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The end of cervical cancer scourge could be near as WHO endorses single dose vaccine

12 April 2022 - 07:08
New evidence from the WHO shows one dose of HPV vaccine for young girls is enough as opposed to the current regimen of two doses. File photo.
New evidence from the WHO shows one dose of HPV vaccine for young girls is enough as opposed to the current regimen of two doses. File photo.
Image: Simphiwe Nkwali

Public health experts are hopeful cervical cancer, which kills thousands of women each year, could be eliminated sooner than expected following new findings that suggest one dose of human papillomavirus (HPV) vaccine is enough to protect against the cancer.

On Monday the World Health Organization’s (WHO) strategic advisory group of experts on immunisation (Sage) said even though the current regimen of two to three doses given to young girls is recommended, new evidence has shown one dose of the vaccine delivers solid protection against HPV which causes the deadly cancer. It advised countries may now choose between a one or two dose schedule for girls aged nine to 14 years.

“This could be a game-changer for the prevention of the disease by seeing more doses of the life-saving jab reach more girls,” the WHO said.

Experts said administering only one dose would not only simplify the delivery of the HPV vaccination programme, but could also eliminate cervical cancer, which is mainly caused by HPV infection.

Almost all cervical cancer cases (95%) are linked to HPV infection, an extremely common virus transmitted through sexual contact. Though most infections with HPV resolve spontaneously and cause no symptoms, persistent infection can cause cervical cancer.

SA-born medic Dr Princess Nothemba Simelela, who is an assistant director-general for family, women, children and adolescents at the WHO, said the single dose recommendation “has the potential to take us faster to our goal of having 90% of girls vaccinated by the age of 15 by 2030”.

She said globally the uptake of the life-saving vaccine has been slow, and coverage in countries has been much lower than the 90% target. In 2020 global coverage with two doses was only 13%.  Factors that influenced the slow uptake of HPV vaccines included supply challenges, costs of delivering a two dose regimen to older girls and the high cost of HPV vaccines.

Simelela said there is a need for political commitment complemented with equitable access to the vaccine.

“Failure to do so is an injustice to the generation of girls and young women who may be at risk of cervical cancer,” she said. 

The single dose option of the HPV vaccine will not only be less expensive, but will be easy to administer using fewer resources.

“It facilitates implementing catch-up campaigns for multiple age groups, reduces the challenges linked to tracing girls for their second dose and allows for financial and human resources to be redirected to other health priorities.”

Cervical cancer remains the deadliest form of cancer among women in SA, killing between 3,000 and 3,500 women every year

Cervical cancer remains the deadliest form of cancer among women in SA, killing between 3,000 and 3,500 women every year. About 6,000 women are diagnosed with it annually.

Vaccination against HPV in SA was introduced in 2014 as part of the national drive to reach girls aged nine to 14 years. However, the vaccination campaign has been received with scepticism by some parents who refuse to have their children vaccinated for fear it might encourage their daughters to engage in promiscuous behaviour.

The advisory group also recommended one or two does for young women aged 15 to 20 and two doses, with a six month interval, for women older than 21. Immunocompromised women, including those living with HIV, should receive between two and three doses as there is limited evidence of the vaccine’s efficacy of a single dose in this group.

Sage chair Dr Alejandro Cravioto urged all countries to introduce HPV vaccines and prioritise a multi-age cohort catch up of missed and older girls.

“These recommendations will enable more girls and women to be vaccinated and prevent them from having cervical cancer and all its consequences over the course of their lifetimes,” said Cravioto. 

Other highlights from the Sage meeting suggest that while Covid-19 vaccinations show waning immunity against infection with the Omicron variant, they have shown high and more sustained effectiveness against severe disease and death, especially after booster doses. To date, 21 countries remain below 10% population coverage, leaving at high risk the most vulnerable populations. The advisory group noted coverage among the high priority groups remains “insufficient to provide the needed protection against severe disease and death”.

Health worker vaccine coverage is 65% overall, with coverage below 50% in some regions and coverage of older adults at 69% and as low as 24% in some regions. 

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