Advanced nations around the world are protecting women and girls through public HPV vaccination programmes – but not Hong Kong. The government can score a big win with women or run the risk of accusations of dragging its feet to tragic results.
My daughter became a teenager last month and her sister is not far behind. All jokes aside, it presents my wife and I with an important healthcare question: Should we pay to have our daughters vaccinated against the HPV virus?
And in Hong Kong, why should there even be a question when, in most other advanced economies, it is part of the public health regime?
Human papillomavirus (HPV) is a sexually transmitted disease that causes genital warts – and cervical cancer. The new vaccines that have come on the market have proven effective and have been widely adopted as part of the standard regime for vaccinations paid for by governments in most developed countries. The Center for Disease Protection in the United States recommends it for girls and boys. Even though boys don’t have a cervix, they can be carriers and spread the virus. HPV can also cause penile, anal and other cancers.
Public health educators suggest the best time for this three-shot vaccine is before the age of 12 – before kids become sexually active. Of course, many conservative Hong Kong parents probably think like I do: my daughters will never have sex. In fact, they will get married and have children leading to grandchildren and, as a father, I’m quite sure no men will need be involved. Right?!
Get real – the cancer is real
Mothers are sometimes more realistic. Cervical cancer, the third biggest cancer in women worldwide, is no joke to them. Hong Kong is particularly prone to cervical cancer with a higher incidence rate than the UK, Canada, the US and Australia. The UK and Australia have government programmes to provide the vaccine free of change as part of the public vaccination programme. The US has widespread promotional efforts at the state level that see an uptake of over 53%.
The Hong Kong government’s Family Health Services web page on the issue lists “How can I get it” at the bottom and tells you to check with your doctor – and has a handy link to the section about cervical screening. Screening is still necessary as the vaccine prevents against most types (up to 70%) of cancer-causing HPV – not all types.
But it is clear that the government is not in the business of providing this vaccine. It gives out thousands of flu shots a year, but not HPV vaccines. Given the government’s concern about future healthcare costs, this seems odd.
The cost case
As a known advocate of free markets, this author may be expected to suggest that people should pay for their own vaccination if they will be better off for it. But with a public health system that is going to pay for the cancer treatment, vaccines are one of the rare, clear cut cases where government spending now can save government spending later. That is to say nothing of the untold human misery that can be prevented by promoting and administering HPV vaccines as part of a systematic public health programme.
If the cost-benefit and health benefit case is so compelling, the lack of action is puzzling. Some people are getting the vaccine while most aren’t. A 2013 study* using 2011 data surveyed girls and parents found only 7.2% had received the vaccine. Those who had not got it cited ignorance about the vaccine and cost as their reasons for not getting it.
Not exactly the 1%, but…
The health benefit gap should make the government very, very uncomfortable.
So who is getting protected? The same study shows that daughters of tertiary level educated mothers were twice as likely to have been vaccinated as those with less education. Another study**, shows that higher income is associated with higher acceptability to pay for the vaccination. Rates for private sector administration of the vaccine run from $3,000 to $6,000HKD, according to Amelie Dionne-Charest of AD MediLink, a consulting firm providing healthcare concierge services and health insurance advice to clients, typically high net worth expats, to make sure they can get what the government doesn’t provide.
One could see where this could turn into an issue to use against the government. The data, though not well-known (yet) shows the wealthy and well-educated are getting the benefit of a vaccine that could be easily and cost-effectively delivered through current vaccination programmes through schools. One could use that as a message to cast the government in an unflattering light.
On the other hand, it is a tremendous opportunity for the government to get a win in its column. By picking up public vaccination as a cause, it could show itself as caring towards women. While HPV can cause other cancers and afflictions, cervical cancer is the most prevalent and heavily (ahem, very heavily) skewed towards women. By promoting the vaccine through public schools, the government would show itself as caring, keeping up with modern nations, and delivering cost-effective programmes with an eye to the future.
Every vaccine administered today could save a woman in Hong Kong’s tomorrow. The government, rather than having a public relations disaster waiting to happen, could get a public relations windfall today.
*Li, Sophia Ling; Lau, Yu Lung; Lam, Tai Hing; Yip, Paul Siu Fai; Fan, Susan Yun Sun; Ip, Patrick HPV Vaccination in Hong Kong: Uptake and reasons for non-vaccination amongst Chinese adolescent girls Vaccine. Elsevier. Oct 19, 2013
**Choi, Horace C.W.; Leung, Garbriel M; Woo, Pauline P.S.; Jit, Mark; Wu, Joseph T. Acceptability and uptake of female adolescent HPV vaccination in Hong Kong: A survey of mothers and adolescents