Against Panel's Advice, Israel Health Ministry Chooses Cheap Cervical Cancer Vaccine

The ministry's tender committee gave the contract to GlaxoSmithKline's Cervarix vaccine because GSK's price was 10 percent lower than the bid submitted by MSD, maker of the rival vaccine Gardasil.

Dan Even
Dan Even
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Dan Even
Dan Even

The Health Ministry recently awarded a tender for the purchase of cervical cancer vaccine that contradicted the recommendation of an expert committee.

The ministry's tender committee gave the contract to GlaxoSmithKline's Cervarix vaccine because GSK's price was 10 percent lower than the bid submitted by MSD, maker of the rival vaccine Gardasil.

But on November 22, the so-called Health Basket Committee - a panel of experts that recommends new treatments to be covered by the national health insurance program - discussed the two vaccines and gave Gardasil a higher rating, of A8-A9, compared to Cervarix's rating of A8. As a result, health professionals expect MSD to appeal the tender results.

Various studies have found that Gardasil is effective against four different strains of the papilloma virus, which causes cervical cancer. But Cervarix, which has been on the market for a shorter time, has so far been proven effective in long-term studies against only two strains of the virus. Most Western countries use Gardasil in their national vaccination plans, and even Britain, which began using Cervarix in 2008, switched back to Gardasil a year ago. Local gynecologists are therefore outraged over the tender committee's decision.

Moreover, the Health Basket Committee is supposed to submit its final conclusions only in late December or early January - meaning the ministry issued its tender without waiting for the panel's final recommendation on whether the vaccine should even be included in the national health insurance plan. Neither vaccine received the panel's highest rating, A9, which goes to the treatments considered highest priority for inclusion. But under the terms of the tender, the ministry is obligated to purchase at least one year's supply of the vaccine even if the committee decides against including it.

A senior Health Ministry official said the decision to publish the tender before the committee issued its recommendations stemmed from economic reasons: Forcing the rival vaccine makers to bid against each other probably resulted in a lower price than the ministry would get by negotiating only with the provider ultimately recommended by the panel, and that would free up money for including additional treatments in the national insurance program.

Moreover, the ministry's advisory committee on vaccinations recommended adding cervical cancer vaccine to the list of those subsidized by the state back in 2007 to bring Israel's vaccination program in line with those of other Western countries. But even though all the other vaccines the panel recommended as part of that effort have been added to the list, the cervical cancer vaccine still hasn't.

The ministry plans to purchase 180,000 doses of cervical cancer vaccine a year, to be administered to some 60,000 girls in eighth grade. Eighth-graders are the target because the vaccine is more effective when administered before a girl becomes sexually active.

According to ministry data, between 129 and 172 Israeli women are diagnosed with cervical cancer every year, and the mortality rate is almost 50 percent.

The Health Ministry said in a statement that most Western countries publish a tender to decide whether their vaccination programs will offer Gardasil or Cervarix, as economic considerations are part of every decision-making process, including on health care.

"The vaccine is meant first and foremost to prevent precancerous symptoms and cervical cancer, and it must be stressed that the efficacy of both vaccines for these purposes is identical," it added. "The difference between them only relates to preventing [genital] warts" - for which Gardasil is more effective.

However, it said, the tender does not mean the vaccine will actually be included in the national health insurance program: That will be determined by the Health Basket Committee's recommendations.

The Gardasil vaccine.Credit: Bloomberg
A central laboratory at a health maintenance organization, Jan. 9, 2012.Credit: Moti Milrod

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