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Cablegate: Romania: Hpv Vaccination Campaign Founders in Face Of


DE RUEHBM #0983/01 3511403
P 161403Z DEC 08




E.O. 12958: N/A

REF: Bucharest 422

Sensitive but Unclassified, not for Internet distribution.

1. (SBU) Summary. An effort by the Romanian Ministry of Health
(MOH) to address the inordinately high levels of cervical cancer
deaths in Romania through a Human Papillomavirus (HPV) vaccination
campaign has largely failed. With parental refusal rates of up to
90 percent two thirds of the way through the campaign, the
Government of Romania (GOR) has lost control of the public message,
with misinformation regarding the safety and efficacy of HPV
vaccines prevalent in the media. What began as a sincere effort to
improve the health of Romanian women instead turned into a handy
pre-election target for parties looking to undermine the credibility
of the current government, which itself invited the fiasco with its
own failure to properly educate and prepare the populace. The hope
is that, post-election, the new government can be persuaded to
develop a better education and outreach campaign and then revisit
vaccinating the same age groups of girls in the spring. End

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2. (SBU) Romania has the highest incidence of cervical cancer in
Europe and was targeted by Merck Sharpe and Dohme (MSD) and
GlaxoSmithKline (GSK) as a good location to develop a broader
European market for their respective HPV vaccines. With an average
of six Romanian women dying every day from cervical cancer, the
companies had hoped that the GOR's agreement to provide an anti-HPV
vaccine at no cost to targeted recipients could be used as a
precedent in encouraging other EU countries to follow suit. MSD,
maker of market-leading HPV vaccine Gardasil, has been actively
pushing this project since May of 2008, when the company invited
former Secretary of State Madeleine Albright to Romania to make the
pitch for a vaccination campaign (reftel). Albright's meetings with
the GOR were successful, and MOH announced in July it would initiate
a campaign in the fall covering all 10- to 11-year-old girls in the

3. (SBU) Post has been engaged at various steps in the process,
helping to organize the Albright visit, reinforcing her message with
officials at MOH, and encouraging the MOH to complete the vaccine
procurement procedures in a fair and transparent manner. In the
end, MOH decided to split the procurement evenly between GSK and
MSD, with the price negotiated directly with each company. While
MSD country director Agata Jakoncic says the company did receive a
small premium for having a quadrivalent vaccine (GSK's version only
targets two HPV strains), she commended the GOR for bargaining hard
with MSD to offer the vaccine at a more than 15 percent discount
from the prevailing Romanian market price.

3. (SBU) According to Jakoncic, the political calendar was a major
factor in timing of the campaign, with the sitting government
determined to begin vaccinating girls prior to the November 30th
parliamentary elections as a demonstration of political commitment
to health care. MOH completed procurement on a compressed schedule
and began offering the vaccine to fourth-grade girls just ten days
before elections. Anticipating a positive public reaction, the GOR
was blindsided when the press quickly turned negative in what
appeared to be a well-orchestrated misinformation campaign. Without
clear and coherent information from the central government, local
public health officials were clearly unprepared for the sudden push
to start offering an HPV vaccine and provided only minimal
information to parents in hastily convened school meetings.

4. (SBU) Lacking credible and consistent information from official
sources, parents turned to the media, which played up stories of
adverse vaccine reactions, claims that Gardasil had led to 20 deaths
in the U.S., and even charges (in the face of solid scientific
evidence) that there is no demonstrable link between HPV and
cervical cancer. The GOR strategy to defuse potential controversy
by giving parents a first-ever "opt out" clause for what was billed
as a mandatory vaccination quickly backfired; the TV news was filled
with images of school meetings across the country where parent after
parent raised their hands to refuse the vaccine. To date, 70
percent of girls in the target group have been offered vaccination
but the parental refusal rate for them is almost 90 percent,
rendering the campaign a failure. The intensity of the negative
media was in sharp contrast to the notable silence of top government
officials as the campaign came under increasing criticism.

5. (SBU) MOH has suspended the campaign with the school Christmas
break looming. MSD's plan, after the Holidays, is to focus
education efforts on the remaining 30 percent of the target group to
try to change the tenor of the debate and thus open the door for all
girls to be offered the vaccination again later in the spring.
Jakoncic expressed great frustration that, early on, the GOR had
rebuffed MSD's offers to help prepare a public relations campaign;
officials told her that MSD's job was solely to supply the vaccine
and that MOH would do the rest. After the PR debacle, and now

sitting on a large stockpile of unused vaccines with limited shelf
life, the GOR is proving more willing to work with MSD to craft an
improved message for the girls remaining to be vaccinated. With the
elections over, the issue has already faded from the press, and MSD
hopes that parents will be more receptive to well-prepared, accurate
information in the months ahead.

6. (SBU) Comment. This appears to be a textbook case of how not to
conduct a public vaccination campaign, particularly one involving
vaccines that have already met with some controversy in the U.S. and
elsewhere. By rushing the campaign to try to score political
points, the GOR failed to prepare the ground adequately. This was
especially apparent in the school meetings, where poorly trained
school nurses and regular classroom teachers were often left on
their own to explain the link between HPV and cervical cancer to
bewildered parents. Deluged by Internet rumors as well as poorly
researched and sensationalistic press reports, it is no mystery that
most parents -- asked for the first time ever to sign a vaccination
consent form -- proved unwilling to trust public health authorities.
Complicating matters was the decision to focus on 10- and
11-year-old girls, with few parents perceiving an urgent need to
vaccinate their prepubescent daughters against a sexually
transmitted disease which is only linked to cancer in adulthood.
Romanian health authorities may have had good intentions in
launching this campaign, but the disastrous execution has been a
real setback for public health in this country. Much hard work lies
ahead to repair the damage. End Comment.


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