In every discussion of this vaccine, no one seems to want to discuss the staggering cost of a vaccination program.

According to this article, the vaccine costs $360. However, lets use $250 after taking into account bulk discounts if a state were to mandate vaccinations. That is $250 for every woman under 30 now and in the future every girl that turns 9 or 10.

For the US in 2007, just for women between 10 and 30 that is 41.3 million eligible recipients. That is a potential cost of just over 10 billion dollars, plus an additional annual cost of 500 million for vaccinating girls that turn 9. This is a gold mine for Merck, but is sum worth spending to save 3,700 lives per year?

Yes, this is a cruel statement, but we could save far more lives by spending the same money on funding for other healthcare treatments for the poor (not even mentioning for poor in other countries). I would suggest that the state would be better off spending the money on reducing the incidence of hospital infections, rather than funding universal vaccination. For those rich enough to afford the vaccine on their own, they are welcome to do so. This would only reflect the status quo in the US where those with insurance and a family doctor are much more likely to be diagnosed early and treated properly for a wide variety of illnesses.

P.S. Unlike what Merck might have you believe, not all cervical cancers are caused by HPV. And the oft cited statistic that it causes 70% of cervical cancers is somewhat speculative.

Don't forget, the rate that people will get the disease goes up by how many partners they have.

So, those who don't spread their legs would be charged as much as those that do, which is unfair for those who want to live in a protective manner instead of just living like a hedonist.

Women die of cervical cancer in underdeveloped countries at a much higher rate than in the US, partly due to poor medical care and a lack of screening, but HPV (particularly the strains that cause cancer) is believed to be much more prevalent.

In my mind, a vaccine would have a tremendous benefit in that situation. Of course we're nowhere near that because of the cost of the current vaccine, but in the future if a lower-cost vaccine were developed that was proven to be effective, I think it would do a lot of good.

If 1 in 3 people already have HPV, they can't get the vaccination. Furthermore, this isn't a mandatory vaccination for all women aged 10 - 30, it's for two school grades' worth - and notably of only half the general population (I agree we should be vaccinating young boys too, since they carry and pass it along.)

Even given the government discount of $250, consider that the patient has to go to the doctor at a doctor's office. This compounds the cost of the vaccine and potentially could create a rise in the insurance premiums for families with daughters. In addition--how long does the vaccine last? For life? For a few years? If the latter, then why vaccinate a ten year old girl when the probability of her becoming sexually active isn't for several years to come? Will a booster be necessary? And what if the 70% the vaccine supposedly prevents (in fact, the vaccine only covers 4 of the presumably 40 strains of the virus) is an overestimate, will Merck release another vaccine in two years to fully cover the risks of developing cancer? If so, wouldn't that be convenient for Merck.

As much as I am a proponent of eliminating any disease that threatens the lives of women, more research, or at least the release of information, is necessary before vaccinating girls because a pharma says it's for the common good.

You also have to toss into your cost-benefit analysis the risks of the vaccine itself. While rarely discussed, all vaccines have a certain fatality rate associated with them.

Mass vaccination, as a general rule, is only undertaken when you want to disrupt the transmission vector of a disease. Normally a widely fatal disease - which HPV isn't.

At 3700/year, cervical cancer is not yet at the emergency level where we should be grasping at any possible solution. Spending a bit of time to actually test the effects of the vaccine and figuring out whether its worth the risk seems merely prudent.

"Still, according to the National Cancer Institute, roughly 11,000 women will be diagnosed with cervical cancer this year in the United States. Nearly 3,700 women will die."

3,700/year may not be an emergency, but 11,000 a year is certainly cause to respond. This is a communicable disease! You don't wait until it is so prevalent that it is unavoidable before you come up with a plan to deal with it. Scientifically, herd theory says that vaccinating children will give you the most resistant population. After a few years of vaccinating most (female) children, we should start to see some sizeable future $avings from fewer people seeking treatment for this cancer.

Your citing of the 3,700 deaths is somewhat disturbing. That is only in the US and to suggest that we shouldn't be thinking about a response is just irresponsible. This vaccine was tested and approved by the FDA. We expect the government to respond to looming health threats and other dangers. We spend millions of dollars on less common and less deadly diseases.

And just like we expect the government to respond to health concerns, the government expects us to behave responsibly. I did research on this vaccine and then got out my checkbook and paid to get it. Even though I am not at risk now, I consider it my personal responsibility to do what I can to prevent getting it and possibly spreading it to others. The same way that I take vitamins and wash my hands to help prevent disease, I got this vaccine to prevent cervical cancer. My personal cost benefit analysis said that I was eligible for the vaccine now and that a couple hundred dollars was way less than the cost of getting the disease. One less thing to worry about.

I kind of feel like someone breaking the news that there's no easter bunny, but most kids who are 10 years old will be engaging in practices that spread HPV, herpes and all sort of other nasties within 5 years. A good portion of those will be within 3 or 4 years. That's why the vaccine is a good idea. The fourteen year old who is sexually active, even if they aren't having intercourse, is less likely to practice safe sex, which only partially protects against STIs like HPV.

Your argument contains a lot of hyothetical "what if" statements. The truth is, this vaccine offers good protection to the most common strains. I hope - and am confident - that it will improve as it's developed to cover more strains, or to last longer. For now, it's the best we've got.

Prevention costs less than treatment.

Not that it isn't worth doing, but the cost-benefit analysis needs to be calculated with 11,000 people, not 3,700, and Xando has a good point that because it is a communicable disease you also need to look at the benefits of reducing its spread in the long run not just saving 3,700 lives.

Most people who do a personal cost-benefit analysis and can afford to vaccinate probably will, so I guess the argument against not making it mandatory is probably just so poor people can have the freedom to decide to do it or not?

You can be a virgin. If your partner is carrying HPV, then you're at risk of contracting it. Trying to palm this off as "only the promiscuous get it" is just as naive as the claim that "only gays get AIDS."

. . . how much does treatment for cervical cancer cost?

the ~$50 billion we spent on Iraq to fund immunizations. We could have left overover and potentially begin healthcare insurance.

$180 billion for 2008 alone for Iraq and Afghanistan, don't know how it is split, but at least 125 billion for Iraq.

Plus, treatment for cervical cancer costs a lot.

lissa:

If 1% has cancer, which is high, that is 3 million people and $180 billion? One billion is a 1000 millions. Think there is enough for 3 million women? $10 billion ought to do.