Thursday 14 November 2019

There's a lot to learn from cancer vaccination saga

This long overdue cervical cancer plan will save lives -- but many will miss out, writes John Crown

The decision by the Minister for Health and Children to introduce a national cervical cancer vaccination scheme is welcome. The majority of cases of cervical cancer are caused by a virus, and vaccination provides a high degree of protection.

Sometime in approximately 2022 we will see a decline in the incidence of cervical cancer, and a subsequent fall in the death rate. Approximately 80 per cent of the 100 or so deaths that occur annually from this disease in Ireland will be avoided.

Importantly, approximately 100-200 other women will avoid the surgery, chemotherapy and radiotherapy that would otherwise be used to cure their cancer. Thousands of others will be spared the mental agony of recalls over borderline smear tests, and of biopsies. The State will be spared millions of euro in future health care costs.

Sadly, some number, in truth probably small, of the girls who were not vaccinated following the minister's earlier decision to cancel the program will develop this disease and some may die. Even at this stage, a call-back program could undo much of this harm.

This decision to rescind the vaccination program was greeted with a justifiable public outcry. In attempting to justify the cancellation, the Government quoted the new screening program for cervix cancer which was then being introduced (er, congratulations -- the screening test was invented in 1955). Screening is good, but prevention is far better and much more cost effective. A government TD argued against vaccination on safety grounds. Another, Dr Jim McDaid, made the brave decision to put loyalty to citizens ahead of loyalty to party and resigned the Fianna Fail whip on this issue of principle.

It was obvious that, in addition to the humanitarian concerns, it was bad economics.

A modest investment in prevention then would save millions later.

As I pointed out in 2008, the cost which was being quoted at the time of the cancellation (e12-16m purchase cost) bore no resemblance to reality. It was based on the recommended purchase price for a single dose by a GP. Any graduate of 'Public Procurement 101' would know that national bulk-buying results in colossal price reduction.

Several public-spirited GPs (prominently James Reilly TD) knew this, and in fact negotiated cheap bulk purchasing costs from the companies to make the product (and their time) available gratis to their patients.

As there were two very similar products on the market made by rival companies, it should have been obvious that a tendering process could lead to a price war. Other countries had done exactly that.

In her recent announcement, Minister Harney reported her success in a process of negotiating the price down from e16m to e3m.

Already, Fianna Fail TDs are emailing constituents to trumpet the Government's success against the drug companies. If the story were true, and if the savings made were channelled into other life-saving health care initiatives, one could just about argue that the two-year delay, due putatively to predatory drug company pricing and not to poor public policy, might have been justified.

This, however, is not the case. The current tendering process which began in late 2009 was the first ever between the State and the companies for this vaccine. At the time the earlier decision was made to cancel the program, there had been no request for tender. The companies were in fact surprised that the decision to cancel had been made without their having being given the opportunity to tender a price.

No, the driver for the cancellation wasn't cool-headed health economics, but was, rather, panic over the public finances. The Government didn't spend two years driving a hard bargain, but in trying to understand something that was widely known -- that high-volume State purchasers have great bargaining power in multi-supplier markets.

The vaccine could have been available in 2008 at the same price as will be obtained in 2010. Two years of school girls have missed vaccination for nothing. Have we learned anything?

Professor John Crown is a consultant oncologist

Sunday Independent

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