a) Vaccination renders you immune to the viruses that cause cervical cancer and prevent you being infected in the first place – this is no ‘band-aid’. If we had an effective vaccine for HIV it would solve the problem, and possibly put us in a position to eradicate transmission of the virus altogether. In many cases vaccination is a one-off event (ok, an initial course of jabs anyway) and then the recipient is immune for life – cheaper, more convenient, and much more comfortable than a lifetime of cervical smears.

b) Cervical smears only work as surveillance if you attend for your appointments (as poor Jade Goody discovered) and even then there are interval cancers that can develop between smears. And this strategy effectively means monitoring a disease-in-evolution with regular smears and burning or chopping the offending bits out if they become too nasty – I would argue that preventing the disease in the first place is a much better strategy – and avoids nasties like cone biopsy and colposcopy as treatments.

Just a thought anyway.

These decisions are always difficult, and the maths involved is highly complex statistics which are influenced by the frequency of the disease in the population. I don’t know if anybody knows whether NICE made the right decision with the public purse. Shame they can’t reveal the costs – surely a FoI application should deal with that.

P

I think these are all good points, but I also think that Herpes/warts are actually one of the more difficult STIs to control with “protected sex” – what do we mean when we say that? Condoms? Warts are a difficult thing to completely protect yourself from even when using condoms, because they affect whole areas that a condom won’t cover – and what about when they are passed between women, who may not particularly have a use for condoms (depending on what they’re doing, of course)?

Personally, although I do take your point about big pharmas and the importance of education, I’d still welcome a vaccine. Dental dams for oral sex are an unglamorous ‘mare, and much more difficult to sell as useful and enjoyable than condoms. Genital-to-genital contact between someone who has dormant HSV (and may not even know it!) is also one of those things where even if you’re very careful, you run risks, and it’d be nice to cut those risks down.

In a world free of all kinds of expense limits, of course. Which isn’t this one. But I don’t think that vaccines are “less feminist”, necessarily – or that they would downsize the need for good sex ed in this country.

I do get the impression that Gardasil *and* Cervarix are being marketed out of all proportion as a “vaccine for cancer”. Which it isn’t, of course, there being no such thing. It seems to be being marketed more for this than for the much less marketable issue of warts, which while not life threatening, are really contagious, really unpleasant, and not curable on a viral level once contracted, only managed.

In developing countries, a case might be made because of high rates of HIV-associated cervical cancers and the difficulties with rolling out an annual screening program for women, say, in rural Africa. You don’t have the lab facilities, the technology to detect is inappropriate for rural clinics, the clinics themselves are inaccessible, there are cultural prohibitions that would deem PAPs invasive at best, immoral at worse.

But in developed countries, what is the need, really? When there are better measures – more feminist measures, measures that encourage being empowered to take care of your body?

I don’t know. But I have serious doubts that these vaccines rolled out in developed countries have anything to with anything besides making as much money as possible for GSK and Pfizer. They have to give these vaccines out at low or subsidized cost to African countries. The profit exists entirely in the developed world market. Hence, “a vaccine that prevents cancer!!!” for first world women. But we can really do better with what we already have…National public health systems should AUTOMATICALLY do annual screening because this detects a number of other reproductive health problems besides cancer. Because women, in fact, pay taxes or health insurance fees for this kind of work to be done. And insisting on protected sex is, indeed, an important part of taking back control of our bodies.

A vaccine is a band-aid, a quick fix. And a sure way to enrich big Pharma. But it doesn’t get at the root of the problem. And it doesn’t actually do a better job than what we already have got.

Thanks for this comment, it really made me think. Interesting stuff.

Marketing sexual health awareness is a tricky business. There’s this whole emphasis on birth control in a lot of sex ed (at least, in my experience!) without looking at STIs as a real issue – for me, at school they were a half-hour “add on” in which we learned that “gonorrhoea” was a word, along with some other words. And that condoms were the way to avoid these words. But nothing about HPV whatsoever.

I think the London chlamydia awareness campaign CheckUrself (https://www.checkurself.org.uk/) was the best SH awareness campaign I’ve seen yet.

Because this isn’t the case in the UK I suspect that the cost of Gardasil out weighed the benefits. There are lots of drugs that aren’t NICE reccommended for precisely this reason, and whilst its tough, its also necessary for the NHS to work.

The thing that always bugs me whenever any new vaccine that will prevent sexually transmitted disease, no matter how vital or lifesaving it may be, is that there is always someone out there saying it will encourage underage sex if we give it to kids. I just wonder to what extent the potential to avoid this odd moral/political point might factor into the NHS’ decision? “Oh no, we’re not giving them drugs to prevent genital warts, we’re giving them drugs to prevent cancer, it’s fine!” Might be the easier defence.

I expect the cost is more important, but it’s always struck me as somewhere between odd and despicable that people who claim to be speaking from a moral point of view are in fact encouraging the suffering of others through disease.

I may also be on a complete tangent.