HPV vaccination in Switzerland: where are we?

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

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Abstract

The Federal Commission for Vaccination recommended that every girl between 11 and 14 should be vaccinated against the Human Papilloma Virus and during the transition period also girls aged 15 to 19 should be included. Since the Federal Government has not yet decided whether to reimburse the vaccination, which costs around 700 CHF at present, until now only two cantons (Geneva and Valais) have decided to offer the vaccine free to all 7th grade girls as from now, limited to one year.

Purpose of health policy or idea

In the long term the objective is to reduce cervical cancer morbidity and mortality drastically. In the short and long term the aim is to reduce HPV transmission/infection and in the long term again to reduce the costs related to HPV infection and to cervical screening by Pap smears .

Groups affected

Girls between the ages of 11 and 19, Health insurers (who would pay the vaccine)

Innovationsgrad	traditionell		innovativ
Kontroversität	unumstritten		kontrovers
Strukturelle Wirkung	marginal		fundamental
Medienpräsenz	sehr gering		sehr hoch
Übertragbarkeit	sehr systemabhängig		systemneutral

An excellent job was done by the expert committee. The Public Health authorities of the cantons Geneva and Valais have made a courageous and scientifically sound decision. However, the Federal Government has been slow and somewhat irresponsible in their lack of decision regarding the integration of the HPV vaccination into the federal insurance benefit basket.

Political and economic background

Human Papilloma Viruses are the most frequent Sexually Transmitted Diseases. Up to 80% of the population will contract HPV infection over the course of time. Certain types of HPV will cause cervical cancer (500,000 new cases a year world-wide, which makes it the 2nd most frequent form of cancer in women after breast cancer). In 70% of the cases HPV16/HPV18 are involved.

In Switzerland the estimated prevalence of HPV16/18 infection is 1% in girls between the ages of 12-14, and 7-9% in young women aged between 16 and 25.

Each year severe cervical dyspasia is diagnosed in 5000 women. Over the past 30 years regular cervical screening by Pap smears has brought down cervical cancer incidence by 38%, with rather less than one hundred deaths yearly related to cervical cancer at present.

Purpose and process analysis

Current Process Stages

	Idee	Pilotprojekt	Strategiepapier	Gesetzgebung	Umsetzung	Evaluation	Veränderung/Richtungswechsel
Implemented in this survey?

Origins of health policy idea

A quadrivalent vaccine is registered and available in Switzerland (Sanofi-Pasteur MSD). The vaccine contains the L1 proteins of the HPV 6/11/16/18 capsids produced through molecular genetic procedures. Its immunogenicity is excellent with seroconversion between 75% (HPV18) and 100% (HPV16). Antibody titles remain high for at least 5 years.

The Federal Commission for Vaccination submitted its report on Human Papilloma Virus (HPV) vaccination recommendations to the Federal Government in spring 2007 [see 2, 3, and 4]. The recommendations are straight forward; the vaccination against HPV is recommended for every girl aged 11 to 14 as well as those aged 15-19 during the transition period.

Though the recommendations of the Federal Commission for Vaccination are clear, the Federal Government has not yet decided whether to reimburse the vaccination (the vaccine costs around 700 CHF at present). This will certainly be a major hurdle to widespread adhesion by the population to the expert committee recommendation.

So far two cantons, Geneva and Valais, have recognized the problem and have decided that they will offer the vaccine free to all the 7th grade girls as from now (limited to one year).

Initiators of idea/main actors

• Regierung

• Kostenträger: Prices are considered as too high

• Bürgergesellschaft

• Wissenschaft

Actors and positions

Regierung
Cantonal health authorities in Geneva and Valais	sehr unterstützend		stark dagegen
Kostenträger
Health insurers	sehr unterstützend		stark dagegen
Bürgergesellschaft
Supporters of natural medicine	sehr unterstützend		stark dagegen
Wissenschaft
Federal experts (Federal Commission for Vaccination)	sehr unterstützend		stark dagegen

Influences in policy making and legislation

The decision of the two cantons to pay for the vaccine will put pressure on the Federal Office of Public Health who is in charge to decide whether HPV vaccination has to be included or not in the benefit basket of mandatory health insurance.

Actors and influence

Regierung
Cantonal health authorities in Geneva and Valais	sehr groß		kein
Kostenträger
Health insurers	sehr groß		kein
Bürgergesellschaft
Supporters of natural medicine	sehr groß		kein
Wissenschaft
Federal experts (Federal Commission for Vaccination)	sehr groß		kein

Positions and Influences at a glance

Expected outcome

Due to the high efficacy of the vaccine (after 3 years' observation a 98% protection against in situ cervical cancer was recorded) incidence of and morbidity / mortality related to HPV infection will dramatically decrease in the years following massive vaccination. A cost benefit analysis in Switzerland suggests a 26,000 CHF/QALY [see 5].

Impact of this policy

Qualität	kaum Einfluss		starker Einfluss
Gerechtigkeit	System weniger gerecht		System gerechter
Kosteneffizienz	sehr gering		sehr hoch

References

Sources of Information

1. www.ekif.ch
2. Empfehlung für die Basisimpfung von Jugendlichen gegen das Zervixkarzinom (Gebärmutterhalskrebs) und andere durch humane Papillomaviren (HPV) verursachte Krankheiten. (www.ekif.ch/fr/downloads/Com_presse_EKIF_18062007finalDE.pdf)
3. Empfehlungen zur Impfung gegen humane Papillomaviren (HPV). Das Wichtigste in Kürze (Mai 2007)(www.ekif.ch/fr/downloads/BAG25_HPV_Wichtigste_dt.pdf)
4.  Empfehlungen zur Impfung gegen humane Papillomaviren (HPV), Juli 2007(www.ekif.ch/fr/downloads/RichtlinienundEmpfehlungen21_2007_07_06.pdf)

5. St[è]ve consultants, Largeron N. Rapport sur l'impact medico-economique de Gardasil en Suisse. Lyon, 2 avril 2007

 

 

 

Author/s and/or contributors to this survey

Philippe Chastonay (proof-reading by Luca Crivelli and Mary Ries)

Adjunct Professor, University of Geneva (l'Institut de Médecine sociale et préventive)
Co-directeur du Certificat de formation continue "Discrimination, santé et droits humains"
Coordinateur du Certificat de formation continue en santé communautaire

Empfohlene Zitierweise für diesen Online-Artikel:

Philippe Chastonay (proof-reading by Luca Crivelli and Mary Ries). "HPV vaccination in Switzerland: where are we?". Health Policy Monitor, October 2007. Available at http://www.hpm.org/survey/ch/a10/1