The HPV vaccine: Preventing cervical cancer in the developing world
In a recent issue of the medical journal The Lancet, Professor Henry Kitchener, Emma Crosbie and colleagues publish a feature piece on Human papillomavirus and cervical cancer. Human papillomavirus (HPV) is the sexually transmitted virus which subsequently can cause cervical cancer. Many strains of HPV exist, however strains 16 and 18 of the virus are the cause of 70 per cent of cervical cancers worldwide.
Therefore vaccination against HPV offers a highly effective method of preventing cervical cancer in the first instance, which Kitchener and Crosbie advocate, stating: “The progress made has been so successful that a means exists to prevent most cervical cancers worldwide. Unfortunately these benefits will only be felt in the developing world if major and far-reaching political initiatives such as the Global Alliance for Vaccines and Immunisation succeed in gathering and providing the resources to implement these advances in under-resourced regions”.
Few are as well versed on the subject of preventing cervical cancer in the developing world than the CEO of the Global Alliance for Vaccines and Immunisations (GAVI), Dr Seth Berkley. Speaking with Dr Berkley his argument is impassioned and compelling, “Often in developing countries cervical cancer can be a slow and painful death”.
He further explains: “In such developing countries which do not have a comprehensive health system, most of these women have never had a pelvic exam, much less cervical screening”. It is a stark difference between the scenario described by Berkley and the ubiquitous and successful cervical screening provision one is accustomed to in the UK. Berkley considers cervical cancer in developing countries as a “triple whammy”; increased incidence, with greater mortality and morbidity and is why he believes passionately that “prevention is the best practice”. He describes the current climate as a “challenging and exciting time” and his jubilance is certainly merited.
A few years ago the two main HPV vaccines were far too expensive to be taken up by developing countries, costing hundreds of dollars for the regimen for one person alone. However, a several months ago the GAVI alliance negotiated with the manufacturers a deal which now means that the HPV vaccines (Gardasil TM and Cervarix TM) can be purchased from Merck & company at a cost of about £2.80 per dose and from GlaxoSmithKline for around £2.90 per dose.
“The pharmaceutical industry has been very helpful,” says Berkley and attributes this “to a change in the pharmaceutical industry mindset by being able to give predictable values which allows them to make appropriate investments”. In addition, he explains that “the opening price of U$ 4.5 dollars” for the vaccine may well fall significantly in the future due to innovation, volume increases and expansion of the product.
Berkley explains that initially GAVI will implement the plan to provide the HPV vaccine to girls aged between nine and 13 this year, to eight countries including Ghana, Laos and Madagascar but hopes to reach 30 million girls by 2020, comprising 40 countries”. In addition to the huge demand for the vaccine amongst girls there is also a growing body who believe that the GAVI HPV vaccination programme should also include boys; a sentiment echoed by Dr Rashna Chenoy.
Dr Chenoy goes on to say: “I am hoping that it will not only reduce the risk of cervical cancer but also vulval, vaginal and anal cancers, that are so much more difficult to treat and the treatments so image-deforming”. Putting forth the question of vaccinating boys with the HPV vaccine to Dr Berkley, he admitted that it was certainly “good to do” but that after cost effective analysis it made more sense to focus on girls at the moment.
Berkley acknowledges that there have been challenges, mainly overcoming negative perceptions and misconceptions surrounding vaccines, which he describes as “nefarious rumours”. Amongst certain public spheres and communities there has been distrust about vaccines in general. Nevertheless, Professor Kitchener, Crosbie and colleagues make a persuasive call: “Scientific discovery has delivered the means to prevent millions of deaths. It is imperative that those who carry the responsibility for the health and well being of women around the world act to ensure that this benefit is realised”.Tagged in: cervical cancer, HPV, Human papillomavirus, vaccines
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