[Update from earlier post thanks to insightful comment]
The government has decided that it is not worthwhile to vaccinate all 12 year old girls against cervical cancer (click here). Tony Abbott has decided that that is enough for him and he wont be paying for his daughters to be vaccinated. The reason given was some uncertainty over the effectiveness of the vaccine and whether a booster would be needed. However, other countries are hopping in so the Australian decision is strange.
I have blogged on this before (click here) but the way to think about the cost is not in terms of how much we are spending per life saved ($126K on the latest figures) but instead how much each of us would spend to know that our daughters would be protected from this type of cancer. That turns out to be $1.73 per year. [FYI: I take the $625m in the news report for the costs of this over the first four years and divide it by 18 (for the 4 cohorts of 12 year olds and single cohorts of 13-26 year olds) and divide through by 20m.]
So what Tony Abbott is saying is he would not be willing to pay $1.73 per year for this treatment. And he thinks the current news report makes him look like “a cruel, callow, callous, heartless bastard”!
Core Economics 
The $650M is actually to vaccinate 12-26 year-olds. So, you should divide by 18, not 8. So, it’s $1.73 per cohort per Australian.
As I commented last time (and Gillard says in the article), the issue isn’t the cervical cancer vaccine’s efficacy on its own, but rather its efficacy in comparison to. current preventative methods (e.g. pap smears and condom use.) The economic argument is much stronger if the vaccine removes the need for pap smears and much weaker if it doesn’t.
As for the ‘peace of mind’ argument, the issue is whether current approaches already give sufficient peace of mind. (Maybe Abbott is confident that his daughters will use condoms! Although those particular daughters have good cause to think that pregnancies are more likely to come from condom use than withdrawal.)
But, anyway, I don’t think the behaviour of other countries is sufficient grounds to declare the PBAC decision strange. Big Pharma plus women’s health is a powerful lobbying combination, but not one that has a monopoly on making the right judgment calls about subsidising a new vaccine.
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Although condoms are highly effective for preventing the transmission of other sexually transmitted diseases (STDs), recent studies have concluded that condoms only offer partial protection, at best, against the transmission of genital HPVs (Holmes 2004; Winer 2006)
Pap smears merely detect the cancer, so then you have to deal with it.
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Thanks Jeremy. I have updated the post accordingly.
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Josh (not Joshua), Wikipedia’s take on Winer’s study is a little harsh. I think “at best” is pretty unfair when the drop in HPV transmission is of the order of 60% for the experimental group compared to the control and 100% for ‘lesions’ (which are what become cancerous.) The obvious downside of condoms is failure to use them or use them properly. To an extent, the case for the cancer vaccine is built on its once-off nature; pap smears and condoms require repeated sound decision-making (and not just by women: there’s women’s partners and the lab drones who process pap smears to think about too.)
As Joshua observed, the cervical cancer vaccine may not always work either. That’s why I keep raising the question of whether the vaccine will replace or supplement pap smears as a method of stopping cervical cancer deaths. Of course, pap smears don’t prevent HPV or cancer. Rather, they are an essential first step in preventing deaths if the vaccine or other HPV transmission preventative methods fail. Joshua earlier wrote that 260 Australians die every year of cervical cancer. But if all or nearly all of those were people who didn’t get regular pap smears, then maybe that’s where we should focus if we want ‘peace of mind’ (albeit probably not value for money, given that the current regime for pap smears must be pretty damned costly.)
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Tony Abbott no doubt thinks his daughters will not need condoms: abstinence except for deliberate attempts at procreation. And, what’s right for Abbott’s daughters (because, you know, they will surely follow dad’s policy), must right for all Australian girls.
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I don’t undersand. If everyone would be willing to pay to get their own daughters vaccinated, what is the case for the government subsidising it? That means we have to bear the deadweight loss of taxes needed to finance the mass vaccinastion. Its far cheaper for society just to pay directly for our own daughters. still, if you want to help me out Joshua, thanks a lot.
Also it seems clear that the Government is trying to get the price down.
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Because you have to pay $400 a dose if it is not subsidised, you know like all other drugs that aren’t subsidised. We subsidise it because this allows the government to do a deal with the pharmco on a volume basis; reducing the cost considerably.
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Okay, I see now. But why then are you criticising them for their negotiating tactics which are trying to do exactly that?
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