In this week’s forum we investigate the introduction of a new vaccine into national vaccine programs using the example of HPV vaccination in Australia.
On 29 November 2006, the Australian Government announced funding for a HPV vaccination program. When the vaccine was first introduced, a catch-up program that consisted of two components (a school-based program and a community-based program) was instituted. The school-based catch-up program for 12 to 18 year old girls ceased in 2008. HPV immunization in the community-based catch-up program was available through general practice and community immunization services for 13 to 26 year old women.
Currently the HPV vaccines are registered for use in Australia in females aged 9–26 years and in males aged 9–15 years. The HPV vaccine is currently funded for 12-13 year old girls in the first year of secondary school, with a recent decision to commence a funded program for boys commencing in 2013 in Australia.
When the HPV vaccine was first introduced, people felt that the long-term effectiveness was uncertain and that it was unnecessary when a successful screening program was available for women. However, the government decided to go ahead with introducing the vaccine
What factors do you think the Government took into account when making their decision?
It is very interesting to consider the decision making process behind the introduction of a HPV vaccine into Australia, although its efficacy and safety have been shown (notwithstanding data on long term effectiveness), other factors certainly come into play especially in a country with comparatively low incidence of cervical cancer and an established screening program[1]. There would have been many factors to consider but I think that 2 significant issues would be cost effectiveness and acceptability. The vaccine is quite expensive at more than $100/dose (3 doses/course), it complements rather than replaces the screening program, and benefits would not necessarily have been realised for many years post-introduction – all factors that require detailed cost/benefit analysis. Some mathematical modelling did suggest that the vaccine program would be cost-effective[2]. Public acceptance of a vaccine (with attendant potential side effects) is also a vital component to be considered before introducing a new program, this does not only depend on clinical/epidemiological facts about a disease but also on the perception of the disease (e.g. effects of the disease, risks of contracting the disease). In this instance, HPV infection in itself may not be perceived as a particular issue, though cervical cancer is undoubtedly more emotive, despite the actual risk being relatively low – this may therefore increase acceptability and uptake. One study found relatively high acceptance of the vaccine (in terms of willingness to vaccinate their children), despite the initial lack of knowledge of the relationship between HPV and cervical cancer[3].
1. http://www.ncirs.edu.au/immunisation/fact-sheets/hpv-human-papillomavirus-fact-sheet.pdf
2. Kulasingam S, Connelly L, Conway E, Hocking JS, Myers E, Regan DG, Roder D, Ross J, Wain G. A cost-effectiveness analysis of adding a human papillomavirus vaccine to the Australian National Cervical Cancer Screening Program. Sexual Health 2007; 4: 165–175. http://dx.doi.org/10.1071/SH07043
3. Marshall, H., Ryan, P., Roberton, D. and Baghurst, P. (2007), A cross-sectional survey to assess community attitudes to introduction of Human Papillomavirus vaccine. Australian and New Zealand Journal of Public Health, 31: 235–242. doi: 10.1111/j.1467-842X.2007.00054.x
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Thanking you for your input, I absolutely agree with you,
Me
The Human papillomavirus (HPV) is one of the most common sexually transmitted viruses in the world today. The virus is particularly common among the sexually active individuals. HPV is associated with many cancers in both women and men, including cervical, vaginal, vulvar, anal, and penile, which necessitates the government action in controlling the spread of this virus (Australian Government, 2014). The Australian government considered the effects of the HPV virus when it introduced programs to combat its spread. Cancers and other conditions associated with the HPV virus are very costly to the Australian society and the economy because of the increased morbidity and mortality. Cervical cancer, one of the consequences of the HPV virus affects many women in Australia and across the world (Chang, Brewer, Rinas, Schmitt, and Smith, 2009). This cancer makes it impossible for women to engage in normal activities, which not only reduces their productivity, but also leads to increased mortality among women. Choi, Leung, Woo, Jit, and Wu (2014) assert that approximately 530,000 new cases of cervical cancer were reported in 2008 while there were approximately 275,000 deaths resulting from cervical cancer the same year. All these cases are preventable with proper vaccination at the right time, which was one of the major considerations the Australian government made when introducing the HPV vaccine in the country.
