Cervical cancer vaccine too expensive for Rudd

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I apologise for the length of this article, but I needed to give you some background knowledge. I wanted to raise an issue that I feel may need discussion within the Socialist Alliance. I recently sent in an article that was published in GLW, for SA’s column “Our Common Cause” on Cervical Cancer, perhaps some of you have seen this. If not you can see it at: http://www.greenleft.org.au/2009/813/41824 I feel that we should perhaps send out a statement by the Socialist Alliance on this issue, but I want to open it up for discussion first and develop a statement. As AV is used for discussion within SA, this is the perfect platform which we can use to discuss this issue. My background: I am currently studying Pathology at TAFE (to become a technical officer in a Path lab), so my comments will reflect the medical science side of cervical cancer. As my article in GLW stated, cervical cancer is principally caused by the Human Papilomavirus (HPV). In fact Australian Health department statistics state that 99.7% of cervical cancer cases are caused by HPV. Now, you might be aware that there was recently a breakthrough in the prevention of cervical cancer in the form of a vaccine. This vaccine was “invented”, for want of a better word, by Prof Ian Fraser (who received the Australian of the Year a few years back), who I believe now receives dividends from the two multinational drug companies marketing this vaccine – Merck (Gardasil) and Glaxo Smith Kline (cervarix). HPV is an interesting virus. We now know that HPV is the cause of many conditions: harmless body warts; contagious, disfiguring and incurable genital warts; Cervical cancer; vaginal and vulvar cancers; some head and neck cancers; some mouth and throat cancers; some breast cancers; penile cancers; some anal cancers; suspected in some bladder cancers. There are of course different strains of the virus causing these different diseases. HPV-16 and HPV-18 are the cause of cervical cancer in 70% of cases. These two strains, are the strains protected against by the two vaccines mentioned above. Other strains that cause the remaining 30% of cervical cancer cases are not covered by the vaccine. Genital warts are primarily caused by two other strains. 90% are caused strains HPV-6 and HPV-11. Both of these strains are also associated with cancer. The vaccine produced by Merck is the only one that protects against these two strains. OK, so that is the background on HPV. Currently around the world, young women are being provided this vaccine. I am not sure if it is free in all countries, but Australia was providing this vaccine free to all women between the age of 12 and 26. In June this year, however, it ceased to be free for women over the age of 13. That means that only young women between the age of 12 and 13 can receive the vaccine for free. All others must pay $450 to protect themselves. OK, some more facts. 75% of all sexually active women will become infected with HPV at some time in their lives. HPV is the most transmitted STD in the world. And, cervical cancer is the second biggest cancer killer of women in the world. So, going by these facts, why is the Australian government removing access to this vaccine by young women? This vaccine isn’t even on the Pharmaceutical Benefit Scheme, meaning that women, and men, need to pay $450 for the privilege of protecting themselves. I guess one of the problems with this vaccine, is that it only protects against 70% of HPV related cervical cancer causes. Also, women still need to undergo regular pap smears regardless of whether they have had the vaccine or not. And in some cases the body can fight off the HPV virus; meaning that only some women who become infected with the HPV virus will go on to develop cervical cancer. In my opinion, if we can reduce the risk of developing cervical cancer by even a small amount, we have achieved a great thing. One thing that I haven’t mentioned. Many women don’t get pap smears. This can be for cultural reasons, it can be for personal reasons (pap smears being very invasive), or it can be for religious reasons. This means that some women will develop invasive cervical cancer and they will die. The disease is extremely invasive and the death is extremely painful. I won’t go into the details of the result, but all abdominal organs must be excised, and the women may still die a horrible death anyway. Is a woman’s health, and ultimately a life, more important than subsidising the coal industry? Clearly it must be as we have just cut out many women from receiving an important vaccination. Yes they can still buy it and have their GP give it to them, but how do poor people, unemployed or young families afford this fee? One point that I haven’t mentioned is that this vaccine does not cure an existing infection! If a woman is already infected HPV-16 or HPV-18, she may still go on to develop cervical cancer even if she now receives the vaccination. Already this article is very long, and I haven’t even begun to argue my case for vaccinations for boys and men. Ever since this vaccine became available, medical professionals have suggested that it should be available and given, to boys and young men. Not only can boys and men develop penile and related cancers, but they are a vector of HPV – they carry and pass on this virus to women. There are a few other aspects to HPV that hasn’t been mentioned in the media. Many young women are engaging in anal sex, believing that anal sex is safe sex. Sure, they won’t get pregnant, but they are exposing themselves to all of the STDs that can be transmitted. In relation to HPV however, they are exposing themselves to the possibility of developing anal cancers. Further gay men are also at risk of developing anal cancers, particularly HIV positive gay men. 95% of homosexual men who are HIV seropositive carry the same types of genital papilloma viruses that cause cervical cancer. Therefore, boys and young men should definitely be vaccinated against HPV before sexual activity begins. Right, that pretty much covers the background of HPV. My points are this: All women before becoming sexually active, and younger women who have had one or perhaps only a few partners, should be vaccinated free, or if a fee is to be charged, at a hugely subsidised cost. Boys and young men, using the same criteria above, should also be vaccinated free, or if a fee is to be charged, at a hugely subsidised cost. Does it matter that only 70% of cervical cancer can be vaccinated against? Therefore should it still be free to all young women as they have to have pap smears anyway? In my opinion they should, but what do you think? If a woman has been sexually active, she may already be infected by the HPV virus. Should she still be allowed to receive the vaccine for free? What should our policy be on this matter? My opinion is:

  • That all young women not yet sexually active be given the vaccination for free;
  • That all other women who have had limited sexual partners (and their partners have had limited sexual partners) be given the vaccine at a hugely subsidised cost;
  • that all young men not sexually active be given the vaccination free;
  • that all young men who have had limited sexual partners (and their partners have had limited sexual partners) be given the vaccination at a hugely subsidised cost.
  • That a television campaign begin to inform the community, once again, of the dangers of STDs, including HPV.
  • That all gay or bisexual men be informed of the dangers posed by HPV and be given anal pap smears at the same cost as women

However what should our policy be regarding women and men who have had many sexual partners, or whom have always been in a monogamous relationship? All women must still have pap smears. Should our policy suggest that sexually active women should be less concerned with vaccination and concentrate on pap smears? Personally I am in favour of vaccinating all of the community. After all, we are just about to roll out swine flu vaccinations for all of the populace. If we had control over the production of these vaccines, we could easily vaccinate the populace for a subsidised cost. What ever the case, our policy, or statement should create a foundation that has the potential to greatly reduce the incidence of cervical cancer, penile cancers, head and neck cancers, mouth and throat cancers, some breast cancers etc... In our statement, if we decide to create one, perhaps we simply need to state these facts and present them to the public. Perhaps those last few points just need to be given reasons, based on the above background, and a document drawn up presenting our case. Of course, we would need to state how to fund this process. We could, as Dick Nichols advised me, bring the National Serum Laboratories back under public control, and produce these vaccines at cost price. We could then of course work on further developing the vaccine so that the other strains, that cause disease can be prevented, thereby eliminating HPV to the history books. Discussion needed?