At a press conference to mark European Immunisation Week on Thursday, health director general Ray Busuttil explained that an immunisation programme against the human papilloma virus (HPV) – a sexually-transmitted disease that causes the lethal cervical cancer – was not the ultimate solution, as other methods of prevention were also available, including screening.
The incidence of cervical cancer in Malta is not considered particularly high, with an annual rate of infection of 2.5 per 100,000 women – well below the European average of 10 per 10,000.
But unless the disease is detected and treated at its earliest stages, it is nearly always fatal. The World Health Organisation maintains that chances of contracting this type of cancer would be greatly reduced with the introduction of a national immunisation programme. Many European countries like Germany, Italy, France, Austria and Sweden have already introduced an HPV vaccination as part of their national free health programmes (see table).
Like the United Kingdom, Malta has so far adopted a more cautious approach, awaiting the results of further testing of the two products currently on the market: Gardasil, developed by Merck Ltd; and Cervarix, developed by GlaxoSmithKline. Both drugs claim to be 100% effective against at least four of the HPV strains known to cause cervical cancer.
Not everyone, however, is enthusiastic about placing the new drugs on the national health programme. In some countries – notably the USA – there is an increasingly vocal lobby group which opposes mandatory vaccination programmes against HPV on purely moral grounds, arguing that an immunisation drive will also encourage promiscuity among girls as young as nine. Such groups advocate abstinence campaigns of the kind endorsed by US President George W. Bush.
Even without the morality argument, there are hefty financial considerations to take into account. Immunisation involves three separate injections costing around Lm60 (€150) a shot: not including additional expenses such as diagnosis, doctors’ fees, etc. A local national vaccination programme of the kind in place in Italy would involve an estimated 5,000 immunisations a year (for both boys and girls), amounting to an annual recurring expenditure of over €2 million.
For these and other reasons, the local health authorities are currently monitoring the situation in the UK, which has yet to conclude its own testing programme on the available vaccines. The UK is Malta’s major pharmaceutical supplier, and whichever drug is chosen for its own NHS programme would automatically result in a drop in price, making the product considerably more affordable than its competitor.
Another issue hovering in the background involves the exorbitant costs of public health in general. One source within the local medical profession told this newspaper that the health authorities need to first address the problems of “wastage” at hospital and public clinics before embarking on any expensive immunisation programmes. Cutting out wasteful practices (for instance, by reducing the quantity of free drugs dispensed at hospital) could drastically reduce our national recurring expenditure on health, making any immunisation programme more viable.
But while the national health authorities have chosen to bide their time, at least one of the two vaccines – GSK’s Cervarix – is already available on the local market. In recent weeks, local agent A. Gera & Sons launched a multi-pronged advertising campaign aimed at raising awareness about the availability of vaccine, with billboards and newspaper ads urging the public to “Be Smart – Think Vaccination”.
The campaign has been careful to present vaccination as one of a number of methods to reduce the risk of infection, alongside screening and Pap tests. But as long as the HPV vaccination remains unavailable on the local schedule of free services, immunisation in Malta will remain a costly affair.
(Questions sent on Thursday to parliamentary secretary Joseph R. Cassar remained unanswered by the time of going to print.)

rvassallo@mediatoday.com.mt