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Vaccines - a wider view

PM Europe talks to Dr Holger Rovini, head of infectious diseases at Datamonitor, the market analysis and business intelligence company, about vaccination schedules - a national concern and a global issue

It is likely that many health services across Europe will reject the widespread funding of the human papilloma virus vaccines, Gardasil and Cervarix, on grounds of cost. Even when a vaccine is approved, people may choose not to vaccinate themselves or their children. Can payers and the public be convinced that a vaccine - particularly for a sexually transmitted disease - is cost-effective, safe and beneficial?

Q: Do you think that the UK population has a markedly different attitude toward vaccines from the rest of Europe, or is it a question of getting across the risk benefit message effectively?
No, not in my experience as a physician in both the UK and Germany. A minority of scared parents opted out of the recommended vaccinations in many European countries, only to suffer the consequences when serious illness due to preventable diseases re-emerged.

Q: There are two new vaccines against the strains of human papilloma virus (HPV) that cause two-thirds of cervical cancer (strains 16 and 18), GSK's Ceravix and Merck's Gardasil. Gardasil also claims efficacy against strains that cause genital warts (strains 6 and 11). What factors will influence whether or not a vaccine against a sexually transmitted infection (STI) is funded by the NHS?
Pricing is definitely a big influencing factor here. The National Institute for Health and Clinical Excellence (NICE) will look at the health economics analysis of HPV vaccines. However, since the health and cost benefit from reduced numbers of cervical cancer cases won't become apparent until 15-20 years from now, the often slightly short-sighted attitude of NICE may prevent HPV vaccines from being paid for by the NHS.

Q: Do you think that vaccines against STIs in the UK are still viewed as a 'just in case' approach to healthcare? What are the prospects for HIV/AIDS vaccines for example?
If we ever see an HIV vaccine, which even at the very earliest will be after 2015, its application will be limited to high-risk people, such as healthcare staff, travellers and sex workers. I can't imagine wide-spread HIV vaccination programmes being used in low-risk countries such as the UK. Hepatitis C may be different, but will probably evolve along the lines of Hepatitis B - ie, high risk only in the UK and everyone in central and southern Europe.

Q: What are the implications of European countries not 'buying into' vaccines against STIs? If the West doesn't fund their development, will such products ever be available in the developing world?
I agree that the public health benefit from HPV vaccines would be much bigger in the developing world. Vaccine research for these countries will probably be increasingly funded by charitable foundations like the Gates Foundation. Since the Gates' have a different approach to funding - ie: 'if you develop a vaccine that works, we will buy it from you at a good price' - it will also be commercially attractive to smaller players.

Q: Will the health benefits of the HPV vaccine be noticed in the developing world where other diseases are prevalent?
The major public health concern worldwide is malaria, and TB is also a growing problem, not to mention the absence of clean drinking water in many areas. The health benefit of herd immunity against HPV - which would include vaccinating boys - would still be felt. Maybe less so in East Africa, but certainly in West Africa, Asia and Latin America.

Q: Is it true to say that the countries that really need vaccines can't afford them and the countries that can afford them feel that they don't really need them?
For the first part, yes. When healthcare infrastructure is bad, prevention is much preferable to unavailable treatment. Unfortunately, actual vaccine cost is only one side of the coin; many vaccines require a continuous refrigeration chain - something that is not present in regions where these vaccines are needed the most.

Q: Is the answer to somehow persuade the UK and the rest of Europe to take a more global view of disease eradication?
Yes. It's a shame that polio has still not been eradicated. But disease eradication is very difficult, if not impossible, for diseases where humans are not the only vector.

3rd May 2007

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