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Experts meet on cervical cancer vaccine

LONDON - Experts met in London Tuesday to discuss how to make a cervical cancer vaccine available to women in poor countries who need it most. The two-day meeting was being attended by some 60 representatives from public health agencies, pharmaceutical companies, non-governmental organizations and philanthropic foundations to try to accelerate the developing world's access to the vaccine.
Merck & Co.'s Gardasil is the first licensed vaccine, and among the places it is available are the U.S., Europe, Canada, Australia and New Zealand. GlaxoSmithKline PLC is expected to file for approval of its vaccine, Cervarix, next year. Both vaccines protect against two types of the human papillomavirus, or HPV, which cause 70 percent of cervical cancers.

While the HPV vaccine has been hailed as a breakthrough in cancer prevention, its price — $360 for a three-shot dose — puts it out of reach for the developing countries where more than 90 percent of cervical cancer occurs.

Last year, more than 500,000 women worldwide were diagnosed with cervical cancer, which is usually fatal if untreated. It is the second-most common type of cancer in women.

"With a technology like this vaccine, the world has a moral obligation to make sure it reaches the women who need it," said Dr. Nothemba Simelela, a senior official at International
Planned Parenthood Federation.

Public health officials are working with pharmaceutical companies to strategize how women in developing countries might get vaccinated as quickly as possible.

"We would be prepared to subsidize the price in the short term, if in the long term it became affordable," said Dr. Julian Lob-Levyt, executive secretary of the GAVI alliance, a global partnership that buys vaccines for poor countries.

He said the alliance must first examine whether the HPV vaccine would become a priority purchase — and whether GAVI might have the funds to then buy it in large amounts.

That decision, Lob-Levyt said, will only come once more data is available from vaccine trials in poorer countries. To date, the HPV vaccine has only been tested in the West, and it is not known exactly what kind of impact it might have in developing countries, as well as what kind of social barriers might exist.

Screening and treatment programs in the West have saved the lives of millions of women from cervical cancer, but the diagnosis remains essentially a death sentence in poor countries, which don't have the resources for such programs.

"They have nothing at the moment," said Dr. Lutz Gissmann, a virologist at Germany's DFKZ Heidelberg who is working on a cheaper, bacteria-based HPV vaccine, which would be one-tenth the cost of commercial vaccines.

While there are a few second-generation HPV vaccines in development, none have been tested in humans. One vaccine under consideration at the Johns Hopkins School of Medicine may offer wider coverage against more strains of the human papillomavirus. And another being researched in Switzerland will hopefully protect not only against cervical cancer, but typhoid as well.

It will be years before any of these candidate vaccines proves successful enough to be adopted widely. The lag time between the discovery of a new vaccine in the West and its implementation worldwide, which often coincides with development of a cheaper version of the original, has typically been at least 10 to 15 years.

In the case of the hepatitis B vaccine, which fights liver cancer, it took two decades before the vaccine was widely available. First produced in the U.S. at a cost of $18, it is now churned out in Indian factories for as little as 30 cents a dose.

Some experts believe poorer countries should be developing their own vaccine manufacturing capabilities.

"By flooding the market with cheap vaccine, countries can cut the price of a vaccine substantially," said Dr. John Schiller of the U.S.
National Cancer Institute

By MARIA CHENG, AP Medical Writer

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