The Government of Rwanda, together with Qiagen NV and Merck known as MSD outside the United States and Canada, announced the launch, in Kigali, Rwanda, of a comprehensive national cervical cancer prevention programme that includes vaccination with Gardasil [Human Papillomavirus Quadrivalent (Types 6, 11, 16 and 18) Vaccine, Recombinant] for appropriate girls 12 to 15 years of age and modern molecular diagnostic screening for women between the ages of 35 and 45.

Rwanda is the first nation in Africa to offer a comprehensive prevention program that incorporates both HPV vaccination and HPV testing. Rwanda has a population of 2.72 million women ages 15 years and older. Cervical cancer ranks as the most frequent cancer in women of all ages in Rwanda.

“It is our goal to create a comprehensive, coordinated programme that includes HPV vaccination, cancer screening with HPV DNA testing, and treatment in order to address the nation's unmet needs for cervical cancer-related health services,” said Dr Richard Sezibera, Rwanda's Minister of Health. “This vaccination and screening programme brings us one step closer to reaching our goal of protecting the girls and women in our country. We are pleased to have the support of Merck and Qiagen on this important government initiative.”

During the first three years of the national prevention program the Ministry of Health, with the support of Merck, will offer Gardasil to appropriate girls 12 to 15 years of age, while Qiagen's DNA-based molecular diagnostic HPV tests - the digene HC2 HPV DNA Test and the careHPV Test - will be offered to women between the ages of 35 and 45. Qiagen's careHPV test has been designed to reach women where access to medical care is more challenging - the portable testing system can be performed in any health clinic setting by healthcare workers with minimal lab training.

Merck will provide more than two million doses of Gardasil to the Government of Rwanda at no cost, while Qiagen will provide 250,000 HPV screening tests at no cost along with all necessary equipment and training to successfully perform the tests. Thereafter, the Government of Rwanda will continue routine vaccination of appropriate 12 year old girls, and Merck will provide Gardasil at a discounted access price that is made available for national vaccination programs in GAVI-eligible countries. Similarly, Qiagen will make its HPV tests accessible under a tiered-market pricing structure designed to enable developing countries to establish and maintain the use of HPV testing within national cervical cancer screening and treatment programmes.

“Over eighty-five percent of cervical cancer cases occur in the world's poorest countries, having an impact on the women affected, their families and their communities,” said Dr Mark Feinberg, chief public health and science officer, Merck Vaccines. “Reducing the incidence of cervical cancer is a very important public health goal. Through this collaboration with the Government of Rwanda, Qiagen and numerous global public health organizations working in the country to introduce HPV vaccination and HPV DNA testing, women and girls in Rwanda will have greater access to a comprehensive cervical cancer prevention program. We hope this initiative by the Government of Rwanda provides a helpful model for other resource-limited countries to consider as they work to develop their own programmes.”

Gardasil is approved in the United States for use in girls and young women 9 through 26 years of age for the prevention of cervical, vulvar, vaginal and anal cancers caused by HPV types 16 and 18; genital warts caused by HPV types 6 and 11; and precancerous or dysplastic lesions caused by HPV types 6, 11, 16 and 18. Gardasil is also approved in the United States for use in boys and men ages 9 through 26 years of age for the prevention of anal cancer caused by HPV types 16 and 18, for the prevention of anal dysplasias and precancerous lesions caused by HPV types 6, 11, 16 and 18, and the prevention of genital warts caused by HPV types 6 and 11.

Merck and Qiagen announced plans to launch a collaborative HPV vaccination and HPV screening programme in September 2009 to help prevent cervical cancer. In addition to their own separate initiatives, the two companies committed to jointly provide up to five million doses of Gardasil and 500,000 HPV tests to developing countries at no charge. As the first recipient of this collaborative effort, Rwanda will become the first GAVI-eligible country to implement a comprehensive program involving both HPV vaccination and HPV DNA-based molecular testing to improve access to cervical cancer prevention programs. Qiagen and Merck continue to reach out to select GAVI-eligible countries to explore the feasibility of implementing cervical cancer reduction programmes.

“Expanding access to HPV testing, regardless of where a woman lives, is a commitment of Qiagen to help reduce the tremendous burden of cervical cancer, particularly in the developing world. Women in Rwanda, and in other countries where our DNA-based molecular diagnostic tests are available, are being screened for prevention of this potentially life-threatening disease with the most modern diagnostic detection technology available,” said Peer Schatz, chief executive officer of Qiagen N.V. “In many countries women are the cornerstone of families and their communities. It is unfortunate that cervical cancer, which effective measures can help to prevent, often strikes women in their prime years of productivity. We are pleased to partner with the Republic of Rwanda and Merck to introduce this comprehensive program that will greatly expand access to HPV testing and vaccination, which together can help reduce the burden of this disease. We believe this program will demonstrate the positive impact that these types of collaborations can have in terms of improving healthcare.”

Gardasil does not eliminate the necessity for women to continue to undergo recommended cervical cancer screening. Recipients of Gardasil should not discontinue anal cancer screening if it has been recommended by a health care provider. It has not been demonstrated to provide protection against diseases from vaccine and non-vaccine HPV types to which a person has previously been exposed through sexual activity. It is not intended to be used for treatment of active external genital lesions; cervical, vulvar, vaginal and anal cancers; cervical intraepithelial neoplasia, vulvar intraepithelial neoplasia, vaginal intraepithelial neoplasia, or anal intraepithelial neoplasia. It has not been demonstrated to protect against disease due to HPV types not contained in the vaccine.

Gardasil is contraindicated in individuals with hypersensitivity, including severe allergic reactions to yeast, or after its previous dose. Because vaccinees may develop syncope, sometimes resulting in falling with injury, observation for 15 minutes after administration is recommended. Syncope, sometimes associated with tonic-clonic movements and other seizure-like activity, has been reported following vaccination with Gardasil. When syncope is associated with tonic-clonic movements, the activity is usually transient and typically responds to restoring cerebral perfusion. Gardasil is not recommended for use in pregnant women.

Merck is pursuing a systematic and thoughtful approach to improve access to Gardasil in the developing world through four key pillars: innovation, partnerships, pricing and implementation. In 2007 at the Clinton Global Initiative, Merck made a pledge to donate at least three million doses of GARDASIL thro Gardasil Access Programme, which is enabling organizations and institutions in eligible lowest income countries to gain operational experience designing and implementing HPV vaccination projects.

The collaboration between Merck and Qiagen represents a new commitment and approach that is in addition to, and distinct from, the charitable Gardasil Access Programme. Qiagen is working to improve access to cervical cancer screening through its Qiagencares corporate social responsibility programme. Through the Qiagencares programme, Qiagen is developing the rapid, portable careHPV Test for low-resource settings and health clinics in the developing world and has committed to donating 1.5 million HPV tests to developing countries with the aim of expanding access to cervical cancer screening in areas with the highest disease burden. In addition to its donation to Rwanda, Qiagen currently provides HPV tests to programs in China and India.  

Merck is known as MSD outside the United States and Canada. Through our prescription medicines, vaccines, biologic therapies, and consumer care and animal health products, we work with customers and operate in more than 140 countries to deliver innovative health solutions.

Qiagen N.V., a Netherlands holding company, is the leading global provider of sample and assay technologies. Sample technologies are used to isolate and process DNA, RNA and proteins from biological samples such as blood or tissue. Assay technologies are used to make such isolated bio-molecules visible.