The U.S. Food and Drug Administration approved the vaccine Gardasil June 8, and it’s now available at the UAA Student Health and Counseling Center _” for a price.
“For the first time, we have a vaccine against cancer,” said Betty Bang, the health center’s health educator.
The pharmaceutical company Merck manufactures Gardasil. The vaccine targets four forms of the human papillomavirus, including two varieties that are estimated to be responsible for 70 percent of cervical cancer cases in the United States.
More than 100 types of HPV have been identified. Many of them simply cause skin warts, but 30 varieties cause genital warts and at least seven of these can cause abnormal tissue growth in women that can develop into cervical cancer. The new vaccine provides immunity against the two most carcinogenic strains, HPV-16 and -18.
According to the Alaska Department of Epidemiology, between 1993 and 2003 there were 188 new cases of cervical cancer in Alaska. The national Centers for Disease Control and Prevention estimates 3,700 women in the U.S. will die in 2006 from this disease.
For those who want the vaccine, the price tag may be high. Gardasil is administered via three shots given over a six-month period. For students at the UAA Student Health Center, the cost for each shot is $138, adding up to a total of $414.
“Megalife (the student health-insurance provider for UAA) won’t cover it,” said Bang. “They only cover required vaccines, the sorts you’d need to live in the dormitories, like rubella and measles. But some other insurance providers might. Staff and faculty with Blue Cross can get coverage for the vaccine as a preventive treatment.”
Genital varieties of HPV are transmitted through direct sexual contact. Men and women infected with the virus often have few or no noticeable symptoms, but they are still capable of passing it on to sexual partners. The Gardasil vaccine cannot cure a case of HPV that has already been contracted, but it can provide immunity to the virus for at least five years.
Joy Zimmerman-Golden, an advanced nurse practitioner whose independent practice also offers Gardasil vaccinations, said “Even women who have been exposed to HPV could still benefit from the vaccine because it’s unlikely that they’ve been exposed to all four strains that the vaccine protects against, so it might protect them against future infections.”
Currently, HPV is recommended only for girls and women age 9-26, because these are the only age groups for whom its effectiveness has been clinically tested. According to the CDC, clinical tests are currently underway for women older than 26 as well as for men and boys.
“Men don’t get cervical cancer, but they sure get HPV,” said Bang.
If the vaccine can give immunity to men, then administering it to both sexes could theoretically reduce the rates of HPV transmission – and incidences of cervical cancer – more than vaccinations of women alone. To encourage use by men, Merck has designed the vaccine to provide immunity against two additional strains of the vaccine, HPV-6 and -11, which are not highly cancer causing but are strongly associated with genital warts.
Uninsured minors under age 19 may qualify for free vaccinations through the Vaccines for Children program. There may not be as many avenues for adults whose insurance does not cover the treatment.
“I think at some point the CDC would like to vaccinate all women age 9 to 26,
said Bang. “As time goes on, insurance companies will realize the vaccine is cost effective compared to the price of cancer treatment. You can see examples of this now in that insurance providers often cover annual breast and gynecological exams for women and prostate exams for men.”
Diagnosis of cervical cancer can include procedures such as colposcopy – a microscopic examination of the cervix – and a biopsy of tissue samples. Zimmerman-Golden said that, the cost of diagnosis alone can reach $900. Nationwide, the annual cost of these diagnostic procedures is $6 billion.
Even when insurance companies do offer coverage, they might not offer quite enough to fit the bill for Alaska clients.
“Insurance companies always have a few hidden ‘outs,'” said local insurance broker Marietta Hall. “They’ll usually base the money they pay on the average charges for a treatment. But what data are they averaging? They might be taking their average from data in Washington State and Alaska combined, in which case Alaskans will always be undercut because drug prices are higher here. And in rural Alaska, the undercut is double because prices there are higher than in Anchorage.”
Regardless of who pays, Zimmerman-Golden underscored the fact that getting the vaccine does not eliminate the need for women to get annual gynecological check ups.
“The vaccine does not replace the Pap smear,” Zimmerman-Golden said. “There are many more HPVs that this doesn’t protect against. Nor does it eliminate the need for condoms. It shouldn’t make people feel less susceptible.”
Although Gardasil is currently the only HPV vaccine approved in the U.S., drug maker GlaxoSmithKlein has already created its own vaccine called Cervarix, which – if approved for the U.S. market – may drive down prices for Gardasil.
|Facts about the HPV vaccine
How is it made?
Segments of of HPV genetic material are inserted into the DNA of a yeast called S. cerevisiae. Within the yeast cells, the viral DNA produces proteins called virus-like particles. These are then used to make the vaccine.
What does the vaccine do?
When you receive the vaccine, your immune system is able to form antibodies against four strains of HPV (6, 11, 16 and 18). These antibodies can then be used to mount a defense against these strains of HPV.
Where is the vaccine offered?
Students and faculty can get the vaccine from the Student Health Center (786-4040), located in Rasmussen Hall. At least three other clinics in town currently offer the vaccine.
_? Anchorage Women’s Clinic: 561-7111
_? Alaska Health Care Clinic: 279-3500
_? Offices of Sandy Clapper, CNM, ANP, and Joy Zimmerman-Golden, RNC, ANP: 264-2333
What are the vaccine’s side effects?
The HPV vaccine does not contain live viruses; you cannot get the disease from a vaccination. It does not contain mercury, thimerosal or egg proteins. Some recipients experience temporary fever. It should not be taken while pregnant or by those with allergies to aluminum products.
What is a Pap smear?
A Papnicolaou – or “Pap” – smear is a test that can help detect HPV and cervical cancer. A sample of cells are taken from the cervix with a cotton swab and examined under a microscope. If there are abnormal findings, further testing is needed to determine the cause. The Centers for Disease Control and Prevention advises annual Pap smears for all women younger than 30.
Where can I get a Pap smear?
Pap smears are available at the health center. The charge for students is $50-70 depending on what sort of tests are needed. Anchorage Women’s Clinic offers free Pap smears, breast exams and mammograms to women below certain income levels, and may offer assistance with further charges if abnormal results are found.