A safe and highly effective vaccine, tragically underused

by Helen Rees | University of the Witwatersrand
Friday, 28 April 2017 10:37 GMT

Hanna Konadu during an HPV vaccination outreach at Oaklink Academy in Congo Villa near Accra, Ghana. Credential: ©Bill & Melinda Gates Foundation/Frederic Courbet

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We can protect young girls against HPV and save millions of lives from cervical cancer – let’s make it a priority

I never met my grandmother. She died in her mid-forties, a housewife married to a coalminer in a poor Welsh mining community. Although my father was never sure, he thought that she died from cancer of the ‘neck of the womb’ – what we now call cervical cancer.

While it’s been eighty years since my grandmother’s death, young women – often mothers – continue to die from cervical cancer at an extraordinary rate. In wealthy nations, nearly 12 women are diagnosed with the disease every hour.  In developing countries, cervical cancer is the leading cancer killer of women, with nearly 30 women dying of cervical cancer every hour. When left unchecked, the disease progresses unnoticed until symptoms finally appear. By then, especially in poorer countries, it’s often too late.

Cervical cancer is caused by the Human Papillomavirus (HPV), a sexually transmitted infection. HPV is the most common cancer-causing infection, with nearly 500,000 cases of HPV-related cancers – including those of the cervix, mouth and throat – every year. Of these, cervical cancer is by far the biggest burden. Deaths from cervical cancer are devastating, not only because of the ravages of the disease, but because these young women, often mothers and partners, are in the prime of their lives.

In South Africa, where I live and work, the high incidence of HIV has also increased the cervical cancer burden. HIV-positive women are significantly more vulnerable to developing a severe form of cervical cancer at a younger age due to their weakened immune systems.

Girls meet to discuss health topics at the Rajasthani Camp Adolescent Forum in Delhi, India. Credential: ©Bill & Melinda Gates Foundation

While better technology has improved the identification and treatment of cervical cancer in rich countries, poorer countries have lagged behind due to lack of funding and weak infrastructure. The current ‘best practice’ approaches to diagnosis use sophisticated laboratory services, remaining out-of-reach for many women in resource-limited settings. Even when there is a diagnosis, many women lack the resources or support to get the treatment they need. While ensuring that we have affordable screening and treatment is critical, prevention remains, by far, the most effective way to tackle the disease.

Today, we have three highly effective HPV vaccines that can protect women against cervical cancer even in settings where screening options are scarce. In countries that have administered the vaccines for close to 10 years, HPV infection has been reduced by up to 90%. And, in addition to protecting against cervical cancer, the HPV vaccine has proved to be effective against at least six other cancer types that affect both men and women.

In the 10 years since the vaccine has been available, 63 countries have introduced it into their immunisation programmes, and many more have launched smaller, targeted campaigns. In 2014, South Africa began offering the HPV vaccine to young girls in public schools to protect girls before they reach reproductive age. The decision to introduce the HPV vaccine was met with a groundswell of support from parents, teachers and the broader community and, three years after the vaccine was introduced, coverage among girls in the public school system is high, at 93%.

But hurdles remain. The overwhelming majority of countries around the world—118—have yet to introduce the HPV vaccine into their immunisation programmes, leading to 300,000 preventable deaths from cervical cancer every year. And even with effective vaccines at our fingertips, uptake has been slow, due in part, to continued concerns over price. Gavi, the Vaccine Alliance, is supporting the introduction of the vaccine in low-income countries and negotiating for lower vaccine prices, but there are still barriers to rolling out the vaccine to everyone that needs it. In resource-limited countries, teens don’t regularly visit the doctor’s office and health systems are simply not designed to meet adolescent girls’ needs – presenting new, costly barriers to delivery. While researchers are now exploring a one-dose option that could improve cost-effectiveness, countries must do more to prioritize HPV vaccine introduction.

As someone who lived through the early HIV epidemic in South Africa, I’ve witnessed what happens when populations are denied access to life-saving technologies. These experiences shaped my commitment and career as equal measure health activist and medical doctor. So when the HPV vaccines were first made available, I jumped at the opportunity to work with the World Health Organisation to expand access to the vaccines in all countries – especially those with limited resources.

Despite this commitment, we still have a long way to go to ensure that all girls and young women have access to HPV vaccines irrespective of who they are or where they live. I’ve seen the power that political leadership and civil society can wield to prevent needless suffering. We can protect young girls against HPV and save millions of lives from cervical cancer – let’s make it a priority.

Helen Rees is the founder and Executive Director of the Wits Reproductive Health and HIV Institute of the University of the Witwatersrand in Johannesburg where she is also an Ad Hominem Professor in the Department of Obstetrics and Gynaecology.