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May 09, 2013

Record Low Price for HPV Vaccine

by Joe DeCapua

Millions of girls in developing countries could soon have access to a vaccine that protects against cervical cancer. The GAVI Alliance has announced a record low price for the HPV vaccine. The announcement was made Thursday at the World Economic Forum for Africa in Cape Town. Despite the lower price, one group believes the cost is still too high.


About 275,000 women die of cervical cancer every year. Most of them are in developing countries. The HPV vaccine protects against the human papillomavirus that causes the majority of cases. The virus is sexually transmitted and can remain in the body for years before cancer develops.

Dr. Seth Berkley, CEO of the GAVI Alliance, a public/private partnership focusing on immunization, said, “Cervical caner is a disease that in most of the wealthy countries is able to be diagnosed using very simple technology and is able to be treated if people have early cancers. We have a triple whammy in these countries where they have a higher incidence of disease. They don’t have the diagnostic test available and they don’t have treatment. So this is a disease that is killing women in the prime of their life.”

Berkley said that if no prevention measures are taken, the annual death toll could rise to about 500,000 in the coming decades. The vaccine is generally given to girls between the ages of 9 and 13.

“We hope to take this vaccine by 2020 to 30 million girls in more than 40 countries,” he said.

GAVI launches that effort with demonstration programs in Kenya -- followed by Ghana, Laos, Madagascar, Malawi, Niger, Sierra Leone and Tanzania. Rwanda may soon start using the HPV vaccine as part of its national immunization campaign.

All that’s possible, said Berkley, due to an agreement with the Merck and GSK pharmaceutical companies. They will sell the vaccine for $4.50 and $4.60 per dose respectively. The vaccine costs more than $100 in developed countries. The best public sector price before now has been $13 per dose.

The cost for developing countries will be based on a sliding-scale at the outset. As they grow economically, they will eventually bear the full cost.

“As a physician, I of course have seen in many countries this very sad scenario, where people present and all we can do is provide pain control. So this is a really big deal for these countries,” he said.

Dr. Berkley said that the goal is to get more vaccine manufacturers involved and eventually drive down the price further.

Not everyone is happy about the price of the vaccine. The medical aid group Doctors Without Borders, also known as MSF, says the cost is still too high. Kate Elder, Vaccines Policy Advisor for the MSF Access Campaign, said, “We think that there could have been a better deal struck for HPV vaccines for these countries. We know that pharmaceutical companies will still be making a very healthy profit off of these vaccines. They have already long recuperated their initial R&D investments. And so why is additional profit being made off the back of the poorest countries? And this is really kind of calling into question the sustainability of introducing some of these vaccines in countries that are so poor and have very fragile health systems.”

Elder said that the cost of new vaccines that are recommended by the World Health Organization has been steadily rising, placing a strain on poor countries. She added that Merck made over $1.6 billion dollars last year from its HPV vaccine, while GSK earned $416 million.

“Precisely, how much does it cost to develop HPV vaccine and how much does it cost to manufacture every dose of HPV? We don’t know. And that’s difficult when you’re talking about affordability and what is reasonable in terms of price reductions,” she said.

Doctors without Borders has called on the pharmaceutical companies to be more transparent about research and development. She says much of the initial R&D for vaccines was done in public institutions, such as the National Institutes of Health. NIH is funded by taxpayers. What’s more, it said the cost for immunizing each girl is really $14 because three doses of the vaccine are needed for full immunization.

GAVI’s Dr. Berkley has responded to the group’s concerns. He said, “Of course we agree that we would like to get the lowest prices that are possible for these vaccines. Now, one of the challenges [is] of course that we have to have a healthy vaccine market. And so what that means for that to have supply security there should be more than one manufacturer that’s supplying vaccine. And in the process of scaling up we are going to have to deal with vaccines that aren’t as inexpensive as we would like.”

Last year, 15 countries applied for the vaccine and GAVI expects another 15 to apply this year.

In developed countries, the risk for cervical cancer is frequently determined by using the Pap test or Pap smear. It examines cells from the cervix and can detect whether they are pre-cancerous. The test is not widely available in many developing countries, preventing treatment at a very early stage of the disease.