Partial coverage, limited immunity and excessive costs would make a free human papilloma virus vaccine a questionable measure. The Altroconsumo association intervened to raise doubts about the ministry's choice to make the vaccine available for all twelve-year-olds from January - supported by a scientific report from the European center for disease prevention and control. Protagonist of a spat with the National Observatory on Women's Health (Onda), which in collaboration with Health is engaged in the dissemination of screening and information campaigns on the vaccine. "There are now dozens of clinical trials demonstrating the effectiveness of the vaccine," is the dry reply of Francesca Merzagora, president of Onda. "If the campaigns are implemented correctly, the synergy between vaccination and pap test will lead to the disappearance of this tumor in 30 years," he explained. Too many years, for a vaccination campaign with still uncertain coverage and very high costs, is Altroconsumo's reply. Therefore «better to avoid pompous tones: the vaccine is effective against four types of the virus, in particular 16 and 18, the cause of 70% in cases of cervical cancer. Women will have to continue to undergo other preventive interventions. Again, the coverage has only been tested for five years: it is not known whether it will still be valid when today's 12-year-olds begin sexual activity. And in the face of this uncertainty, the certain expenditure – for the NHS is 75 million a year. Altroconsumo's perplexities partly reflect what was reported in the latest issue of the Aifa information bulletin on medicines. Who in an "update" on the efficacy of anti-Hpv vaccines recalls the open questions: the duration of the immune response and the possible need for "boosters"; the impact on the incidence of cervical and anogenital cancers; efficacy against other HPV-related cancers (eg, head and neck); the increasing prevalence of non-vaccine virus types after widespread vaccination; the impact on screening adherence and sexual behaviors. Randomized trials on the efficacy of HPV vaccines Cin = cervical intraepithelial neoplasia; Ais = adenocarcinoma in situ; Gw = growths in the genital area; Vin = vulvar intraepithelial neoplasia; Vain = genital intraepithelial neoplasia; No = not reported. (*) Efficacy for specific type of HPV vaccine; (**) efficacy for any type of HPV vaccine; (***) a) quadrivalent; b, bivalent. Modified from Kahn JA, et al. Lancet 2007; 369: 2135-7 Il Sole 24 Ore Sanita' of 05/02/2008 N. 5 – 5-11 FEBRUARY 2008 p. 4
