New Hampshire's health department will send its first shipments of a new vaccine that prevents cervical cancer to doctors this week. But many local practices say that the amount being sent won't be enough to meet the demand for an unusually popular vaccine.

Doctors and practice managers say that they already have long waiting lists of patients who want the vaccine, which protects against the human papillomavirus, a common sexually transmitted infection, which causes cervical cancer and genital warts. The vaccine will be offered for free to girls between 11 and 19 as part of the state's childhood immunization program.

The state budgeted to buy enough doses to vaccinate 25 percent of eligible girls this year, and officials distributed it to practices based on their previous use of other vaccines given to teens. But clinicians said that because of the prevalence of HPV and effective marketing by the vaccine manufacturer, the HPV vaccine is not like other immunizations.

"I will tell you that I have never had so many parents say to me, 'When are you going to have this vaccine?' " said Linda Mattlage, a nurse practitioner at Concord Pediatrics, which has hundreds of eligible patients but expects only 25 doses a month. "I can never remember hearing someone say, 'When are you going to have that pneumococcal vaccine?' or 'When are you going to have the meningicoccal vaccine?' "

Extremely effective

The vaccine, called Gardasil, is given in three doses over six months, and is approved for females between 9 and 26 years old. Studies have shown that it is nearly 100 percent effective in preventing four strains of HPV - two that are responsible for causing most cervical cancers and two that cause most genital warts. It is the first vaccine ever developed to prevent a cancer and has been hailed as a major advance in women's health, with the potential to significantly reduce the number of women who develop malignancies.

"From a patient's or a parent's point of view, I can't overemphasize how excited I am about it," said Mary Danca, an obstetrician/gynecologist at the Capital Region Family Health Center in Concord, who frequently sees cervical cancer and genital wart cases in her practice.

The virus is only transmitted through sexual contact but is common enough that about half of all men and women who are sexually active will be infected with the disease at some point, according to estimates from the Centers for Disease Control and Prevention.

The CDC recommends that the vaccine be added to girls' regular vaccine schedule at age 11 or 12, to ensure their immunity before they become sexually active. But with such a large unvaccinated population, doctors must now decide who should get the HPV vaccine first: the younger, recommended population, the oldest teens who are about to age out of the free vaccine program, or sexually active teens who stand the most chance of catching the disease.

Some practices will honor their waiting lists first, some will distribute vaccine on a first-come, first-served basis, and some are still deciding how to prioritize patients.

"We ordered a large number from the state, but we are only going to get a small percentage of the amount we think we're going to need," said Elizabeth Smith, a pediatrician and the medical director at Dartmouth-Hitchcock Concord. She said doctors have been meeting to discuss strategies for vaccine distribution. "We need to decide how we're going to proceed if we have so much less."

No long-term problem

State health officials said that they're willing to be flexible if the planned distribution schedule doesn't work, but they emphasized that there will be no long-term shortage of the vaccine. It will just take a few years for all girls to get vaccinated.

"We think it will all even out over time," said Michael Dumond, the program manager for the New Hampshire immunization program.

The New Hampshire immunization program is funded by the state, the federal government and contributions from private insurance companies. By pooling their resources, commercial and government insurers are to buy childhood vaccines in bulk for a discounted price. In the case of HPV, the state is buying doses of the vaccine for about $25 less than its normal $120 sticker price, still an extremely high cost. The $4.8 million the program has budgeted for Gardasil this year is nearly a third of its entire vaccine budget.

Single page