The Current Unavailability of the HPV Vaccine – When Money is Worth More Than Your Life

Complex issues slow the supply and distribution of a cancer-preventing vaccine

Story and photos by Ashlie Doran

A vaccination is all that is needed to save the lives of thousands of women from a cancer caused by the human papillomavirus (HPV), a sexually-transmitted disease that is spread through genital contact. However, it is nearly impossible to find a medical facility willing to offer the vaccine in the local area, or in most areas of New York State.

HPV is the most common sexually-transmitted infection in the United States, according to the U.S. Food and Drug Administration (FDA). About 6.2 million Americans become infected with genital HPV each year and more than half of all sexually active men and women become infected at some time in their life, according to the Centers for Disease Control and Prevention (CDC). The number of new cases of cervical cancer attributed to HPV is about 9,710 every year, and it kills about 3,700 women in the United States every year.

“It's a real shame that cost can be a barrier to health needs.”

Luckily, not all strains of HPV lead to cervical cancer. There are over 100 different strains and types of viruses identified as HPV. Both males and females can acquire the STD. However, women face greater biological risks than men. The “high risk” strains of HPV can lead to cervical cancer for women, and genital warts can also result for both men and women. The HPV vaccine protects against four “high risk” strains of HPV. For most other strains, a person's body fights the virus itself, while displaying no symptoms.

It is important to note that this STD is not preventable by condom use. The virus is transferred sexually through skin-to-skin contact. While condoms prevent an individual from acquiring diseases spread through vaginal and seminal fluids, it cannot prevent all genital contact that occurs between a potentially infected individual and their partner during sexual intercourse. This makes the vaccine the strongest line of defense against the risks associated with HPV.

The U.S. Food and Drug Administration on June 8 licensed the new vaccine for cervical cancer prevention caused by certain HPV strains.

However, many local health professionals are currently not offering the vaccine because they cannot make a profit from it. Therefore, the second leading cause of death for women, cervical cancer, will kill thousands more, while millions are left at risk--a risk that could have been prevented by a series of three shots costing approximately $360. Most insurance companies won't cover the cost, and according to Clinton County health officials, many local residents can't afford the vaccine on their own.

Therefore, they must wait for Merck, the maker of the vaccine, to drop the price. Or they must wait until insurance companies cover all or part of the cost. This could happen once demand increases; therefore, supply would increase and the price would likely drop, county health officials said.

Another roadblock to dispersal of the vaccine is that most nurses must wait for a "standing order," or permission, to administer the vaccine. Nurses will have the permission they need once the Advisory Committee on Immunization Practices (ACIP) create and publish official recommendations for the HPV vaccine. As of September 14, the HPV vaccine was discussed at the ACIP meeting. However, no official vote was taken for their recommendations of the HPV vaccine.

The office of Dr. Usha Saha, MD, Obstetrics & Gynecology, gave the vaccine to one patient in early October, according to an employee. However, because the patient's insurance company was only paying about 60 percent of the cost, the office was considering not offering the vaccine until the insurance companies cover the complete cost, said the employee.

Representatives from most local medical facilities surveyed said the vaccine will not be offered until these changes are made. The Clinton County Health Department, Champlain Valley Physicians Hospital, Northern Adirondack Planned Parenthood, Plattsburgh Pediatrics, and many others in the area are not offering the vaccine at this time. This seems to be the trend across the state. Representatives from each facility said they hope to offer the vaccine in the future.

The Student Health Center at Plattsburgh State University College's campus will not be offering the vaccine because it is too costly, said Becky McCasland, a registered nurse on staff.

Nearly half of those infected with HPV are aged 15 to 24-years-old, according to the CDC, so local and national health officals think it could be beneficial for college age women to have access.

“If I knew that there was a vaccine to prevent cervical cancer caused by HPV and where it was available, I would get it, as long as it wasn't too expensive," said Lena Kohlmaier, 21, a junior at PSUC. "If I didn't get the vaccine and then I got the cancer and died when it could have been prevented, my parents would be upset it cost so much.”

McCasland, the mother of two teenaged daughters, said she advises other mothers to immunize their children because it is “a way to eliminate one more risk.”

Nonetheless, in today's world, if you don't have the money, it may kill you. Currently, private doctors' offices are willing to give the vaccine--if the full cost of the vaccine is paid by the individual. The vaccine costs $119.75 per shot and three shots are needed for a total cost around $360, according to the CDC. This does not include other fees if you go to a private medical facility.

“It's a real shame that cost can be a barrier to health needs,” said Martha Stahl, Public Relations for Northern Adirondack Planned Parenthood. “Healthcare needs to be available for everyone at a cost they can afford.”

Physician's Assistant Danielle Baker of Plattsburgh Pediatrics said of the cost barrier, “It's sort of an eternal problem in medicine. It's not the best. Unfortunately, it is how it is.”

The CDC reports that cervical cancer disproportionably affects women of lower socioeconomic status, who are often without insurance or regular access to health care.

It most certainly is a class issue, said Tim Palmers, a representative of the Clinton County Health Department. “Welcome to capitalism.”

Do you plan to get the vaccine? Will you encourage loved ones to get it?

Facts about the vaccine

The vaccine is recommended for girls and women aged 11 to 26-years-old. However, many pediatric medical facilities believe that administering the vaccine to girls from age 9 to 11 is the best. The vaccine can be administered to those who are sexually active. However, giving the vaccination before the onset of sexual activity is most desired.

A men's vaccine is in research and development.

It is delivered intramuscularly. This means a larger needle is used, and it is administered to a large area of muscle. The vaccine is given in a series of three doses over six months. The shots are given at a zero, two, and six month interval. Vaccinated individuals are protected from the virus for five years. The vaccine does not contain the HPV virus, according to the FDA. Booster doses are not recommended at this time.

Those who have allergic reactions to yeast should not receive the vaccine. An individual's doctor should be informed of all allergies. Pregnant women are also discouraged from receiving the vaccine.

Cervical cancer screenings are still encouraged because not all types of HPV that cause cervical cancer are prevented by this vaccine. Condoms are still strongly suggested to protect against other STDs.

Women should schedule Pap smears regularly. There are no outward signs that a person may have HPV, unless they've contracted the type that causes external genital warts. Consult your doctor if you notice any irregularities.

One Woman's Voice

By Holly Boname as told to Ashlie Doran

I was in a relationship with my partner for two years. He was the only person I had sex with in Plattsburgh. After we broke up, I had an appointment with my OB/ GYN [Obstetrician/Gynecologist] for a yearly check-up. I was shocked when they called me back two weeks later to tell me that they had found mutated cells on my cervix and they needed to do further tests. They explained to me I had contracted HPV from my partner and it had developed into cervical cancer. I ended up in the hospital for surgery, missing school and depressed.

I did not know about HPV prior to this. Education past the embarrassing commercials needs [to happen] at a younger age. I had no clue [about this STD] until I was 20. That is not acceptable. Testing for HPV should start when OBGYN visits start (generally when a person becomes sexually active).

I want women to be aware of [how common HPV is]. Watch your bodies.

Holly Boname, 21, is a senior majoring in photojournalism at PSUC.