What you need to know about HPV vaccination

The South African Health Ministry’s recent announcement to vaccinate young girls against the human papillomavirus has been met with mixed public reaction.

But how effective are the available HPV vaccines, and is South Africa’s health infrastructure stable enough to roll them out?

Did you know?
  • The human papillomavirus is a root cause of cervical cancer in women.
  • South Africa will start administering cervical cancer vaccines in some schools from February 2014.
  • More than 100 strains of HPV exist, and 30 of them are associated with below-the-belt cancer.
  • Gardasil and Cervarix (two of the available vaccines) target HPV 16 and 18, which are thought to be main causes of cervical  cancer.
  • Research shows the shots provide complete protection from both 16 and 18, and Cervarix offers extra protection against three other cancer-related versions.
  • Researchers say there is no proof that vaccination will encourage earlier and riskier sex.
Greater awareness

An estimated 500,000 of the world’s women are diagnosed with cervical cancer each year, and the bulk of those deaths occur in developing countries, which lack the infrastructure and resources to implement routine screening.

In South Africa, cervical cancer is the second most common cancer among women and, according to the National Cancer Registry, the highest rates can be found among black women aged 66 to 69 years of age.

“When a woman is exposed to HPV, her immune system usually prevents the virus from doing any serious harm. Although, in a small number of women, the virus survives for years. Eventually, it can lead to the conversion of normal cells on the surface of the cervix into cancerous ones,” says Doctor Mary M Gallenberg of the US-based Mayo Clinic.

But while the cells may at first only show signs of a viral infection, they may eventually develop into precancerous changes, according to Dr Gallenburg.

So, the vaccination plan should be relevantly clean-cut: three quick shots over six months guarantee immunity from HPV, which, in turn, equals protection from cervical cancer.

However, what about public perception, vaccine costs and other possible barriers?

The general South African consensus is that the vaccine is a much-needed intervention against cervical cancer, with a recent News24 poll of 14,000 readers showing that 7,800 were in favour of young girls getting it, “provided it was with parental consent”.

But not everyone is eager to roll up their sleeves for the shot, as was revealed with some online comments:” the government is secretly trying to neuter young girls” and “they are encouraging them [young girls] to engage in early, riskier sex”, since the vaccine also protects against sexually transmitted infections.

“There is very little evidence that this vaccine encourages early sexual activity, and our data shows huge support for the vaccination of young girls before they become sexually active,” Dr Sinéad Delany-Moretlwe, Director of Research at the Wits Reproductive Health and HIV Research Institute (WRHI).

And researchers at Emory University, in Atlanta, USA, say girls already vaccinated against HPV in that country didn’t show signs of increased sexual activity.

Possible challenges

Agreeing that more still needs to be done on public education, Prof Lynn Denny, who heads the Gynaecological Oncology unit at the University of Cape Town, also noted the poor health infrastructure as another concern.

 “The plan is to use the school health system and to vaccinate children aged 9 to 13 at schools. The problem is that the school health system itself needs serious revamping and this may be the precise stimulus to get that going.

Another point of interest for many role-players is the pricing structure whether South Africa would be able to afford such a costly exercise.

South African Health Minister Aaron Motsoaledi, during his announcement, noted how prohibitive the current pricing structure is, at between R500 and R750 a dose, and with three doses needed to be effective.

The Bill and Melinda Gates Foundation established the Gates Action for Vaccines and Immunisation (GAVI) to help make the drugs more affordable in developing countries. South Africa, however, did not qualify because it was regarded as “too rich”.

 “We will enter negotiations in our own right to also be given a fair deal in the interest of the lives of the women of this country,” Minister Motsoaledi has said.

Although many countries are now scrambling to offer an HPV vaccine, Australia was the first to roll out a national programme, in April 2007, when big pharmaceutical companies were unflinching on their prices. But with determination, proper financial planning and systems, the country has reported huge successes.

As South Africa prepares to implement its rollout early next year, perhaps Australia’s model of vaccination could offer some guidance?

The way forward

“Australia provides us with very strong evidence of the benefits of a well-implemented vaccine programme. We anticipate that, over time, we could show similar benefits for both men and women in preventing HPV infection,” WRHI’s Dr Sinéad Delany-Moretlwe concluded.

South Africa’s poor public healthcare system continues to be the topic of heated debate, both here and abroad. This is why the HPV vaccine might be a better option over the long term. Although it will be of little use to those women who already have cancer or have been sexually active, the benefits for the target group could be invaluable.

With firm political will and commitment from government and other role-players, South Africa could also, in the near future, be showing the positive results that Australia is now boasting.

Read: HPV tied to throat cancers 

Australia’s success
  • Australia’s vaccine rollout started in 2007 and targeted girls between 12 and 13.
  • Three years later, coverage rates for girls that age in Australia’s school-based programmes reached 83 percent for the first dose, 80 percent for the second dose and 73 percent for the third.
  • Researchers from Sydney’s University of New South Wales found that diagnoses of genital warts among young women aged 12 to 26 plummeted by 59 percent two years after the programme began.
  • For men in the same age group, genital warts cases dropped by 39 percent.
  • In a phenomenon known as “herd immunity”, the high rate of immunisation among young women also protected young men who had not been vaccinated.
  • During the same period, there was also a striking decline in the rate of high-grade cervical abnormalities in teenage girls, a sign that a decline in cervical cancer cases may be on the horizon.
  • There was little resistance to the HPV vaccine in Australia, just the usual anti-vaccination people and a few religious groups
 Read more

Schoolgirls in North West get HPV vaccine
CANSA CEO responds to HPV vaccine rollout
Why you should get your child vaccinated against HPV

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