HPV vaccines: prospects for eliminating ano-genital cancer
Virtually all cases of cervical cancer and its precursor intra-epithelial lesions are a result of infection with one or other of a subset of genital human papillomaviruses (HPVs), suggesting that prevention of HPV infection by prophylactic vaccination would be a highly effective anticancer strategy. Two HPV L1 virus-like particle vaccines have been developed, a quadrivalent HPV16/18/6/11 product and a bivalent HPV16/18 product; both have been shown to be highly immunogenic with a good safety profile and 100% efficacy against HPV16/18-related high-grade cervical intra-epithelial neoplasia (CIN2/3), implying that they will be effective at preventing HPV16/18-related cervical cancer.The HPV L1 VLP vaccines are immensely important developments in public health and the benefits that they promise are immense, offering the opportunity to prevent, in the long term, 80% of cervical cancers, 60% of vulval and 90% of anal cancers in women. They will impact significantly in the short to medium term on the incidence of high-grade CIN reducing the number of women who have to undergo large loop excision of the transformation zone and economically, in the long term, they will reduce health-care costs. But the overwhelming benefit is the major improvement for human health and well-being of women everywhere.
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Tags: Biology, Health, Medicine, Microbiology, Science, Vaccines, Virology
While the advent of not only one, but two highly effective and safe vaccines against high-risk human genital papillomaviruses can only be lauded as a major advance in humanity’s fight against lethal disease, there is a sour note in the chorus of praise.
And that is their price….
The Merck vaccine – Gardasil – will retail at ~US$360-00 for a course of three jabs; GSK’s Cervarix is unlikely to be much cheaper.
That is the equivalent, in one treatment, of the per capita per annum cost of health care in a country like Zambia – where vaccine is needed far more than in the target market of the USA and Europe.
I have spent 10 years trying to make a cheap papillomavirus vaccine using plants as an expression system. We have achieved signal success; we have a product which will probably work – and no-one really wants it because of the costs of tooling up, and because the pharma behemoths have their product out already.
Make no mistake, these are good vaccines. They will also not reach the several hundred thousand people who, this year, will get the infections that will lead to cervical cancer sometime in the future, that will probably kill them.
Because they simply cost too much.
Vaccines and drugs: the new unacceptable face of capitalism.
What is making the vaccine so expensive? (It’s FAR too expensive to use in developing countries.) Is it the long-term cost of R & D expenditures?
Madame Monet
winewriter.wordpress.com
R&D is expensive, but Big Pharmas also make big profits. OTOH, they’re not charities. See: Globorix: GSK – good pharma or bad pharma?.
The cost of a vaccine is in large part determined by (a) amortisation of expensive plant (~US$100 million) and (b) recouping the cost of development / research (~US$500 million?) over a fixed period; (c) costs of material and processing (minor); (d) distribution and vialing and QC; (e) marketing and profit.
Reducing (c) does little to lower end-user price; reducing (a) and (b), on the other hand, mean very significant reductions are possible – which is why generics and out-of-patent vaccines are so much cheaper, as the plants are already built and no research costs need to be recovered.
This is where governments come in: if they commission vaccines – as the UK did with Chiron for one of the conjugate bacterial vaccines – then the companies don’t need to charge as much as they have a guaranteed market up front.
But realistically, vaccines like the HPV offerings and even rotavirus (Rotarix, GSK) cost a lot because the companies see them as blockbuster products that need to be milked for profit while the going is good.
And developing countries are not a market, except for guaranteed sales to UNICEF or WHO.
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Ed said above:
This is where governments come in: if they commission vaccines – as the UK did with Chiron for one of the conjugate bacterial vaccines – then the companies don’t need to charge as much as they have a guaranteed market up front.
The other possibility is for governments to carry out the research themselves, and license the patents to generic manufacturers, in that case the cost (a) and (b) would be government expenses–but remember much of it is already government expense, as the research from the N.I.H. is often handed over to private companies for a pittance (that is what is meant by a “public-private partnership” frequently) And what is also happening is that Big Pharma is so focused on a “Blockbuster” drug that the cost for all of their failed medicines, especially the ones that are discarded during clinical trials after racking up an expense of several tens of millions of dollars, that those costs have to be folded into the cost of those vary few drugs that make it to market. It should be very consoling to those who can’t afford the medicines that they need to live that many of those failed medicines where for aliments suffered by rich middle aged men, like erectile dysfunction and male-pattern baldness.
Another possibility is awarding prizes to pharma corporations or consortia that create vaccines for different aliments, and then once the prize is paid, the patents for that medicine would be owned by those who awarded the prize–either a foundation or an NGO or possibly a govt agency.