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HPV vaccine pays off for pre-adolescents but long-term value remains uncertain

August 21, 2008 |  2:32 pm

The makers of a new vaccine aimed at protecting against cervical cancer are aggressively advertising Gardasil for a wide range of girls and young women, and many state and national officials are calling for broad public campaigns of inoculation with Gardasil. But private insurers and administrators of public insurance programs such as Medicaid are debating whether inoculating women with the costly vaccine will pay off in long-term healthcare costs.

     A new study published in the New England Journal of Medicine says it will -- if you inoculate girls at age 12, presumably before they become sexually active.

    That's not the only if, and the other conditions that make widespread inoculation with Gardasil a good bet are big ifs, writes Dr. Charlotte J. Haug in an editorial published alongside the study. The latest economic calculation of widespread Gardasil vaccination for young women assumed that Gardasil provides lifelong immunity from Human Papilloma Virus (HPV), which can give rise to cancerous lesions in the cervix -- an assumption not yet proven. It assumed that vaccinated women would still get pap smears to screen for early signs of cervical cancer -- a prediction not yet borne out in practice. And it assumed that nature will not respond to the new vaccine by devising clever ways to work around it by, for instance, spawning vaccine-resistant forms of cancer-causing HPV. That's something that is not likely to be known for many years. (For a recent discussion of issues surrounding this, check out an Aug. 11 Health section story by Linda Marsa and one Aug. 19 in the New York Times by Elisabeth Rosenthal.

   "With so many essential questions still unanswered, there is good reason to be cautious about introducing large-scale vaccination programs," writes Haug, who is editor-in-chief of the Journal of the Norwegian Medical Assn.

   Also raising concerns about widespread vaccination with Gardasil are reports made to the federal government of a range of health problems experienced by women newly vaccinated with Gardasil, although cause and effect have not been established.

-- Melissa Healy

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