HPV vaccine: the key to eliminating cervical cancer inequities (2024)

1. Trisha L Amboree, postdoctoral fellow1,
2. Joslyn Paguio, advocate for patients with cervical cancer2,
3. Kalyani Sonawane, associate professor3

1. ¹The University of Texas MD Anderson Cancer Center, Houston, TX, USA
2. ²Patient author, The Cervivor Advocacy Group, CA, USA
3. ³MUSC Hollings Cancer Center, Charleston, SC 29464, USA

1. Correspondence to: K Sonawane sonawane{at}musc.edu

Vaccine equity

Foundational to the success of England’s universal HPV immunization programme was the consideration of equitable access. More than 100 countries have introduced HPV vaccination programmes, and inequities in vaccine access and availability are documented.15 To successfully eliminate cervical cancers, policy makers must develop, implement, or redesign programmes to ensure equal access to the HPV vaccine for all individuals, regardless of their income. For example, the Vaccines for Children programme in the US provides free HPV vaccination to children from a low income household, as a result of which vaccine coverage in teenagers from such households is comparable to (and exceeds) coverage among teenagers from high income households.16 Similarly, the national immunization programme in Australia, introduced in 2007 and providing free HPV vaccination to schoolchildren aged 12-13 years, led to rapid uptake and attainment of 80% vaccine coverage.17 The human and monetary consequences of cervical cancer and treatment averted through HPV vaccination outweigh the costs of making it accessible to all age eligible individuals.18

Another notable finding from Falcaro and colleagues’ study is the incremental effect of building up HPV vaccine coverage in successive birth cohorts. Typically, the effect of a public health programme is often not fully evident during the early phases due to lag time in population uptake. In England, for instance, HPV vaccine coverage (a proxy for herd protection from HPV) increased from 38.9% to 48.1% in individuals born between September 1990 and August 1993 to 70.8-75.7% in those born between September 1993 and August 1995 and to 80.9-88.0% in those born between September 1995 and August 2000. The reduction in cervical cancer risk in these three cohorts was incremental—35.5%, 71.3%, and 86.0%, respectively.

Inherently, these data also emphasize the importance of attaining the 90% coverage target recommended by the World Health Organization.19 Currently, HPV vaccine coverage is below target in many countries despite being offered for several years.20 Inequities in vaccine access, hesitancy, and variation in the extent to which healthcare providers recommend vaccination create a major challenge to target attainment in countries with existing HPV vaccine programmes.21222324 Additionally, upstream factors (finances, health system capacity, supply, and vaccine prioritization) can deter introduction and scale-up in countries with no programmes.25 To overcome the challenges of reaching target coverage and to maximize population herd immunity, collective efforts of government, community stakeholders, and healthcare professionals in these countries will be necessary.

In conclusion, the HPV vaccine is the key to eliminating cervical cancer inequalities. An equity driven approach is critical for the success of HPV vaccination programmes.

Footnotes

• Competing interests: The BMJ has judged that there are no disqualifying financial ties to commercial companies. The authors declare the following other interests: Dr. Sonawane has consulted Value Analytics Labs on unrelated projects.

• Further details of The BMJ policy on financial interests is here: https://www.bmj.com/sites/default/files/attachments/resources/2016/03/16-current-bmj-education-coi-form.pdf.

• Provenance and peer review: Commissioned; not externally peer reviewed.

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