Cervical cancer vaccine backed


WASHINGTON -- An influential committee of health experts recommended to state and federal health officials yesterday that girls ages 11 and 12 routinely receive a new vaccine that protects against cervical cancer.

The panel, whose decisions carry great weight with government health departments and private health insurers, said girls as young as 9 and women up to age 26 could be given the vaccine if doctors approve.

Anne Schuchat, an official at the federal Centers for Disease Control and Prevention, hailed the move as a "huge breakthrough for women's health" and said 11- and 12-year-olds were targeted to gain "the maximum preventative impact."

People in the room in Atlanta where the recommendations were announced burst into applause after the unanimous votes, said a member of the panel, the Advisory Committee on Immunization Practices.

The new vaccine, Gardasil, protects against strains of a sexually transmitted human papillomavirus that cause 70 percent of cervical cancer cases. The disease is expected to strike about 9,700 women and kill 3,700 in the United States this year.

Doctors and scientists say the vaccine works best when administered before a female becomes sexually active. It is given in three doses, for which its manufacturer, Merck & Co., is charging $120 each.

Recommendations of the panel, which urged the government to make the vaccine available free to children of low-income families, are subject to approval by federal health officials. And states and communities must decide whether to promote and administer the vaccine.

The decisions could raise budgetary concerns in cash-strapped health departments. And some conservatives who support abstinence might apply pressure to resist the recommendations.

Linda Klepacki, a sexual health analyst for the group Focus on the Family, said states should not treat the vaccine like those for mumps and measles, because it guards against a disease contracted through sexual activity. She said its use should be left up to parents and not be required by the states.

"It's parents who should be in charge of their children, not the government," Klepacki said. "Parents should have a right to determine whether their child is vaccinated or not, especially when it involves a sexually transmitted disease."

Dr. William Schaffner, a liaison to the advisory panel from the Infectious Diseases Society of America and the National Foundation for Infectious Diseases, said the panel's recommendation was not intended to pressure states into requiring that girls receive the vaccines. He said he sees no sign that states are considering making the immunizations mandatory.

Instead, the committee wanted to encourage parents and their children to consult with doctors about the vaccinations, said Schaffner, chairman of the department of preventive medicine at Vanderbilt University medical school. "That is exactly where it is being left," he said.

Greg Reed, who runs Maryland's immunization programs, said the state health department has not reviewed the advisory panel's recommendations but usually follows such advice.

"There are currently no plans to make this a school requirement," said Reed, program manager for the Maryland Center for Immunization.

A preliminary study that gauged attitudes among 30 parents and 15 teenage girls in the Rochester, N.Y., area found them receptive to the vaccine if their doctors recommended it and if they were assured that there were no side effects.

"Most parents said they would like to vaccinate their sons as well as their daughters," said Dr. Cynthia Rand, an associate professor of pediatrics at the University of Rochester's medical school who conducted the study for the CDC.

Gardasil also protects against genital warts, and Merck is studying the impact of the vaccine when it is administered to males. But the company has not asked federal drug regulators to approve such use.

This month, federal drug regulators approved sales of Gardasil, which studies found to be safe and nearly 100 percent effective. Merck, the manufacturer, said it has already shipped "tens of thousands of doses" across the country.

Cervical cancer deaths in the United States occur far less frequently than in the past because of widespread Pap screening. But most health experts have expressed enthusiasm about the vaccine's potential to virtually eradicate the disease.

Liberal advocates and government health officials have expressed concern that the vaccine's price - $360 for the three-shot series - is far higher than that of traditional vaccines and might be too costly for low-income women.

Mary Mincer Hansen, Iowa's public health director and president-elect of the Association of State and Territorial Health Officials, said states are being squeezed by the rising costs of new vaccines with promising public health benefits. Her department plans to ask the federal government for more money to cover the cost of vaccinating poor and low-income residents.

"We need funding to support this new recommendation," she said.

Dr. Joshua Sharfstein, Baltimore's health commissioner, said the city will try to get money from the federal government to provide the vaccine for low-income females not covered by federal subsidies.

"That's a major financing gap," he said.

The federal Vaccines for Children program, which insures low-income children, is set to begin negotiating with Merck for a discount on the price of immunizations for 9- to 18-year-old girls.

Private health insurers had been awaiting the recommendations before deciding whether and how to incorporate the vaccinations into their coverage. Similar reviews of coverage for other vaccines have taken three months to a year.

"If it's a recommended vaccination that the medical community agrees with, chances are it will have coverage upon review," said Mohit Ghose, a spokesman for America's Health Insurance Plans, an industry group whose 1,300 members cover 200 million Americans.


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