Some three million teenage girls in Germany are to be urged to take part in a mass vaccination campaign to help to stamp out cervical cancer.
The go-ahead for the jabs — in effect Germany’s first nationwide anticancer immunisation — is likely to nudge other EU countries, including Britain, to consider similar steps. Germany is Europe’s largest market for medicines and pharmaceuticals.
The course of three injections, costing €150 (about £100) each could mark the beginning of the end of the smear test.
In Germany, the Standing Commission for Vaccination is recommending that all girls between the ages of 12 and 17 be vaccinated against the Human papilloma virus which causes precancerous and cancerous lesions. About 70 per cent of cervical tumours are caused by the papilloma 16 and papilloma 17 viruses.
The vaccines, marketed under the names Gardasil and Silgard, have been available in German pharmacies since last year. But the green-light from the Commission, made up of experts from the Robert Koch Institute in Berlin, has transformed the economics of mass vaccination: state insurance companies will, from next week,, take over the full cost of the injections, opening the way for a radical public health campaign.
Although celebrities such as the tennis player Gabriella Sabatini and the British sailor Samantha Davies have helped to raise the profile of the fight against cervical tumours, vaccination is still regarded by some specialists as luxury treatment.
Cervical cancer kills around 17,000 women a year in industrialised countries which, thanks to systematic smear tests, is significantly lower than the 218,000 victims in developing nations. Despite relatively low death rates in the West, German doctors say mass vaccination should be deployed.
“It not only prevents cancer,” says Lutz Gissman of the German Cancer Research Centre in Heidelberg, “it also takes away the fear of many thousands of women waiting for the outcome of tests for the illness”. Some 6,500 women a year contract cervical cancer, and 1,600 die from it. “That is an unacceptably high rate for a developed country like Germany,” says Dr Gissman.
The vaccine will be available for free only to girls within the 12 to 17 age group. The aim is to inject the vaccine before they begin to have sexual relations.
The vaccine is available for older women, but only if they pay most or part of the cost. “Every woman who has not yet come into contact with the virus should get herself immunised,” said Achim Schneider, head of gynaecology at Berlin’s Charite hospital. “If all 35-year-old women receive the vaccine, the cancer risk will probably drop by about 40 per cent.”
Dr Schneider and other leading German specialists believe that if the vaccine remains effective for a lifetime it could dramatically lower the danger of cervical cancer for the next generation.
“If we one day manage to vaccinate against all HPV variants and if we manage to get hold of all the girls before they have started a sex life, then we will no longer need to carry out cervical smear tests,” he says.
The German Commission, by urging vaccination only for female teenagers, has dodged one of the major debates in Europe: whether to immunise boys. Austria has started a vaccination programme that includes boys on the grounds that they can pass on the virus through sex.
The focus elsewhere however is still on young girls. Some US states have made the vaccination compulsory for all 12-year-old girls. Over one million doses of the vaccine have been sold in the US since it was introduced last June.
Killer disease
— About 470,000 new cases of cervical cancer occur annually worldwide
— It is the second most common cancer in women
— It kills 1,120 women die each year in the UK
— Mortality from cervical cancer has been falling in big European countries since 1990, but the rate has remained consistently higher in Germany
— A two-year trial of Gardasil showed it to be 100% effective against the two virus strains that cause most cervical cancer
Sources: World Health Organisation; dkfz.de; European Cervical Cancer Association; gardasdil.com
