A commercial on television or the patient's information in the waiting room of gynaecologists: both recommend the new vaccination against Human Papilloma Viruses (HPV) for young women. HP- Viruses are sexually transmitted and are considered as a main trigger for cervical cancer. Therefore, the recommendations of the Standing Vaccination Commission (STIKO) of the German Robert Koch Institute state that all girls between 12 and 17 years should be inoculated against HPV before the first sexual contact.
However, critics question the sense of the vaccination: “It only fights the HPV types 16 and 18, but there are at least 14 other high risk types which can lead to cervical cancer“, says Wolfgang Becker-Brüser, publisher of a German magazine that concerns itself critically with drug and medicine matters. “Moreover, nothing is known about the long time effect. Therefore, inoculated women still have to attend early stage diagnosis to be on the safe side.“
Effectiveness with restrictions
Dr. Susanne Stöcker, press agent of the Paul-Ehrlich Institute (PEI), the German licensing authority for the vaccine, explains, why girls should still be inoculated: “The vaccination demonstrably prevents from developing cancer. We examined this in studies with more than 20,000 test persons.“ And although these are only intermediate data, STIKO press agent Susanne Glasmacher also recommends the licensing of the vaccine: “It is not ethical to hold off an effective vaccine. At some point one also has to put it into practice.“
The bases of the intermediate data are the virus types 16 and 18. “They are involved in cervical cancer in 70 percent of the cases“, explains Dr. Andreas Kaufmann, biologist in the CervixCentrum of the Charité Berlin. The study examined whether the vaccination prevented mucous changes also called dysplasia. These can lead to cancer when left untreated. It was proven that the vaccination was 100 percent effective when it comes down to the virus types 16 and 18. “However, the protection is fully effective only when no HPV infection had previously taken place and when all three vaccination doses were given“, explains Kaufmann.
High costs for the health system
However, Kaufmann criticises the vaccine’s high price in Germany. “Unfortunately, the responsible authorities have failed to negotiate an adequate price.“ With 465 Euros the vaccine in Germany is more expensive than all eight vaccinations against childhood illnesses together. The legal health insurances are obliged to pay the vaccination for girls between 12 and 17 years, because the Common Federal Committee (G-BA) publishes a vaccination directive in which it orientates itself by the recommendations of the STIKO. This means: If girls being born the same year were to be inoculated, it would cost the legal health insurances more than 200 million Euros each year. According to Becker-Brüser, this money should better be invested in early stage diagnosis so that all women can benefit from it.
Kaufmann thinks too that early stage diagnosis is still a very important tool and should be strengthened. “Every fifth sexually active woman is infected with HP viruses at some point in her life“, he explains. “However, in most cases the illness is harmless and heals without consequences. Only in one percent cancer develops.“ In Germany these are about 6,500 women a year - 1,700 die. If more women used early stage diagnosis, this number could be further reduced.
It is still not clear how many girls can be saved from cervical cancer through vaccination. Up to now 700,000 girls have been inoculated in Germany. “Whether cancer rates decrease will be shown in ten years - at the earliest“, says Kaufmann. “To do without the vaccination due to costs is ethically out of the question. Moreover, subsequent investigations following worrying results or the treatment of a carcinoma are also connected to high costs for the health system.“