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FEATURE: Rebecca Coombes Life saving treatment or giant experiment? BMJ 2007; 334: 721-723 [Full text]

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Life saving but out of reach of many

Ashok Beckaya   (7 April 2007)

Will the HPV Vaccine be effective?

Andrew D Lynk   (7 April 2007)

The High Cost of Vaccinating

Sarah Chaudhary   (12 April 2007)

Madness

S K Basu   (12 April 2007)

Life saving but out of reach of many 7 April 2007
Ashok Beckaya, Child Health Doctor Epsom & St. Helier NHS Trust Send response to journal: Re: Life saving but out of reach of many	Introduction of HumanPappiloma Vaccine is to be welcomed. The concerns expressed in some quarters that the introduction of this vaccine may encourage more sexual activity amongst the teenagers is simply ludicrous, in my view. However, I agree with the concerns expressed regarding substantial costs involved and this would mean that the vast majority of world's vulnerable population will be denied the benefits of the vaccine. These are the areas where screening is non existent for the most part. Competing interests: None declared
Will the HPV Vaccine be effective? 7 April 2007
Andrew D Lynk, Consutlant Pediatrician Cape Breton Regional Hospital, Nova Scotia, B1S 3L3 Send response to journal: Re: Will the HPV Vaccine be effective?	Most reasonable people will welcome the prospect of a safe and effective HPV vaccine that prevents cervical cancer. Merck has spent a lot of marketing money to convince health ministries and the public that their new vaccine Gardisil will do the job. Gardasil contains two strains of human papillomavirus: types 16 and 18, that are responsible for 70% of all cervical cancers, and the three injections together cost about $360 US (£185). In Canada, most provincial health ministries are struggling to manage budgets that are growing at an unsustainable annual rate of 5-9%. Is this vaccine a good public health investment? Will it truly lower the incidence of cervical cancer in the near and distant future? Would scarce healthcare resources be better spent improving the (often dismal) percentage of women who receive regular Pap testing? Will the other 30% of HPV oncoviruses not covered in the current vaccine quickly (the operative STD adjective) fill the onco-ecological niche and render the current vaccine obsolete? Speaking as a pediatrician who believes vaccines are one of medicine's most cost-effective interventions, I am having trouble with the HPV vaccine. Where does the hype end and the truth begin? Competing interests: None declared
The High Cost of Vaccinating 12 April 2007
Sarah Chaudhary, Research Assistant Stanford University School of Medicine, Palo Alto, CA 94304 Send response to journal: Re: The High Cost of Vaccinating	In her commentary, Rebecca Coombes reports that the 3 injections of the HPV vaccine are “about $360 a shot.”¹ Dr. Lynk is correct in his clarification that the cost of the HPV vaccine is actually $120 per shot² for a total price of $360 for the entire 3 dose immunization. Nevertheless, this is still an extremely expensive price tag. In comparison, the cost of the Hepatitis B vaccination (also a 3 injection treatment) is around $50 per shot² for a total cost of less than half the cost of the HPV vaccine. Such a discrepancy may add to the concerns that profit motives may be underlying the promotion of the vaccine. My main concern, however, is that the vaccine’s hefty price tag may ultimately hinder its potential public health benefit by limiting access to the HPV vaccine amongst socioeconomically disadvantaged females. -Sarah Chaudhary 1.Coombes R. Life saving treatment or giant experiment? BMJ 2007; 334: 721-723 2.Center for Disease Control Vaccines Price List, available online at http://www.cdc.gov/ Competing interests: None declared
Madness 12 April 2007
S K Basu, Hospital Doctor DN2 5LT Send response to journal: Re: Madness	Can anybody tell me the incidence of Cervical cancer? Has it been proven beyond reasonable doubt that HPV is the only cause of Cervical cancer and thet the vaccine will completely prevent the occurrence of this condition? 3 cases of Guillain Barre in the trial is something not to be taken lightly. Think about the girl who got this life threatening condition following vaccination for prevention of a condition which she would not probably have got it in her lifetime,if she didn't have the vaccination! We do know that transverse myelitis was a complication of one of the previous anti-Rabies vaccination.Do we really know the other longterm ill effects that may occur of this vaccination? Some of them may be autoimmune diseases! Who knows? Thanks Competing interests: None declared