In his treatment room at the Catharina Hospital in Eindhoven, gynecologist Ruud Bekkers receives the question regularly, and increasingly often, from women in their late 20s and early 30s: “Can I also have an HPV vaccine?” And: “Why do young girls get it and I don’t?”
HPV, in full the human papilloma virus, can cause cancer. The vaccine significantly reduces the risk of six types of cancer: in the mouth and pharynx and in the penis, anus, vagina, labia and cervix. But men and women over the age of 27 are outside the government’s HPV vaccination program, and because the vaccine has only been included in the vaccination program since 2010, people over 30 have had no chance of getting the shot at a young age.
Where does that age limit come from?
Sexually active
This has been determined by the Ministry of Health, Welfare and Sport on the basis of scientific research and advice from the Health Council, the National Institute for Public Health and the Environment (RIVM) said. “And the question is how effective it is, because the older you are, the more likely you are to be sexually active and possibly infected with HPV. An HPV vaccination works best if you are not yet infected with HPV. In Overall, we know that effectiveness decreases as someone is older at the start of HPV vaccination.”
Bekkers is familiar with those studies, which were completed twenty years ago. “Many of those studies have been done on women up to age 26,” he explains. “And the vaccine now appears to be very effective in that group.”
So he understands that the government is primarily targeting this group. “I welcome every step taken to prevent a disease caused by HPV.” But, he also says: raising the age limit can further reduce the number of women with HPV or, for example, cervical cancer. “We now know that from more recent studies.”
For example, according to Bekkers, it is ‘a big myth’ that the vaccine, sometimes also called the ‘stomach shot’, would only work if the vaccinee has not yet had sex. “It is true that it works best if someone has not yet had HPV, or is still a virgin,” explains Bekkers. “Studies have been conducted that show that women aged 45 to 50 also produce antibodies after receiving the vaccine.”
Lots of species
It may also work if women (or men) have been infected with the virus before, studies are currently being done on this. “There are many types of HPV,” explains gynecological oncologist Christianne Lok of Antonie van Leeuwenhoek. “If you have one type of HPV, the vaccine can still protect against other types.”
In addition, the vaccine can also prevent the body from becoming re-infected with the same type of HPV. “So I understand that older women over 30 also want such a vaccine.”
The video below answers five common questions about the vaccine:
But if the age limit is suspended and people over the age of 27 are also allowed to get a vaccine for free, it would “incur even higher costs,” according to the RIVM spokesperson. Lok agrees: “It will indeed be expensive if you start vaccinating everyone, because you have to vaccinate a lot of women to prevent a very small number of people from developing cancer.”
Duration
The injections now cost, if you have to pay for them yourself, 200 euros each. For optimal protection, you need two within a five-month time frame. Bekkers says about the high price of the vaccine: “That is now especially expensive because you have to go to the GP or the GGD and the vaccine has to be transported, prepared and administered individually for you. If the government were to purchase it on a larger scale, could it be cheaper.”
That is why the editors of the magazine LINDA Meiden started this year a petition to ask the government to lower the price of the vaccine so that women can pay for the vaccine themselves if they wish, or to shift the age limit to 30. Because, according to the editors: ‘If you are not yet 30, you should you also have to wait until you are eligible for a pap smear.’ The Pap smear allows HPV to be detected early and action can therefore be taken in time if necessary. The petitioners wonder, “Why should people who fall exactly between 27 and 30 years of age be at greater risk?”
Bekkers thinks it is a good idea to raise the age limit, but only for women who fall into a risk group. “80 percent of women who get HPV eventually produce antibodies themselves, so that the body clears the virus itself. They do not need the vaccine, have a good immune system and do not fall into a risk group.” Bekkers advocates only giving a vaccine to women over the age of 27, who already had to be treated once for abnormalities in their cervix. “They are more likely to get cancer in their vagina, cervix, anus, labia and throat.”
A pittance
When asked, RIVM says it will not send an information letter to people over the age of 27 with the message that a vaccination can also be useful for them. “Informing a broader target group about this is done via general practitioners and possibly the GGD,” said the spokesperson. “Setting up a separate campaign for this costs money, and the question is also how effective that is. In our communication, we always include that people over the age of 27 can also get the vaccine themselves at their own expense.”
Gynecologist Bekkers also doubts whether it is good to send women over 27 a letter with the option of getting a vaccine, if they can afford it. “Then health inequality arises,” he says. “And you don’t want that in healthcare. There are people for whom such an amount is a pittance, and there are people who have to bend over for it.”
“Actually, you should put it this way,” concludes Lok: “Offer a vaccination to everyone before 27, and after 27 on indication, for example for people who want it themselves or who have never had intercourse, or who are a risk factor. be cost-effective, because then you have the right group.”
2023-08-18 17:56:17
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