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A good day to bury bad news Part 1: Cervical cancer vaccine plan abandoned three months after introduction November 5, 2008

Posted by WorldbyStorm in Irish Politics.

Rarely do we get an opportunity to see the effects of cutbacks so pointedly as with the following. For as reported in the Irish Times

THE GOVERNMENT has abandoned a plan announced just three months ago to have all 12-year-old girls vaccinated against a virus that causes cervical cancer, citing “very scarce” health resources.

Minister for Health Mary Harney said yesterday that the economic situation had “rapidly and seriously” deteriorated since the plan was announced in August.

The costs? Financial, and more importantly, human?

The human papilloma virus (HPV) vaccination would have cost an estimated €9.7 million annually. Between 70 and 80 women with cervical cancer die in Ireland each year and some 200 new cases are diagnosed.

So the alternative?

“I have decided that the best that can be achieved in these circumstances is to prioritise funding for the development of the cervical screening programme [which have cut mortality rates by 80%] and treatment services at the eight designated cancer centres, which includes the challenge of funding very expensive cancer drugs.

The problem is, as the Irish Cancer Society notes;

“If this is going to be the beginning of a pattern around hard-fought decisions being reversed, the Irish Cancer Society would be awfully concerned about it,” Mr McCormack added.

He acknowledged that it would be difficult to have a commitment made to the programme in the current economic environment.

“But this is a cancer prevention measure and one euro’s prevention is as good as two euros of cure.”

And there we are. Not using the vaccine will inevitably mean that some women will eventually develop the cancer. Or as Dr. Muiris Houston noted in the IT:

Because of this very strong link between HPV and the cancer, giving a vaccine for HPV to a woman before she becomes infected with it has the potential to hugely reduce the number of women at risk of cervical cancer.

The HPV vaccine is a step forward, but not simply because it prevents cervical cancer, but also because in less serious instances it predicates against genital warts. And, the treatment for Cervical Dysplasia, which can lead to the cancer, is one that involves various different invasive and – let’s face it – expensive medical treatments.

I’ve been trying to get a read on costs, and in the US the total cost for a course of three injections given across six months is $450. It’s telling that the Minister has admitted that:

…the Health Service Executive had not been able to say how much the procurement cost for the vaccine would be.

But [she] said that the administration cost, set out by the HSE was “not inconsiderable”.

So, the vaccination programme is cut off despite a full assessment of the costs? But let us suppose that the figure of $1,000 (or double the US cost) was there or thereabouts. I could point to the fact that this government until last month allowed tax relief at the higher rate of tax for medical expenses. I could echo Caoimhghín O Caoláin’s words that this was a ‘disgrace’ at…

at a time when tax breaks were being left intact for the developers of private hospitals.

I could note that even Fine Gael has roused itself to decry this:

…health spokesman Dr James Reilly said that the decision was “a slap in the face to people who believe in prevention being better than cure”.

“For a miserly sum, they are now going to expose our children, our young women, to cervical cancer,” he said.

And here’s the thing. I plucked $1,000 more or less out of the air, but I discover that:

Following the Minister’s announcement yesterday, there is no prospect of young girls receiving free HPV vaccine from the State. The only choice for parents will be to pay for the three-part vaccination and have it administered by their GP. The estimated cost of a course of private HPV vaccination is in the region of €600.

For God’s sake. We’re meant to be shifting to primary care, it’s writ large in the Green Party manifesto as well as that of the Labour Party. Prevention is a way to ensure there aren’t astronomical health costs down the line. This state can’t cough up the readies for a vaccination programme of 13 year olds?

And let’s consider that Ireland, supposedly one of the wealthiest countries in the world lags now behind Germany, France, Italy, the United Kingdom (natch) and Greence in turning its face against the use of the vaccine.

But as we’ve seen, we live in an economy, not a society, where all must pull together to ensure the solidity of that economy. And the result of these sort of decisions? Economic collateral damage.

The weakest, the most vulnerable in our society? Sacrificed on the pyre of cutting spending.

What a bizarre, ethically dysfunctional, system we tolerate.


1. Wednesday - November 6, 2008

It’s even more cynical than you think. The HSE issued the statement about five seconds after Order of Business had finished and the Taoiseach had left the Dáil chamber.

Ironically this week’s Irish Medical News (published, obviously, before this decision was announced) carried a study demonstrating the “cost-effectiveness” of a universal vaccination programme. It made the point that we’re one of the few countries where such a programme could be completely justified on financial as well as public health grounds.


2. WorldbyStorm - November 6, 2008

Disgraceful doesn’t really cut it, does it? Clearly rushed through in order to take advantage of an opportune moment.

You don’t have a copy of IMN do you? Or is it available on the internet?


3. crocodile - November 6, 2008

In 5 or 10 or 20 years’ time, a future Minister for Health will think it is time to rectify the scandalous fact that we’re the only country in western Europe without this vaccination, and it will be introduced.
The Moore McDowell or Jim Power of that time will say: ‘Look how our health spending is spiralling out of control!’
‘But’, we’ll protest, ‘ we’re only trying to catch up after the cuts of 2008-2020!’
‘Sorry’, Moore or Jim will mutter. ‘These levels of health spendng are just not sustainable’.
How do we know this will happen? Because it has happened all over the public service between the 1980s and the present. When you’re spending to catch up, of course you’re spending more.


4. Ciarán - November 6, 2008

When you’re spending to catch up, of course you’re spending more.

Except, this would have been spending now in order to avoid incurring higher costs later, as evidenced in the IMN article Wednesday cites above (referring to public health costs and in terms of treatment (as suggested by Dr. Henrietta Campbell to the Joint Oireachtas Committee on Health and Children last year.


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