British Medical Journal
19 February 2011 Volume 342, Issue 7794
http://www.bmj.com/content/current

Features
Vaccines: Global HPV vaccination
Sophie Arie

[Initial article language]
Most deaths from cervical cancer occur in countries without the resources to screen, treat, or vaccinate against the disease. Sophie Arie explores what’s being done to make HPV vaccination available to low income countries

In roughly five years since they arrived on the market, vaccines against human papillomavirus (HPV), which causes cervical cancer, have been rapidly and widely adopted in countries that can afford to do so.

The United States and much of Europe have introduced vaccines for school age girls in addition to existing well established screening programmes for women. The vaccines—Cervarix, made by GlaxoSmithKline (GSK), and Gardasil, made by Merck—protect against the most common types of virus, which cause around 70% of all cervical cancers, but they are among the most expensive of all vaccines. Both companies say their prices reflect a major investment in research and development and relatively complex manufacturing processes. Pricing varies from country to country but the current price in the US for a three dose course of Cervarix is a little under $300 (£187; €222) for government health service providers and close to $360 for private healthcare providers.

In the developing world, however, the situation is very different. Nearly 530 000 women each year develop cervical cancer and 275 000 die from it. 2 More than 85% of those deaths occur in low and middle income countries, where cervical cancer is the most common type of cancer in women, but screening is usually available only to women who can afford it privately, and where there is little or no capacity to treat the disease, let alone the resources to invest in a vaccine.

More than 60% of women who contract the disease in the developing world die of it because of late detection. According to the World Health Organization, if current trends continue, the …