Life and world

By Doctor Bibek Pradhan

The development of the vaccine to prevent cervical cancer is the most exciting recent event in the history of cancer care in the world. The vaccine has been universally approved by now and several developed countries have already initiated the national vaccination programme on girls.
The cancer of cervix has been recognized as number one cause of death amongst women in Nepal. Therefore this vaccine could prove to be most effective means of preventing this deadly disease in women in Nepal thereby preventing suffering and death.

The cancer of cervix is unique in the sense that it can be detected at precancerous stages through screening with Pap smear which could be treated locally and thereby prevent the development of cancer. In the developed countries the incidence of this cancer has been significantly reduced by national programme of screening with Pap smear whilst in Nepal this screening is very limited because of high infrastructure costs and lack of nationwide facilities.

Another important aspect of cancer of cervix is that it is invariably caused as a result of sexual relationship proved by the fact that it is rare in nuns and spinsters who have never had sexual relationship. Next significant factor is that women are vulnerable to a local infection by a virus called Human Papilloma Virus (HPV) which is transmitted through sexual relationship (STD) and millions contract it from early stages of sexual activities. This has led to the suspicion for a long time that cancer of cervix might be related to HPV and only in recent years scientists discovered through advanced DNA studies that HPV is definitively responsible for causing 70% of all cancer of cervix.

This discovery encouraged research and development of the vaccine to prevent the HPV infection and thereby prevent the cancer caused by HPV. Ultimately the company called Merck launched the vaccine called Gardasil in October 2005 followed by another company Glaxo whose vaccine is called Cervarix. Both vaccines are proved to be 100% effective in preventing HPV infection.

Immediately multinational trails were conducted including US, Canada, Australia, UK and EU countries on thousands of women and they all concluded that these vaccines are effective and are safe to be given under national vaccination schemes. Then online opinion research companies surveyed on thousands of physicians throughout developed countries and all those universally approved the vaccination against HPV and mandated their use for national vaccination programme to prevent cancer of cervix.

Any new vaccination has to be approved by national watchdog committees after rigorous tests. On 8 June 2006 the US Food and Drug Administration (FDA) announced the approval of Gardasil and declared that it was an important day for public health and women’s health in the prevention of cancer of cervix. Same time the UK National Vaccination Advisory Board recommended vaccination against HPV nationally. Last year almost all developed countries approved this vaccination and some countries have already started it. These are several US States, Canadian States and Australia. In UK the Government has announced that they would give free vaccination to all girls under NHS from next year. As the vaccination should be given before sexual activities these countries have decided to give vaccination to all girls at the age of 12.

For Nepal this vaccination could be ideal for prevention and death from cancer of cervix because of ease in administration and little infrastructural support needed. However the drawback is the cost of the vaccine. A single dose of Gardasil today costs $120 (NR.750 approx) and a course of three that needs to be given within six months will cost approximately NR.25000. Although the developed countries have no problem to afford such cost for national programme it is virtually impossible for Nepal.

However I was very encouraged to discover last year that Bill & Melinda Gates Foundation decided helping developing countries to buy vaccines and the Foundation has donated $27.8 million in January 2007 for vaccination in India and Vietnam in Asia, Uganda in Africa and Peru in South America through a charitable organization in US called PATH.

Two years ago Bill Gates spoke at the Live Aid Concert held in London attended by around 100,000 people when he said “you show the problem and you show the solution, people will be moved to act and success depends upon knowing what works and bringing resources for the problem. Someday all people, no matter where they are born, will be able to live a healthy life.” I was so impressed by this statement that I have actually been in touch with Bill Gates and he has personally approved to plagiarize this in my talks on what little philanthropic work I do for Nepal. This fact encouraged me now to look for a Grant from Bill & Melinda Foundation to buy HPV vaccine for Nepal.

In 2004 nine other Nepalese and I living in various parts of UK established an organization called UK Friends of Bhaktapur Cancer Hospital (UKFOBCH) with objectives to help cancer care in Nepal in general and Bhaktapur Cancer Hospital in particular and I am its present Chairman. We registered it under UK Charity Commission to initiate international projects involving Nepal. On 21 July UKFOBCH at its AGM decided to extend its objective to include preventive work on cancer in Nepal and decided to apply for a Grant from Bill & Melinda Gates Foundation to initiate HPV vaccination in Nepal.

In conclusion my purpose of writing this article today is to bring awareness of this exciting progress in prevention of cancer amongst the Nepalese communities, the organizations related to cancer and social services and women’s organizations. Awareness creates demands and demands bring resources. Someday soon rich and affluent people would be able to pay for the vaccine to prevent cancer in their daughters and we will keep on trying bringing resources for vaccination for the poor who are majority in Nepal.