HPV vaccines are the first of several new preventive technologies aimed at adolescent girls - an entirely new market that poses a series of unique policy and finance challenges to developing country governments and donors. As a result, decisions about HPV introduction have been so closely linked to the eventual availability of AIDS vaccines and microbicides that the conversation has largely shifted away from talk of cost-effectiveness and public health benefits (e.g. herd immunity) that are the traditional hallmarks of the global vaccine discourse and assumed the "health as a human right" rhetoric more often associated with the AIDS debate. Thus, within global health circles the discussion is generally couched as a question of how - not whether, when or under what circumstances - to introduce, finance, and deliver HPV vaccines throughout the developing world.Now, a new coalition is formally adopting this charge. The
Global Call to Stop Cervical Cancer, which was launched at the World YWCA International Women's Summit in Nairobi earlier today, "urges governments to prioritize cervical cancer in national development and health budgets, calls on multilateral agencies to ensure accelerated regulatory processes, appeals to international donors to ensure new vaccines and diagnostics are widely available, and calls upon industry to provide adequate supplies of new technologies at radically tiered prices." (See the
press release for more details.) By launching the Global Call at a conference focused on HIV and AIDS, the organizers hope to encourage HIV activists and cervical cancer activists to learn from one another and share strategies to expand access to prevention and treatment.The availability of this impressively effective vaccine seems to have magically brought down the walls of global health silos, but ultimately the adoption and uptake questions should be based on an assessment of the vaccine's own particular benefits (and costs) as an intervention in a given context, and not solely as a preparatory step for future products. One of the biggest hurdles - and current unknowns - is the price of the vaccines (set at $360 per course in the U.S.) and the costs and feasibility of programs to reach adolescents in developing countries. A recent study in the
New England Journal of Medicine found that "for countries with a gross domestic product of less than $1,000 per capita, the per-dose cost may need to be as low as $1 to $2 to make vaccination both cost-effective and affordable." With that in mind, then, we need to be careful that we don't put the cart before the horse - or in this case, the advocacy bandwagon before the cost-effectiveness analyses, impact evaluations and other operational research activities that can best inform policymakers as they weigh this important decision. So I propose that the Global Call call for one more thing, too: the systematic generation of practical, credible knowledge that should inform country-by-country decisionmaking about whether introducing HPV vaccines makes sense.
Via Christine Gorman
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