Dealing with cervical cancer vaccination

Cervical cancer is a disease caused, at 80 per cent, by the sexually transmitted Human Papilloma Virus. Each year, in the world, 275.000 women die of Cervical Cancer, and 88% of cervical cancer related deaths occur in developing countries (GLOBOCAN, 2011).

Cervical cancer is a disease caused, at 80 per cent, by the sexually transmitted Human Papilloma Virus. Each year, in the world, 275.000 women die of Cervical Cancer, and 88% of cervical cancer related deaths occur in developing countries (GLOBOCAN, 2011).

1502043755Yvan-Butera
Dr. Yvan Butera

Moreover, Cervical cancer is the most prevalent cancer among women in Rwanda. Currently, in the world, there are two approved prophylactic vaccines against HPV that causes Cervical cancer, namely, Merck & Co.’s Gardasil and GlaxoSmithKline’s Cervarix. However, there has been a 15 to 20 years gap in introducing a vaccine in developed and developing countries.

 

It is in this context that in April 2011, the government of Rwanda, partnering with Merck & Co rolled out the Gardasil vaccine in Rwanda. Because 98% of Rwandan girls frequent primary school, the first rollout targeted girls in primary grade six and achieved 95.04% coverage. Nonetheless, Ouedraogo and his colleagues critiqued the rollout of the Gardasil vaccine stating that it was not in the “best interest of the people” (Ouedraogo et al., 2011).

 

Although it was substantially criticized, the roll out of the Gardasil vaccine opposed socially constructed notions of effectiveness, cost effectiveness, and contended the notion that all people should have equal access to care.

 

Ouedraogo and his colleagues deemed the rollout of Gardasil Vaccine not “cost effective”, without considering the vaccine market changes. They argued that GAVI would, at one point in time, stop funding HPV vaccine because of its high price. By building on the existing efficient supply chain, integrated primary health care interventions, and intersectorial collaboration in delivering vaccines to its people, the Rwandan government demonstrated the possibility of scaling up vaccine access and achieving high coverage.

As a result of this, halfway through the first year of Rwanda’s HPV vaccination program, Merck & Co. dropped the price of Gardasil by 70.6% - from 16.95 to 5 United States Dollars (Binagwaho et al., 2013).

Furthermore, the price is expected to farther decline, since, in 2012, GAVI incorporated the HPV vaccine into its routine funding portfolio, which would lead to increased demand for the vaccine from GAVI-eligible countries.

In addition, Ouedraogo and his colleagues challenged the effectiveness of the Gardasil vaccine, without broad research on the subject. In contrast to the comment Ouedraogo made about the effectiveness of Gardasil; a study done, in 2008, by Jouraand his colleagues, demonstrated that Gardasil had close to 100% efficacy in preventing HPV infection.

Additionally, Ouedraogo and his colleagues’ opinion that, the rollout of Gardasil vaccine is not in the best interest of the people, demonstrates a human right violation.

It is against human rights to deny the women of Rwanda, or, as a matter of fact, any women living anywhere in the world from a vaccine that prevents the most common cancer in their population.

Despite being heavily criticized, the roll out of the Gardasil vaccine in Rwanda, opposed the socially constructed idea of effectiveness, cost effectiveness, and defended the belief that all people should have equal access to care. Rwanda’s efforts to deliver Gardasil to its female population should serve as an example to other countries where HPV vaccine is not given, and therefore, march towards the elimination of Cervical cancer worldwide.

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