Cheaper alternatives to vaccines that protect women from cervical cancer need to be found so that they can be included in government-funded mass vaccination programmes such as India.
Each year, cervical cancer affects 5 lakh women worldwide, 1.3 lakh of them in India, killing half one woman every two minutes of them.
“One of the major hindrance for mass vaccination with the existing cervical-cancer vaccines is obviously the cost,” said Dr NK Ganguly, distinguished biotechnologist and former director-general of the Indian Council of Medical Research at the First Symposium on Human Papillomavirus (HPV) Vaccination in Seoul, South Korea.
“Unless the price of these vaccines is drastically reduced, developing countries such as India cannot make them a part of routine immunisation.”
“It was only when manufacturers such as Shantha Biotech and some others in India started producing the vaccine against hepatitis by the buckets, bringing the cost of the 3-dose vaccine to 13 cents a dose, that it could be made part of the government programme,” Dr Ganguly added.
Recurrent HPV infection, which is transmitted sexually, is a cause for cervical cancer.
There are two vaccines available that offer protection against cancer-causing strains of the human papillomavirus (HPV) — Gardasil (Merck, against HPV 6, 11, 16 and 18) and Cervarix (HPV 11 and 16). In the US, the price per dose is US$ 125, which takes up the cost of the three-dose vaccine alone to US$375.
“These vaccines are prophylactic (protective) in nature, giving no protection to women with cervical cancer and offering very little cross protection against the 100 other strains of HPV that also cause cancer,” Dr Ganguly said.
“In India, HPV 45 is also associated with cancer of the cervix, and is the third-biggest cause of cervical cancer worldwide after 16 and 18. In the Asia-Pacific region, HPV 52 and 58 are also prevalent. We need to find vaccines that offer a broader protection than the current ones.”
“It is not possible for India to fund the vaccination of adolescent girls (10 to 13 years) because of cost and logistic issues,” said Dr Suneeta Mittal, head of the department of gynaecology and obstetrics at the All India Institute of Medical Sciences, New Delhi.
“First, screening to identify and treat women already infected with HPV has to be done before the infection develops into medium and high-grade cancer. That alone can save the lives of thousands of women in India every year,” she added.
A vaccine that treats cervical cancer would be more beneficial. Said Dr Ganguly: “A therapeutic vaccine that treats and cures will bring more benefits as the number of women who will have to be vaccinated will be fewer.”
“But we must keep in mind that on an average, vaccine development takes an average of 18.5 years and costs US $500 million, so more attention also needs to be paid to cancer screening programmes along with other avenues.”
“Vaccines clearly work and have not just eradicated smallpox from the world but also polio from the Americas,” said Dr Ganguly.