Can the central government not do what local government is doing?

The Istanbul Metropolitan Municipality launched its free HPV vaccination program last week. The Ankara Metropolitan Municipality, meanwhile, will begin its program in June.

There has still been no progress regarding the free HPV vaccine that Health Minister Fahrettin Koca announced two years ago, stating that they had "begun work" on it. While many countries have achieved a reduction in cervical cancer cases thanks to the vaccine, it is impossible to understand why no steps have been taken by the central government in our country.

The cervical cancer information page on the Ministry of Health's website states that the incidence of cervical cancer in our country is 4.2 per 100,000 and that 2,125 women were diagnosed within a year.

It also mentions that vaccines with high protective efficacy, developed against the most carcinogenic types of HPV, are available. Furthermore, it adds that the World Health Organization recommends vaccinating girls and boys aged 9-14 against cervical cancer. However, this is the only emphasis on the vaccine in the ministry's information text. You cannot obtain any information about the work the ministry claims to have "begun."

Again, while "low socioeconomic status" is listed among the risk factors, it is not mentioned that the disease is a vaccine-preventable one.

I suppose ministry officials find the screening tests performed on women aged 30-65 every 5 years to be sufficient.

Thousands in line for the vaccine

The free HPV vaccination program launched by the Ankara and Istanbul Metropolitan Municipalities is a major piece of good news for a significant portion of the population. This is because there are two important reasons and outcomes for the free administration of these vaccines.

Considering the population density in these two metropolitan cities, these steps are certainly very valuable. However, they are not enough. More than 85,000 applications were received by the IMM within a day or two, and the vaccine covers the 9-26 age group. In Ankara, the vaccine will be administered to the socioeconomically disadvantaged group in the 9-30 age range.

As is known, HPV vaccines are provided free of charge to the public in many countries. HPV vaccines, known as cervical cancer vaccines, have led to a reduction in cancer rates in many countries to date. In Australia, new cases have ceased to be seen. What enabled this was the inclusion of the vaccine in the national immunization schedule and its free administration to everyone.

WHO'S 2030 GOAL

HPV does not only cause problems in the cervix. It can also lead to cancer in organs such as the vagina, throat, and bladder. Along with these, it is reported that HPV-related cancer types such as anal cancer and penile cancer in men can also be prevented through vaccination.

The World Health Organization (WHO) has created a series of action plans to be completed by 2030 so that countries can progress rapidly toward eliminating cervical cancer. Accordingly, the WHO, which recommends that 90 percent of girls be vaccinated by the age of 15 before they begin sexual activity, has the ultimate goal of wiping the disease off the face of the earth through vaccination.

HEALTH IS OUR CONSTITUTIONAL RIGHT

Family Physician Dr. Emrah Kırımlı, our guest this week on the 12'de Sağlık program, also emphasized that protecting health is our constitutional right, summarizing the central authority's approach to the issue by saying, "We pay taxes; if it is being done in the world, it can be done here too. But it seems they want health to cease being a right and for everyone to access health services, medicine, and vaccines only as much as they can afford with their own money."

One of the problems that can be described as the locomotive of the health system is that the necessary measures in preventive health services have not been implemented. According to Dr. Kırımlı, who quickly explained the chronic problems in the system during the program, if preventive health is not prioritized by the state, alternative medicine practices, vitamins, and supplement products step in. The public turns to other ways to protect their own health.

FREE VACCINES ARE ADMINISTERED IN AFRICAN COUNTRIES

Vaccination efforts become "meaningful" when they reach the general public because a certain threshold must be exceeded. It is essential that the vaccines, which for now can only be given to those receiving social assistance, be expanded to the majority and made accessible to everyone.

It is not limited to just the HPV vaccine. Unfortunately, many vaccines that have been in routine use worldwide for years are still not covered under free programs in our country.

When we spoke with infectious diseases specialist Prof. Dr. Mehmet Ceyhan for immunization week, he drew attention to this issue again and explained that the Rota, HPV (cervical cancer vaccine), and meningococcal (meningitis) vaccines should be included in the immunization schedule, just like other vaccines provided for free. He emphasized that the Rota vaccine is administered for free in 150 countries worldwide, the HPV vaccine in 104 countries, and that meningococcal vaccines are on the immunization schedules of approximately 50 countries (including the poorest countries in Africa). He pointed out that the budget required for these three vaccines in our country is around 200 million dollars, which is far below the money allocated for any bridge or road project.

So, what are we lacking compared to dozens of countries?

Perhaps we have even more reasons for these vaccines to be included in the routine schedule, but the indifference on this issue has left thousands of children and young people's access to vaccines in limbo for years.

Vaccine prices are not affordable for citizens

Considering that half of the population in Turkey works for a wage near the minimum wage, it is not difficult to guess how many people can afford vaccines that range from 2,000 to 3,200 TL per dose.

Starting with the HPV vaccines on the agenda; the current price of the most preferred HPV vaccine, known as the 9-valent vaccine, is 3,230 TL for a single dose. When 3 doses are recommended for those over 15, you have to set aside and pay a total of 10,000 liras within five months.

For the Rota vaccine, which is recommended to be administered in two doses, the price of 1 dose is 1,741 TL. Since two doses are required, the cost of this vaccine also comes to 3,500 TL.

As for the meningitis vaccine, another vaccine with an important place in childhood, the price per dose is 2,092 TL. Fortunately, a second dose is not required for this vaccine.

THE SAME PROCESS IS EXPERIENCED WITH BLOOD GLUCOSE TEST STRIPS

A similar situation has been experienced for several years regarding the free provision of blood glucose test strips. While resources are transferred from the budget to almost everywhere, whether necessary or unnecessary, the fact that small children in particular cannot access these test strips for free makes us unique in Europe as a country. Efforts are made to keep the issue on the agenda constantly through civil society and thanks to a few physicians who have dedicated themselves to this struggle. But it cannot go beyond the efforts of a few municipalities to distribute free glucose meters.