The HPV vaccine: Preventing cervical cancer in the developing world

Dr Sima Barmania
hpv 300x181 The HPV vaccine: Preventing cervical cancer in the developing world

(Getty Images)

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”.

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  • DeadReckoning

    Blatant sexism leaving boys unprotected against penile cancer and genital warts. But that’s fine in the feminised NHS.

  • Adrian

    Go to Youtube, search for Gardasil.

  • Rasputinsrevenge

    Bill Gates loves vaccines.

  • Bob_T

    HPV 16 also infects through the oral route giving head and neck cancer (SCHNC). SCHNC is affecting more men than women and younger people than expected. Recent research has also detected HPV 16 in the saliva of young children suggesting that they can become infected through kissing and from toys etc. (Screening and detection of human papillomavirus (HPV) high-risk strains HPV16 and HPV18 in saliva samples from subjects under 18 years old in Nevada, 2012).

    Although the current vaccines are useful they are not required for most people, as 95% of people clear the HPV16/18 naturally. Also since the above study shows that children under 7 have the highest incidence of HPV infection many children will already have been infected when they get vaccinated.

    What is really needed is to get rid of persistent HPV infections in those people that cannot clear the virus themselves. Rather than innoculate everyone we need to target those that need extra help. Perhaps future vaccines will address this need. There is of course the danger that eradicating HPV16/18 will allow one of the other 30 carcinogenic strains of HPV to dominate and we have no vaccines for those.

  • kawasakiman

    The HPV vaccine:Being tested in the developing world.

    It would solve a big chunk of the overpopulation problem if this vaccine happened to increase infertility on the side.

  • kawasakiman

    That’s next years money spinner…

  • ltlwing

    A money grab from big pharma. As a survivor of cervical cancer, I would never allow a child of mine, boy or girl, to take part in this experiment. There is NO long term study on this, it DOSEN’T prevent cervical cancer and will probably give women a false sense of security that they are immune to cancer and other HPV strains. Cervical cancer is easily beaten IF IT IS DETECTED EARLY. Like prostate cancer, if people smartened up, got over the ‘ick’ factor and just got tested regularly, this marketing excercise wouldn’t get off the ground.

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