants the government to set up “HPV centres” to inform the public about such vaccines, provide correct and clear facts and, update the information on a regular basis.
HPV vaccines are still new to the public. People, especially parents, need to be more informed about the risks associated with them, she said.
“One doctor told me the vaccines can help protect against cervical cancer when I get older.” said a 17-year-old student Thatcharom Yoosomboon, who received her first HPV jab when she was 14. “I’ve been lucky enough not to have developed any side effects. It’s just similar to any routine vaccine.”
Patcharee (assumed name), who has three daughters, arranged for the eldest one to have HPV shots when she was 14, believing it would help lower the chance of her daughter contacting the dreaded virus later in life.
“I don’t want to see my daughter become a victim,” Patcharee said. “Now I plan to get the other two, who are twins, vaccinated.”
Meanwhile Siriwimol Chaisathit, 15, said, “Recently a hospital approached my school to see if any of us were interested [in the paid vaccination programme] but I refused, thinking that it may not be necessary. However, if the government is going to provide it free of charge, I will surely go for it.”
8 in10women worldwide who are sexually active are infected with HPV at some time in their lives.
Even thoughcurable, genital warts can come back after treatment, especially in the first three months.
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