Gardasil vial, via Wikimedia Commons. This is what we

Human Papillomavirus (HPV) is one of the most common sexually transmitted infections. HPV symptoms include outbreaks of genital warts, and several of the strains (primarily types 16 and 18, which account for roughly 1 in 20 infections according to CDC statistic) are responsible for the majority of cervical cancer cases. Cervical cancer is the second leading cause of cancer deaths amongst women worldwide, particularly in developing nations.

So when vaccines that protect against the high-risk strains of HPV became available in 2008 it was a good thing, yes? A concerted vaccination program would reduce new infections, see a decrease in cervical cancer diagnoses over the next 15-20 years, and save millions of pounds in public health spending on pap smears, right? Well, sort of. The issue here is that there are two vaccines available, Gardasil from Merck and Cervarix from GlaxoSmithKline. Whilst both protect against strains 16 and 18, Cervarix does not provide any protection against the non-cancerous strains responsible for genital warts. Gardasil, by contrast, also protects against strains 6 and 11, which cause 90% of genital wart cases. Gardasil also has a rather high list price of £240 per person, whereas the makers of Cervarix have significantly undercut their list price in an unreleased contract with the NHS.

In countries such as Australia, that have taken up Gardasil, there has been a 75% decrease in new cases of genital warts over the last three years; the UK, over the same period, has seen no difference in the number of new cases. Whilst women aged 16-19 are the group most affected by this, the issue is one that matters to everybody: greater uptake of the vaccine increases herd immunity, protecting those who haven’t been vaccinated as well (for the same time period cases in unvaccinated heterosexual males fell by one third in countries using Gardasil).

So, and this is the problem, we’re now offered a vaccine that provides no protection against genital warts, and almost no information about the alternative (I could find just one mention of Gardasil on the NHS’s HPV vaccination page here ). Those in the know are seeking out Gardasil through private clinics, whilst the majority, arguably including those most at risk of infection, are left in the dark.

“We, as consultants in sexual health, have been told to say nothing publicly that would damage the current vaccine programme, as the Cervarix vaccine has already been purchased. We have had to be circumspect in public but in private we have all purchased Gardasil for our own children and advised colleagues to do the same.” – Dr. Colm O’Mahony and Dr. Steve Taylor

This is leading us into a split system whereby those who can are taking the greater protection of Gardasil, and everyone else is getting Cervarix. This is, I think, neither a reasonable nor efficient use of NHS funding, and somewhat gives the lie to health secretary Andrew Lansley’s promise of “no decision about you without you.”

Treatment of genital warts costs the NHS £31 million annually and takes trained staff away from time that could be spent on other serious conditions. It is difficult to gauge how this balances against the savings from sticking with the cheaper Cervarix, because the NHS will not release the details of their contract with GSK. With the contract coming up for renewal now is the time when Lansley needs to reveal the details of the contract, involve the public in the decision, and provide more accessible information regarding Gardasil.

Why is this relevant on a feminist blog? Fair access to this information (and related sexual health matters) is vitally important to women (and indeed to men). We all need to be equipped to not only make the best decisions for our own sexual health but also to campaign for those in the most at risk groups — who are currently being let down by the lack of information provided by the NHS. The choice of vaccine is an important issue that will effect tens of thousands of lives every year, and it is one the public needs to be involved in.

(Here’s the British Association for Sexual Health and HIV’s press release on the issue, which has links to some relevant papers.)