VZCZCXYZ0010
PP RUEHWEB

DE RUEHBM #0983/01 3511403
ZNR UUUUU ZZH
P 161403Z DEC 08
FM AMEMBASSY BUCHAREST
TO RUEHC/SECSTATE WASHDC PRIORITY 9036
RUEAUSA/DEPT OF HHS WASHINGTON DC PRIORITY

UNCLAS BUCHAREST 000983 
 
DEPT FOR EUR/CE ASCHIEBE 
STATE PLEASE PASS TO USTDA DSTEIN AND JMERRIMAN 
 
SENSITIVE 
SIPDIS 
 
E.O. 12958: N/A 
TAGS: ECON ELAB EINV PGOV SOCI AMED RO
SUBJECT: ROMANIA: HPV VACCINATION CAMPAIGN FOUNDERS IN FACE OF 
WIDESPREAD MISINFORMATION 
 
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 
Summary. 
 
¶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 
country. 
 
¶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. 
 
GUTHRIE-CORN