Another consideration the Australian government made when planning to introduce the HPV vaccine in the country was acceptability. Many women across the world are accepting the HPV vaccine readily with the aim of preventing the HPV-related cancers and diseases. Brandt, Sharpe, McCree, Wright, Davis, and Hutto (2009) claim that women from the rural regions also appreciate the HPV vaccine. For long, women in the urban centers were the only ones cautious about their health including proper screening and medical check-ups that helped them to avert major diseases, including cervical cancers. Acceptance by the women in the rural regions is a clear indication that women from all over are accepting the HPV vaccine. Therefore, countries that did not introduce the vaccine early use such studies as stepping stones to gauge whether the people there will also accept the same.
The issue of vaccine safety was also a major consideration made by the Australia government before it introduced the HPV vaccination programs. Studies carried out by a number of researchers indicate that the HPV vaccines are safe. Jin, Lipold, Sikon, and Rome (2013) assert that tests done to elucidate the safety of the HPV vaccines were positive, whereby; they did not lead to any adverse health reactions after injection. The HPV vaccine makes the host immune system stronger to fight most of the HPV variants, including 6, 11, 16, and 18. Variants 16 and 18 are the most dangerous as they are responsible for cervical cancer and other types of cancers. The HPV vaccines have an efficacy of more than 90%, which makes them very effective in combating the viruses according to Stokley and colleagues (2014). Safety is a major issue for any drug and the conclusion that HPV vaccines are safe is enough for any government, like the Australian, to start offering this vaccine in the country. According to Basu and colleagues (2013), the effectiveness of the HPV vaccine was evident in Australia in three years after its introduction.
refrences :
1.Australian Government. (2014). HPV factsheet forhealth professionals. Retrieved from http://hpv.health.gov.au/downloads/factsheet-for-professionals
2.Basu, P., Dipanwita, B., Singh, P., Bhattacharya, C., &Biswas, J. (2013). Efficacy and safety of human papillomavirus vaccine for primary prevention of cervical cancer: A review of evidence from phase III trials and national programs. South Asian Journal of Cancer, 2(4), 187-192.
3.Brandt, H.M., Sharpe, P.A., McCree, D.H., Wright, M.S., Davis, J., &Hutto, B.E. (2009). HPV Vaccine Acceptance in a Clinic-based Sample of Women in the Rural South. American Journal of Health Education, 40(3), 174.
4.Chang, Y., Brewer, N.T., Rinas, A.C., Schmitt, K., & Smith, J.S. (2009). Evaluating the impact of human papillomavirus vaccines. Vaccine, 27, 4355-4362.
5.Choi, H.C.W., Leung, G.M., Woo, P.P.S., Jit, M., & Wu, J.T. (2014). Acceptability and uptake of female adolescent HPV vaccination in Hong Kong: A survey of mothers and adolescents. Vaccine, 32, 78-84.
6.Jin, X.W., Lipold, L., Sikon, A., & Rome, E. (2013). Human Papillomavirus Vaccine: Safe, Effective, and underused. Cleveland Clinic Journal of Medicine, 80(1): 49-60.
7.Stokley, S., Jeyarajah, J., Yankey, D., Cano, M., Gee, J., Roark, J.,……Markowitz, L. Human Papillomavirus Vaccination Coverage Among Adolescents, 2007–2013, and Postlicensure Vaccine Safety Monitoring, 2006–2014 — United States. MMWR.Morbidity and mortality weekly report, 63(29), 620-624.
Was a cost effectiveness study undertaken prior to the HPV vaccines being introduced? What were the findings from this study and how did the results compare to other vaccines being considered for introduction?
Me ,
When preparing to introduce any vaccine, it is imperative to carry out a cost-effectiveness study. When Australia was preparing to introduce the HPV vaccine, the government had to determine the cost-effectiveness of the vaccine. According to Kulasingam and colleagues (2007), the Australian government performed a number of cost effectiveness studies before the government committed to introducing the HPV vaccine. The model followed was the Markov, which is among the most effective in determining the cost effectiveness of something. The study by Kulasingam and colleagues (2007) concluded that the HPV vaccine would lead to savings of more than 50,000 Australian dollars for every girl and boy vaccinated against the virus. Additional studies by Sanders and Taira (2003) suggest that HPV vaccine led to savings of approximately 54,000 dollars with just 35% efficacy. These studies are a clear indication that the overall costs savings for all the vaccinated boys and girls would amount to billions of dollars per annum.
There are other vaccines funded by the Australian government, including influenza and pneumococcal polysaccharide vaccines (National Center for Immunization Research and Surveillance, 2012). Although these vaccine programs are successful and cost-effective, their effectiveness is not as high as that of the HPV. This is because the costs of treating the conditions for the diseases associated with these viruses are relatively low as compared to theHPV cancers and diseases.
