HPV vaccine cost, hurdle to access medicare in Nigeria

With just a handful of Nigerian women going for cervical cancer screening and vaccination in the country, more women are at risk of dying from Human Papillomavirus (HPV), the most common sexually transmitted infection affecting sexually active women at some point in their lives.

While nearly all cervical cancers are caused by HPV and 8 out of 10 of cancer of the anus are linked to HPV, this development has raised concerns from stakeholders following 2013 data by ICO Information Centre on HPV and Cancer which showed that  47. 72 million women in Nigeria aged 15 years and older are at risk of developing cervical cancer.

Cervical cancer ranks as the second most frequent cancers among women aged between 15 and 44 years of age in Nigeria. As cancer vaccines are designed to boost the body’s natural ability to protect itself through the immune system from dangers posed by damaged or abnormal cells such as cancer cells, the cost of accessing HPV vaccines (either the bivalent vaccine/ quadrivalent vaccine) is out of the reach of those who that live less than $2 dollars a day.

BusinessDay investigation reveals that while both vaccines are available in the country, the bivalent vaccine which is more widely available costs about $50 (N8,000) while the quadrivalent one costs about $100 (N16,200), exclusive of cost of giving the shots or doctor’s charge.

“The drug company price for either vaccine in the United States is about $130 per dose. This cost does not include the cost of giving the shots or the doctor’s charge. The drug companies have reduced the price of both vaccines to about $5. This is already being implemented in 8 countries namely: Kenya, Ghana, Lao People’s Democratic Republic, Madagascar, Malawi, Niger, Sierra Leone and Tanzania,” Abia Nzelu, executive secretary, Committee Encouraging Corporate Philanthropy (CECP-Nigeria), said.

She continued: “The bad news is that Nigeria is not a beneficiary of the price reduction. The federal, state and local governments of Nigeria should do more to ensure that Nigerians benefits from this price reduction.”

The need to lower the price for HPV vaccines to enable millions of women access medicare comes as a new report from a Working Group convened by the International Agency for Research on Cancer (IARC)  and United States National Cancer Institute (NCI) shows how the evaluation and licensing of prophylactic HPV vaccines could be significantly accelerated.

The report entitled ‘Primary End-points for Prophylactic HPV Vaccine Trials’ provides a series of technical recommendations for clinical efficacy trials.

“Being able to evaluate vaccine efficacy at an earlier stage can lead to faster approval and  implementation, providing major public health benefits,” Christopher Wold, IARC Director said.

Currently, there is considerable interest in conducting additional clinical trials of prophylactic HPV vaccines.

“These recommendations could help reduce the cost and duration of clinical studies and  facilitate research in important areas, such as reducing the number of doses of the current vaccine, or evaluating new vaccines similar to those already licensed,” Rolando Herrero, head,  Prevention and Implementation Group at IARC stressed.

A cursory look at HPV vaccine show that eight countries- Ghana, Lao PDR, Madagascar, Malawi, Niger, Sierra Leone, Kenya and Tanzania- are benefiting from access to a sustainable supply of HPV vaccines for $4.50 per dose from Global Alliance for Vaccines and Immunisations (GAVI) as at mid-2013.

The same vaccines can cost more than $100 in developed countries and the previous lowest public sector price was $13 per dose. HPV vaccines are primarily available as part of routine immunisation to girls in relatively wealthy countries as few women have access to screening and treatment in low-income countries.

“A vast health gap currently exists between girls in rich and poor countries. With GAVI’s programmes we can begin to bridge that gap so that all girls can be protected against cervical cancer no matter where they are born. By 2020, we hope to reach more than 30 million girls in more than 40 countries. This is a transformational moment for the health of women and girls across the world. We thank the manufacturers for working with us to help make this happen,” Seth Berkley, CEO, GAVI Alliance said.

Since GAVI began accepting applications for HPV vaccines support in 2012, it has received unprecedented demand, with 15 countries applying and a further 15 to 20 expected in 2014.

UNICEF as procurement partner for GAVI Alliance have run a public tender process expected to purchase HPV vaccines from Merck & Co. at $ 4.50 per dose and from GlaxoSmithKline at $ 4.60 per dose for the award period, 2013-2017. 

Merck has agreed to extend significantly lower prices to GAVI if total volumes increase in the future.

Alexander Chiejina