Kelly McKillion takes a look at the retraction of the promised-HPV vaccine, and what this might mean to Irish women.

IN NOVEMBER last year, the Department of Health and Children announced that the planned provision of the HPV vaccine for all 12-year-old girls was to be held back until September 2010. A year later than what was originally promised, the reason for postponement was cited as the recent fall of economic prosperity.

vaccineImplementation of the vaccine would cost the Government approximately €9.8 million per annum. With the allocation for expenditure within the HSE standing at approximately €14.8 million – a lower increase than previous years – some argue that there are health concerns requiring more urgent attention than the HPV vaccine.

Cervical cancer is responsible for the deaths of a minority of the Irish population, approximately 76 women per year. When compared to breast cancer which claims the lives of 650 women per annum, calls to scrap the vaccine may be deemed valid in purely economic terms.

However the mortality figures for cervical cancer do not take into account the numerous after-affects the condition inflicts upon those who are fortunate enough to survive. The removal of the cancer via hysterectomy, or removal of the uterus, is a harrowing and physically painful experience. The body can take a number of weeks to resume its normal functions and the inability to have children can be very difficult for the woman to come to terms with.

Radiation and chemotherapy are other forms of treatment which have equally uncomfortable effects, among them loss of hair, bleeding and nausea. The return of the cancer is an eternal possibility years after treatment and continuous checkups are necessary.

The psychological effects can be deeply traumatic and can lead to severe anxiety, depression or post-traumatic stress disorder in the patient. It is not just the patient who endures this emotional hardship, but also other family members who may require counselling at such a challenging time.

Regarding the provision of the HPV vaccine, Ireland is lagging behind in comparison to its neighbour Britain, where the NHS has had the vaccine in place since 2008. The vaccine has also been available for 2-3 years in the US, Canada, Australia, France and Greece to name but a few countries.

Taking the US for example, the vaccine is in place alongside the screening system to detect cervical cancer. Government assistance has also been implemented in Australia where the vaccine is free of charge for girls aged 7-12. These programmes are run by local councils, to which the government supplies the vaccine.

A similar system is in place in Canada where the choice has been given to individual provinces to decide on the free provision of the vaccine. Consequently, this universal implementation has led to calls from the Irish public for the same initiative to be introduced in Ireland. Independent health organisations are taking steps to make the vaccine available to the public at a reduced cost, since the Government have backtracked.

The Dublin Well Woman Centre, which has clinics in the North Dublin areas of Coolock and Darndale has worked to make the vaccine available at a cost of €240, instead of the standard cost of €645. The organisation has also been in negotiation with the HSE with the aim of providing the vaccine at a further lower cost of €150 to all medical card holders.

“mortality figures for cervical cancer do not take into account the numerous after-affects the condition inflicts upon those who are fortunate enough to survive”

Without this cost cutting measure, low income communities such as those in North Dublin would be unable to protect themselves from the potentially fatal disease of cervical cancer.

The HPV vaccine has been proven to be almost 100 per cent effective against the two main strains of the virus, 16 and 18, which cause 70 per cent of cervical cancers. Surely this rate of effectiveness justifies its provision by the HSE.

Furthermore, statistical support for the vaccine has been provided by the American National Health Institute which states that widespread vaccination has the potential to reduce deaths by cervical cancer around the world by as much as two thirds, if all women were to receive the vaccine.

This said, the worth of such a lifesaving vaccine should not be measured by its cost as this equates to putting a price on life. Furthermore, the Institute also acknowledges in its findings that the vaccine can in fact reduce the need for medical cards, and biopsies, thus helping to reduce healthcare costs related to follow up procedures. Financially, it could work to the advantage of the HSE to implement the vaccine, which undermines their financial motives for its postponement.

The medical card controversy is another issue which has attracted opposition in recent months. The Government announced that all those over 70 would be required to apply for their cards in place of automatic entitlement, to determine their eligibility. There was significant confusion concerning the exact details of the decision among both politicians and the public.

The Government was accused of backtracking on their decision when they increased the eligibility level by €40, though they denied such an accusation. According to the new regulations, those over 70 who qualify for a medical card must have an income of €700 a week or less or €1400 a week or less for couples.

In recent times, the Irish public have lost a lot of faith in Mary Harney and the HSE due to an inability to deliver on their promises. Economic troubles may be the reason given for the removal of such health provisions as the HPV vaccine, but perhaps the health system would be in a better state of affairs, if spending had been managed more effectively during the glorious period of the Celtic Tiger.

Furthermore, we may be experiencing economic strife but is the HSE targeting the right areas to cut back on? Perhaps saving money is not a satisfactory motive for taking the right of medical cards from pensioners and vaccine provisions for women.