The World Health Organization (WHO) Strategic Advisory Group of Experts on Immunization (SAGE) has stated that a single dose of HPV vaccine is comparable to two or three doses in providing strong protection against human papillomavirus (HPV) infections, for types 16 and 18 which cause 70% of cervical cancer cases.
Increased efforts must also be made to address the lack of knowledge about HPV and the cancers it causes, which is common worldwide.
If countries choose to adopt this new recommendation, it could potentially double the number of girls reached with this essential life-saving vaccine. Cervical cancer, caused by abnormal cell growth in the cervix that can lead to vaginal bleeding and pelvic pain, is one of the biggest killers of women – it claims the life of a woman. woman every two minutes and killed 342,000 women in 2020, 90% of whom were in low- and middle-income countries. The WHO said this recommendation would be “a game-changer”.
Urgent need to improve vaccine access
Despite the high disease burden in these countries and the availability of the HPV vaccine, girls have not had sufficient access to the vaccine for several reasons.
Yet access in low- and middle-income countries is vital: cervical cancer screening rates are extremely low – in sub-Saharan Africa screening uptake is just 12%. This means that cancers will often be diagnosed far too late, making prevention the only way to reliably reduce morbidity and mortality rates.
The HPV vaccine is also important in low- and middle-income countries, as they also have the highest number of women living with HIV. Women with HIV are six times more likely to develop cervical cancer than those without.
Fewer doses needed, more girls vaccinated
According to the SAGE recommendation, the target age for the HPV vaccine is 9 to 14 years old, as this is before most girls have sex. The vaccine will protect them from infection with HPV – a sexually transmitted virus – before they have an active sex life.
Most low- and middle-income countries have chosen to administer the vaccine in schools to reach girls, but not all girls in this age group in low- and middle-income countries have access to the vaccine. education. This is why some countries, such as Kenya, have used a combination of several vaccination strategies: vaccinations given in schools, health facilities and community outreach workers to reach girls.
These strategies mean that a major challenge so far has been reaching girls for their second dose six or 12 months later. The WHO global target for HPV vaccination is 90%; in 2020, global coverage with two doses was only 13%.
So the finding that one dose is enough for women up to age 21 should both increase uptake of the vaccine because girls don’t have to come back for a second or third dose, and ensure that there are more vaccine doses for everyone.
Other barriers to break down for better access
The cost of HPV vaccines has been a barrier for some countries to provide enough doses to their populations, although organizations like Gavi have ensured that low-income countries can purchase the HPV vaccine for 3-5 .18 US dollars per dose.
Attempts by countries to increase their HPV vaccine coverage have also been affected by a shortage of doses. Although manufacturers are finding ways to ease supply constraints, the need for a single dose could significantly ease that pressure.
Increased efforts must also be made to counter the lack of knowledge about HPV and the cancers it causes, which is the case all over the world. For example, a study in the United States published last year in JAMA Pediatrics found that 60% of American men and 32% of American women between the ages of 18 and 26 did not know that HPV causes cervical cancer. uterus. In addition to a lack of HPV vaccine awareness, vaccine hesitancy is also a rejection factor to get vaccinated.
Increasing HPV vaccine uptake will also require significant shifts in awareness of cervical cancer and the merits of the vaccine to prevent it.