TRENTON, New Jersey (AP):

Girls jumping rope chant "one less, one less" in TV commercials for the new cervical cancer vaccine Gardasil, vowing they will be one less cancer patient.

But in the real world, Gardasil is being used less than United States doctors would like. Paediatricians and gynaecologists from Arizona to New York are refusing to stock Gardasil because of its US$360 price for the three doses required - the most for a vaccine ever - and "totally inadequate" reimbursement from most insurers.

Paediatricians, in particular, are rebelling, fed up after years of declining insurance reimbursement for vaccines, an explosion of new vaccines and fast-escalating vaccine prices.

Many practices must tie up US$50,000 or more in vaccine inventory, run multiple refrigerators, insure the vaccines and spend lots of time on inventory management. They also must absorb the cost of broken or wasted vials, and say that's not possible with most insurers reimbursing at just $2 to $15 over the $120 per dose charged by Gardasil's developer, Merck & Co. of Whitehouse Station, New Jersey.

Inadequate insurance reimbursement

Dr. Jill Stoller of Chestnut Ridge Pediatric Associates in Woodcliff Lake, New Jersey, said the inadequate insurance reimbursement for Gardasil is keeping "a wonderful new vaccine" from many patients.

"It really is a shame," said Stoller, who also assesses a surcharge.

Paediatricians and gynaecologists at solo and large group private practices contacted by The Associated Press said they would, at best, break even if they stocked the vaccine. Most will give patients a prescription to get filled and bring back, but that could cost patients far more.

Girls should get the vaccine before they are sexually active, say medical groups representing paediatricians, gynaecologists and cancer specialists. That is because Gardasil, launched last June, prevents cervical cancer by blocking infection from the two strains of human papilloma virus - a common sexually transmitted disease - that cause most cervical cancer. It also protects against genital warts.

Experts recommend routinely vaccinating 11- and 12-year-old girls, who get other shots then, and say Gardasil can be given to girls as young as nine and as a catch-up for those 13 to 18.