Costs and benefits

“Cancer” was and still is a dreaded word, a diagnosis that sounds like a death knell, a warning that one’s time on earth is limited.

Much of the menace associated with cancer is the mystery attached to its origin—no one knows why, in many kinds of cancers, cell growth goes awry, threatening the survival of the host.

But the world already knows the cause of cancer in two organs of the body. Speaking at the recent “HPV Summit,” Dr. Cecile Llave, coordinator of the National Cancer Institute Initiative, said “there are only two organs where we know the cause of cancer.” One is the liver, where cancer has been linked to the Hepatitis B virus. The other is the cervix, where studies have found very strong links between the human papillomavirus (HPV) and cervical cancer.

This is the reason liver and cervical cancer are the only two “preventable” forms of cancer, through vaccination against the cancer-causing viruses. But while many Filipino children and adults are already protected from liver cancer with the inclusion of the “Hepa-B” vaccine in the expanded program of immunization—part of the “menu” of vaccines given routinely and for free by the government—Filipinos have yet to receive routine and free vaccination against cervical cancer and other forms of cancer linked to HPV.

The reason for this is mainly cost. Given in a series of three injections over six months, each dose now costs P3,500, a significant deduction from the P6,500 per dose when the vaccine was introduced. But still, at over P10,000 for the full series, the HPV vaccine is still prohibitive for the majority of Filipinos.

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But when you add up the costs of screening, diagnosing and treating cervical and other cancers associated with HPV, the savings from HPV vaccination pile up. At the individual, family, community and national levels, the savings gained from vaccination versus treatment are quite obvious.

In the words of Dr. Gerry Wain, an Australian gynecologist-oncologist, the HPV vaccine is both “cost-effective and cost-efficient.” In Australia, where the vaccine has been given free since 2006 to school girls (and boys, starting next year) through the school system, HPV has proven to be an “extremely efficient” vaccine. Already, the country is seeing “a dramatic reduction in abnormal pap smears,” the most common screening method in Australia. They have also documented a “96-percent reduction” in the number of young men and women among the vaccinated age-group with genital warts, used as an indicator of the presence of HPV. “The vaccine is behaving in the real world as the clinical trials indicated,” said Wain.

The same rate of success is being seen in the United States, where HPV vaccination is given through public and private clinics, covered by public and private health insurance. Dr. Danilo Casimiro, a Filipino-American who works on viral vaccine research for Merck USA, says that studies show “a statistically significant reduction” in genital warts among young Americans below the age of 21, the target population of HPV vaccination. Problems remain, Casimiro acknowledges, including the rarity of clinic visits among American teens (who are, or should be, at the healthiest times of their lives), and the lack of clear guidelines on the vaccine.

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What about the Philippines? Dr. Tony Leachon, DOH consultant on noncommunicable diseases and a champion of the “sin tax” bill, offers a tantalizing opportunity. Unless legislators (like Sen. Ralph Recto) reduce the target, government should be able to raise about P200 billion from the “rationalized” taxes imposed on cigarette and liquor. This amount has been earmarked for upgrading the budget for universal health, and conceivably, said Dr. Leachon, some of it could be channeled toward subsidizing HPV vaccination, offering protection to millions of young women and men.

In the long run, it could save the government millions in health costs (for treatment of cancer) while families are spared from needless heartache. Dr. Llave spoke at the summit on the “Mother Daughter Initiative” being piloted in seven municipalities in the country, where mothers and their young daughters are invited to come to health centers, the mothers for cervical cancer screening and treatment, the daughters for HPV vaccination.

So far, says Llave, the project which was initiated in 2008 has screened (through VIA) almost 65,000 women, with lesions found and treated in 428 women. Some 4,000 girls between 9 and 13 years old were also vaccinated, with 88 percent completing all three doses.

Present at the summit were representatives of three municipalities where the Mother-Daughter Initiative is being tested: Los Baños, Laguna; Pagbilao, Quezon; and Minglanilla, Cebu. During a group discussion, the local health officials spoke of certain barriers to full coverage: the fact that government health centers are open only on weekdays, while the girls are at school; and difficulties in getting the girls to come back for the second and third doses.

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But, say Llave and the local health officials, once sufficiently briefed and informed about the vaccine, mothers are easily convinced to bring their children with them, with many expressing concern about protecting their daughters (and sons) from cancer.

Weighing the costs of cancer treatment versus vaccination is no longer difficult. The benefits are obvious, most especially that of gaining “lifetime protection” for young people who are only just starting on their life journeys, with the fear and stigma of cervical and other cancers lifted off their shoulders.