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Dutch GPs are being urged to exercise restraint in the face of increasing demand to vaccinate young girls against human papillomavirus—seen as the main cause of cervical cancer.
The Dutch Health Council, which advises the Dutch government on public health issues, is due to report by the end of the year on whether to include the vaccine in the national vaccination programme.
But Sanofi Pasteur MSD, which manufactures the new vaccine Gardasil, has launched an information campaign highlighting the dangers of human papillomavirus. This includes radio spots featuring a media personality and websites, including www.beschermjedochter.nl (“Protect your daughter”). Complaints have been made that this contravenes the ban on public advertising of prescription only drugs, but the company argues that it is only offering information on a medical condition.
Meanwhile individual gynaecologists have also taken initiatives to offer the vaccine. The Spaarne Hospital near Amsterdam has invited parents and children to information evenings. Haye Knipscheer, a gynaecologist, said, “We are proud to be the first in the Netherlands to offer this [vaccination] on a large scale.”
The Dutch College of General Practitioners, responsible for practice guidelines, has now, in response to requests from its members, issued provisional guidance. This guidance calls for a “restrained approach” in advance of the council's report.
Its guidance says that an “intensive marketing campaign,” aimed in part at the consumer, is “advising girls and boys to be vaccinated before they become sexually active.” This has resulted in many GPs, gynaecologists, paediatricians, and community care doctors regularly receiving requests for vaccination from patients.
The college acknowledges that Gardasil can prevent infection with human papillomavirus types 16 and 18, responsible for approximately two thirds of the 600 cases in the Netherlands each year of cervical cancer. About 235 women die from the disease each year.
But it argues that most girls do not run an “acute large risk” of infection with the virus. For those who are not sexually active the risk is virtually nil. Therefore delaying vaccination until the council makes its recommendation is, in most cases, unproblematic. This policy also avoids inequality, as the €400 (£270; $540) vaccine is not currently covered by health insurance.
The college's senior scientific assistant, Tjerk Wiersma, said: “There is a division of responsibilities in Holland. What should be included in the vaccination programme is a decision for the Health Council. We do not wish to anticipate their decision.”
The college is not against the vaccine but believes that questions about its long term effectiveness and cost remain for the council to answer.
A spokesman for Sanofi Pasteur MSD, Willem van den Oetelaar, said the college's advice differed from the position of the Association for Obstetrics and Gynaecology, which had recommended that vaccination against human papillomavirus should be included in the national programme.
Authorities in France and Germany have recently joined Italy and Austria in backing the vaccination, while in the United Kingdom the Department of Health is seeking advice from the Joint Committee on Vaccination and Immunisation.