Uptake of the human papillomavirus (HPV) vaccine among the private medical profession has been dismal, leading to unnecessary deaths every day, according to Johannesburg gynaecologist and obstetrician, Dr Peter Koll.
“Penetration into the target patient population has been huge elsewhere in the world – up to 80% in some European countries. In SA, it is certainly under 5% and probably as low as 2%,” he said.
Considering that one in 20 women in this country who receive the HPV vaccine will be saved from cervical cancer, the second most prevalent cancer among women in SA, Dr Koll finds it hard to understand the lack of will among private doctors to protect their patients from the disease.
“It is unrealistic to expect the state to spearhead vaccination against a disease that will only present in 20 years time, when it is already financially strapped and overburdened by treating diseases that are happening right now,” he pointed out. “But private doctors don’t have the same constraints.”
“What I find alarming, is the lack of awareness and misconceptions among doctors in the private sector. There are still doctors who are telling patients that if they are not promiscuous, they don’t need the vaccine, which is absolute nonsense. Women don’t have to be promiscuous, they don’t even need penetrating intercourse, they just need close sexual contact with one person who’s carrying the HPV virus and they are going to get it. Everybody needs the vaccine, not just the promiscuous.”
Angela Ferguson, founder of an organisation called ‘Dance for a Cure’, which raises funds to vaccinate disadvantaged children against HPV, says there also is a perception among many doctors that HPV is only a disease that affects poorer, rural communities.
This, too, is nonsense, according to her. “The person who inspired me to start this project, a friend who died from the disease, was an upmarket woman from Sandton. Most Johannesburg gynaecological practices will tell you that they see at least one case a day.”
Some predominantly Jewish practices are also guilty of lethargy in the fight against cervical cancer, she said, because circumcision has been shown to provide some protection against the virus.
Ferguson targets the corporate sector for donations, which she used to vaccinate some 500 children in Johannesburg and Durban since commencing with the project in 2009. Netcare has just donated 100 vaccines and she hopes this will spur other groups to follow suit.
Dr Koll continued: “It’s a fight that must involve numerous roleplayers: private sector doctors and schools, as well as pharmaceutical companies and the broader commercial sector, through their corporate social investment programmes.
“I’d like to see the medical schemes covering the cost of HPV vaccines. I’d also like to see pharmaceutical companies supplying on government tender at a vastly reduced price. From what I’ve seen, the suppliers of both Gardasil and Cervarix, the only two registered vaccines in SA, would be ready to chip in their portion.”
Dr Koll said the most important thing to realise is that the vaccine is most effective in young girls, pre sexual debut. “The ideal age is probably around 10, so that they are well covered by the time they become sexually active.”
While a national school rollout programme would be the ideal goal, lack of funding currently makes this impossible, although vaccination programmes in private schools would be more feasible. Active vaccination campaigns for boys and girls at between the ages of 10 and 14 years old should be implemented in schools that can afford it, he said.
HPV causes male head and neck cancer
“What is not very well known is that HPV vaccines also protect against head and neck cancers in males, which are increasing globally, in addition to penile and anal cancer. Indeed, in the UK, where all females aged 9-26 are vaccinated, projections are that within the next few years, the incidence of head and neck cancers related to HPV in males is going to exceed cervical cancer in females.”
Dr Koll acknowledges that in a busy GP practice, it would be impractical to expect doctors to spend 10 minutes with each patient explaining the benefits of being vaccinated against HPV. “But they could obtain information leaflets produced by both of the vaccine suppliers, and have their receptionists hand them out them to every patient who walks into their rooms. The practice nurse could then administer the vaccine to people who want it.
“What I would really love to see, and I do it just on a small scale in my practice, is for doctors to administer the vaccine at cost price. I don’t charge a consultation fee and I don’t charge a fee for administering it. But I do is ask the patient for a R100 donation, which I give to Dance for a Cure.
“A big GP practice could easily implement a service like that.”