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The choice is simple様et them live

Author: Laurie Garrett, Senior Fellow for Global Health
February 28, 2007
International Herald Tribune

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Last March I lost one of my dearest friends to cervical carcinoma. As I sat for days beside her hospital bed, watching her gulp air and cry out in pain, I couldn’t help wondering whether Kathy would have died had she had access to the new Merck or GlaxoSmithKline vaccines that block infection with the most common forms of human papilloma viruses, the causes of cervical cancer.

In the United States, cervical carcinoma was once a leading cause of death for women under the age of 60. Thanks to routine Pap smear testing, gynecologists have dramatically reduced the numbers as they are able to catch the pre-cancerous changes HPV causes in cervical cells at an early stage.

The problem with Pap smears is twofold: They do not reduce the overall prevalence of HPV in society and therefore do not change the risk of infection, and they require a health infrastructure. If girls and women do not have access to routine gynecological care they cannot get annual smears.

My friend Kathy, a college-educated woman of Irish descent, was one of the 48 million Americans who do not have health insurance, so for a few years she had missed her routine Pap smears.

There are millions of women and adolescent girls who, but for reasons similar to Kathy’s, fail to have such examinations.

Partly as a result of this, 4,000 American women died last year of cervical cancer. The American Cancer Society reckons 2,800 of them would not have died had they been innoculated with the HPV vaccine in adolescence. Coupled with routine Pap smears, the immunization might have saved all 4,000 of them.

Internationally, most of the world’s women have no access to routine gynecological care and are rarely screened for any type of women’s health problem. One result is that cervical carcinoma annually kills some 300,000 women worldwide.

The conservative Family Research Council has been among the organizations leading the charge against Perry, Merck and other advocates of mandatory adolescent female HPV vaccination. On its Web site, the organization argues that: “The strains of HPV that cause cervical cancer are transmitted only through sexual contact. The paternalistic view that just because something is good for you the government should force you to do it is not one that most American families would welcome, especially when transmission of the virus can be prevented through behavioral change alone.”

If this is so, why stop at blocking HPV vaccination? Why not also block tax-payer support of Pap smears, routine tests for all types of sexually transmissible diseases and all forms of education about sexual disease?

But the fact is that HPV is not solely transmitted through sexual contact. It is considerably more contagious than HIV, syphilis or gonorrhea, and can be spread through handshakes, toilet seats and childbirth if the transmitting individual has genital warts, the most common visual evidence of HPV infection. HPV is such a tough virus that it cannot even be 100 percent blocked by proper condom use. That is why today in America , HPV already infects roughly 43 percent of college-aged females and about half of all the citizens of the United States. Yes, even married, monogamous women get infected with HPV, and can contract terminal cancer.

In the poor countries of the world, women do not have the option of denying their sex partners or getting routine gynecological examinations. Only immunization could radically alter the cervical cancer risk equation for hundreds of millions of women.

But at Merck’s current astronomical cost of $400 per 3-dose HPV immunization, the vaccine is completely out of financial reach for most of the world’s poor women, uninsured Americans and all but the wealthiest elites of middle-income societies. Even at a 75 percent discount, global use of the vaccine will require fiscal support from the wealthy world.

The choice here is clear: U.S.taxpayers must be willing to foot the bill for HPV vaccination of the uninsured among us, and help—along with other wealthy nations and private philanthropies—pick up the tab for widespread global access to the vaccine. Let science and humanity guide policy, not wishful thinking and moral absolutism.

This article appears in full on CFR.org by permission of its original publisher. It was originally available here.

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