Introduction

    HPV vaccines mainly act as prevention of cancer-causing infections and precancers. Since 2006, the effectiveness of HPV vaccines has increased, and infections that cause HPV cancers for teenage girls have dropped by 88% (HPV vaccine par. 9-10). However, in 2017, only about 66% of adolescents aged 13-17 received the first dose of the vaccine (Understanding HPV coverage par. 1). To determine the factors that influence the coverage -estimated percentage of people who have received HPV vaccines (VaxView vaccination coverage par. 2)- of the HPV vaccine, Professor Anna Beavis and Professor Kimberly Levinson analyzed 31,500 cases in the United States. The result shows that the main concern parents have is the safety problem, followed by its expensive price (Beavis par.8). Compared to the vaccine’s advantages in the prevention of related cancers, concerns may be dispelled through recommendations and data collected. Even though there was a failed coverage of HPV vaccines in Japan, pharmaceutical companies, the local and Federal governments, and insurances companies should cooperate by lowering market prices and messaging the vaccine’s potential to prevent cancers in order to make it more accessible in the United States.

Case Study: Japan’s Failure and Re-dissemination of HPV Vaccine

    In Japan, the financial support by the government on HPV vaccination was initiated in 2011, with recommendations introduced in April 2013. Although the vaccine’s effectiveness had been demonstrated and it was provided for free, the rate of vaccination remained low or continuously decreasing (Keiko et al. par. 1). Later, the Japanese media reported that the main concern about adverse effects led to public distrust. The study targeted 7-11th grade girls, and they were recommended to have a series of three doses. During the summer of 2012, about 65.4% of 7th-grade girls had received the HPV vaccines; however, the rate reduced drastically to 3.9% by 2013. The report concluded that the Ministry of Health, Labor, and Welfare’s suspension announcement (due to media reports of alleged adverse vaccination events) discouraged those parents to have their daughters vaccinated, concerning safety and side effects (Ueda par. 2-3). As a result, improved education about the benefits and importance of HPV vaccines is needed worldwide.

    From Japan’s failure to vaccinate all targeted girls, the need for public education on HPV vaccination is urgent. To successfully apply HPV vaccination in the United States, the local government should not recommend HPV vaccines to citizens at first, but send information about the vaccine and screening for cervical cancer along with past data for experimental and clinical tests. In this case, the public would be able to evaluate the importance of the HPV vaccine and thus reduce their safety concerns.

    Under suspension of the government’s recommendation in 2019, a local government in Isumi City, in turn, sent out a leaflet containing information on cervical cancer and HPV vaccine to all 139 girls who were born in 2003. The cumulative vaccination rate significantly increased from 1.44% to 10.07% by December 31, 2019 (Ueda et al. par. 12-15). Across the nation, less than 5.6% of the local government has ever sent a leaflet that contained only information and guidance on cervical cancer and HPV vaccine without recommendations. Although there existed the failure of vaccination coverage in Japan, the successful case in Isumi City suggests that sending leaflets could be introduced with adaptation in the United States. Therefore, the local government can persuade the targeted girls to be vaccinated through a more thorough education on the HPV vaccine’s importance in the prevention of related cancers.    

One of the Limitations - Price

    The HPV vaccine is one of the most expensive children’s vaccines, costing $360 to vaccinate one child against HPV. In comparison, other children’s vaccines cost less than $50. Fortunately, most large health insurance companies including Advisory Committee on Immunization Practices (ACIP) recommended vaccines, including the HPV vaccine, as a plan benefit (Gudeman par. 7-8). In this case, 55% of children covered with private insurance could get access to HPV vaccines. However, insurance coverage alone will not be enough to guarantee vaccine availability. Although some insurance companies covered the HPV vaccination cost, clinicians are unwilling to provide the vaccine through insurance because of high up-front costs. To meet the expected demand, private providers need to purchase 1,200 doses (costing $144,000) at first, covering all service delivery costs beforehand. Since the vaccine must be stored at a controlled refrigerated temperature, the up-front cost will include the purchase of a new refrigerator (James par. 2). As a result, clinicians are reluctant to provide HPV vaccines with high investment costs. Thus, the accessibility of HPV vaccines is limited by the high cost of HPV vaccines.

    To accommodate the problem, the Federal Government has an established mechanism for the federal program – the Federal Supply Schedule (FSS). A cross-analysis was conducted by the Medical Expenditure Panel Surveys (MEPS) from 2003 to 2006. With FSS, the government was able to set the price with pharmaceutical companies. The obtained information included all medicines available in MEPS. The result found that the potential annual savings would amount to $21.9 billion (Gellad et al. par. 18). This proves that price negotiation with pharmaceutical companies is feasible, based on the policy.

    Hence, the private insurance company should keep the coverage of high HPV vaccination costs; the Federal government may consider a subsidy for clinicians with the presence of positive externality as the benefit spills over to a third-party (Externalities par. 3) and price negotiation pharmaceutical companies to ensure HPV vaccination coverage of all targeted girls.  

Pharmaceutical Companies’ role in Vaccination Policymaking

    Dr. Mello (experimenter from Harvard School of Public Health) conducted a study to investigate the role Merck & Co Inc (a pharmaceutical company) plays in HPV immunization policymaking. The group interviewed 73 key informants who engaged in HPV vaccine policy and combined the data. Across all responses, the study concluded Merck’s role was mainly an informational resource to legislators and the public (Mello et al. par. 12). The company requested some specific policy strategies about Gardasil (HPV vaccine), providing alternatives to policymakers. In addition, Merck mobilized medical organizations and interest groups under considerable pressure of supporting those groups financially. Public officials also find pharmaceutical companies beneficial since they motivate potential patients to seek out the vaccine.

     In this case, the pharmaceutical company not only plays a role in negotiation with policymakers but provides the public with more information and availability. Thus, more pharmaceutical companies should engage in these practices to contribute to higher accessibility of HPV vaccination, resulting in higher vaccination coverage.

Conclusion

    Learning from Japan’s failure to vaccinate all targeted girls, the local government started to provide information about cervical cancer to educate the public about the importance of the HPV vaccine. The insurance company covering all costs of HPV vaccines decreases the main concern of high price; collaboration between the Federal government and clinicians will further prompt availability of vaccine provision. Pharmaceutical companies’ significant role in communication with policymakers and the public will benefit society with higher vaccination coverage. When all these improvements are recognized, the accessibility of the HPV vaccine would increase drastically, providing benefits for targeted patients in the prevention of cervical cancers. As a result, the public would recognize benefits of HPV vaccines, reducing concerns about safety with more thorough information.