Intended for healthcare professionals

Letters (Not) warts and all

Government fully considered HPV vaccine

BMJ 2008; 337 doi: (Published 19 November 2008) Cite this as: BMJ 2008;337:a2552
  1. David M Salisbury, director of immunisation1
  1. 1Department of Health, London SW1A 2NS
  1. judith.moore{at}

    It was unfortunate that Hammond wrote his piece without asking us the government’s reasons for choosing the human papillomavirus (HPV) vaccine.1 We fully considered all of the issues he raised and much more that was scientific, logistic, and economic.

    We used the cost effectiveness analysis of Jit et al to allocate points for the quality of scientific information on protection against cervical cancer, protection against warts, and stability out of the cold chain,2 and only after the scoring was completed were the prices revealed. With the same analysis,2 the prices were scored for cost effectiveness in balance with the other factors. The scoring system had been shared in advance with the manufacturers. In central contracts the price offered by manufacturers can differ considerably between products and against the list price.

    We took full account of the burden of genital warts and the benefits that might come from vaccinating males. Perhaps Hammond might have asked himself how much he was prepared to pay to prevent genital warts; I assume that even he must have a figure in mind beyond which it would not be cost effective to use a quadrivalent vaccine.


    Cite this as: BMJ 2008;337:a2552


    • Competing interests: None declared.