Opportunity was missed in choice of cervical cancer vaccine, health campaigners say

Girls throughout the United Kingdom will receive the human papillomavirus vaccine Cervarix in the national immunisation programme after it launches in September, the Department of Health has said.

Cervarix, which is made by GlaxoSmithKline, offers protection against human papillomavirus types 16 and 18, which are responsible for about 70% of cervical cancers.

In England, 300 000 girls aged 12 to 13 will be given the vaccine in the first year of the programme. In the next two years 1.8 million doses of vaccine will be dispensed for routine and catch-up vaccinations for girls aged 14 to 18.

Dawn Primarolo, the health minister, described the vaccine as “an exciting opportunity” that could save the lives of 400 women a year.

However, sexual health charities have expressed disappointment at the decision not to offer Sanofi Pasteur’s Gardasil in the national programme. Gardasil protects against four types of human papillomavirus (types 6, 11, 16, and 18), including two strains that are responsible for nine in 10 cases of genital warts.

Worldwide, Gardasil has been the vaccine of choice to date. It has been selected by health authorities in the United States, Australia, New Zealand, Canada, Switzerland, Italy, Spain, and Sweden for regional or national immunisation programmes against cervical cancer.

Joyce Gould, chairwoman of the Independent Advisory Group on Sexual Health and HIV, which monitors the progress of the government’s strategy for sexual health, described the new programme as “an extraordinary breakthrough for women in this country.”

However, Baroness Gould added that it was important to review the effectiveness and benefits of both vaccines. “We would also welcome more clarity as to why Cervarix was selected above Gardasil, given [that] protection against genital warts seems a very important benefit for women as well,” she said.

While welcoming the programme, Julie Bentley, chief executive of the Family Planning Association, said, “Selecting the Gardasil vaccine would have been a huge preventive measure in terms of health and financial costs to the NHS. Genital warts is the second most common sexually transmitted infection in the UK after chlamydia.”

Lisa Power, head of policy at the HIV and AIDS charity the Terrence Higgins Trust, called the choice of vaccine short sighted.

She said, “By failing to choose the vaccine with the widest coverage, the Department of Health is condemning Britons to a further increase in genital warts and other cancers which could have been prevented. They are saving pennies to spend pounds later.

“It seems that the UK is fated to be not just the poor man of Europe but also the warty one.”

The health department would not disclose details of its deal with GlaxoSmithKline to supply the 300 000 doses of Cervarix that will be needed every year to target all girls aged 12 to 13 years.

However, a spokesman said that the contract has been awarded for the vaccine that scored best overall against a number of pre-agreed criteria and offers best overall value to the NHS.

“The vaccination programme has always been about cervical cancer protection, irrespective of which vaccine was chosen. We chose the vaccine that best met this need,” said a statement.

Primary care trusts are to receive an extra £8.9m (€11.3m; $17.6m)—just over £55 000 per average sized trust—to support the implementation of the programme (for example, to pay for nurses).

A spokesman for GlaxoSmithKline said that it was unsurprising that Gardasil had won more contracts than its own drug, as Gardasil was licensed a year earlier. Gardasil received its European Union marketing authorisation in October 2006, while Cervarix received its almost a year later, in September 2007.

Since Cervarix has been available in Europe it has won 19 out of 29 European national or regional tenders, including that in the UK. In Italy it has won 11 out of 14 contracts, in Spain it has won four out of five, and in Poland three out of seven, but it failed to win either of the two contracts in Sweden.

It has not yet been licensed in Switzerland or the United States.