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Where are the Ethics?

By April 28, 2009News

The Irish Times 28 April, 2009

Alison Healy

Ireland is falling well short of its European counterparts on cervical cancer vaccination, a study published today reveals, writes ALISON HEALY

IRELAND IS one of the few countries in western Europe without some form of vaccination programme against cervical cancer, a new survey has found.

The first review of vaccination policies in 40 European countries noted that Ireland and Iceland were the only European countries to cite economic crises as the reason for postponing a national vaccination programme. Details of the study are being released today.

Last August, Minister for Health Mary Harney said she was going to provide a national immunisation programme for all 12-year-old girls against the human papilloma virus (HPV), which causes most cervical cancers. But in November she said the plan was being shelved for the moment because the country couldn’t afford the estimated €10 million a year it would cost.

The HPV Vaccination in Europe report was produced by the European Cervical Cancer Association and released in Brussels yesterday in association with the Irish Family Planning Association.

It said a national vaccination programme for pre-adolescent girls was “an important cervical cancer control strategy” and accompanying it with cervical screening would provide the best protection against this deadly disease.

Its survey found that, while many European countries had free or subsidised vaccination programmes in place, the UK was the only country that had fully implemented a national school-based vaccination programme. It was introduced last year.

Nine countries offer the vaccination free to at least one age group of girls.

They are Denmark, Germany, Greece, Italy, the Netherlands, Luxembourg, Portugal, Spain and the UK.

France and Belgium offer the vaccination on a subsidised basis and Switzerland administers vaccination programmes at local level.

Philip Davies, director general of the European Cervical Cancer Association, said governments had an “ethical obligation” to prioritise the introduction of vaccination programmes.

He said Ireland was to be commended for introducing its national cervical screening programme last year but the benefits of organised cervical screening programmes were recognised a long time ago and England had implemented their programme more than 20 years ago.

“I expect the Irish government did not move forward more quickly with a screening programme is because they did not think they had the money for it. Now we have a similar situation where we have another tool, HPV vaccination, that has been shown to be highly effective in preventing infections with the two most common cancer-causing types of the HPV but the government again does not think it has the money to implement it,” Mr Davies told The Irish Times.

“We all have to recognise that the economic crisis will have an impact on all our lives but when you have effective tools to prevent a devastating and deadly disease like cancer, governments have an ethical obligation to prioritise their implementation without undue delay.”

His report recommended providing the vaccine through schools rather than in health clinics because schools were more likely to reach the target population quickly.

Providing the vaccine at GP or healthcare clinics could result in people from poorer backgrounds or minority groups missing out, the report found.

The report pointed to provisional figures from Scotland, where the vaccine is delivered through schools. The programme covered 92 per cent of the target group for the first dose and 88 per cent for the second jab.

Dr Caitriona Henchion, medical director of the Irish Family Planning Association, said the report pointed to the need for the Government to rethink its decision to scrap the programme.

“In Ireland, anyone wishing to vaccinate a child against cervical cancer has to have it done privately,” she said. “This takes time, planning and money – between €390 and €600.”

This situation was “inherently inequitable”, Dr Henchion said, as it widened the gap between the wealthy and the disadvantaged.

Women from low socio-economic backgrounds were already more likely to contract cervical cancer but they would not be able to afford the cost of vaccination.

She pointed to a Health Information and Quality Authority (Hiqa) report published last year which found that a universal HPV vaccination would be cost-effective, saving €2.74 million per year over a 70-year period due to disease avoided.

“The Government has opted to save a small bit of money in the short term rather than making an investment that will not only save the lives of women in the future, but will also save the State money in the long term,” she said.

Dr Henchion said the report showed a clear east-west divide, where the wealthier countries in western Europe had moved forward quickly with vaccination programme.

Countries in eastern Europe had much higher rates of cervical cancer but had done very little to implement national campaigns.

Romania was one of the few eastern European countries to buck the trend when it introduced a school-based programme last year. However, uptake was very low and it is now being examined with a view to relaunching it.

“While Ireland has cervical cancer rates similar to most western European countries, our lack of cervical cancer vaccination programmes puts us firmly in line with eastern European countries,” Dr Henchion said.

The Irish Family Planning Association has called for a full vaccination programme for 12-year-old girls and a catch-up programme for 13-15 year olds.

There are more than 200 new cases of cervical cancer diagnosed in Ireland each year and about 73 deaths from the disease. It is the second most common cancer in women aged from 15-44 years.

Demand for screening for the disease from young women increased in recent months due to the media focus on the reality TV personality Jade Goody, who died from cervical cancer.

Last month, Fine Gael’s health spokesman, Dr James Reilly, said he was donating €20,000 of his salary to an initiative by a group of GPs which involved offering the vaccine free of charge to 12-year-old girls in north Dublin.

Asked in recent weeks about the fate of the vaccine, Ms Harney said she remained committed to its introduction “as quickly as possible”, but the cost and value had to be weighed up against other needs such as screening for colorectal cancer.

Dr Henchion said she hoped that plans for the vaccine would soon be revived but it did not appear to be the priority that it once was. “You would like to think it would be introduced soon but I wouldn’t be hugely optimistic,” she said.