Cervical cancer is the second most common type of cancer among women, with deaths projected to rise by almost 25 per cent over the next 10 years, according to the World Health Organization (WHO). In 2005 there were more than 500 000 new cases of cervical cancer, of which over 90 per cent were in developing countries. Left untreated, invasive cervical cancer is almost always fatal.
Well-organized screening and early treatment programmes have been very effective in preventing the most common kind of cervical cancer but they are costly and difficult to implement in low-resource settings. In 2006, a vaccine- that protects against infection and disease associated with the HPV was licensed, and another vaccine may be licensed soon.
The recently licensed vaccine is effective in preventing infections with the HPV types (16 and 18) that cause approximately 70 percent of all cervical cancers, as well as in preventing infections with those types (6 and 11) that cause approximately 90 percent of genital warts. This and another HPV vaccine are under regulatory review in countries around the world and may offer a new opportunity to eliminate cervical cancer, the number-two cancer killer of women.
“New vaccines against HPV in the developing world could save hundreds of thousands of lives if delivered effectively,” said Dr Howard Zucker, WHO Assistant Director-General for Health Technology and Pharmaceuticals. “The roll-out of effective HPV vaccines is important for several reasons: They help in combating a deadly cancer and are a potent technology to add to existing cancer control programmes based on prevention, screening and treatment.”
The vaccines — which are initially targeted at girls and may be expanded to boys in the future before or around the time of first sexual activity — offer the unique opportunity to address segment of the populations that are traditionally difficult to reach: young adolescents. Thus, a multifaceted strategy should exploit the opportunity to promote sexual and reproductive health by strengthening health programmes for adolescents.
“We don’t know the final cost of the vaccine in developing countries,” said Arletty Pinel, Chief, Reproductive Health Branch of UNFPA. “But, we can be certain it is going to be a major challenge to introduce quickly where it is needed most – in the poorest countries. Eighty per cent of women who die of cervical cancer are generally poor and live in underserved areas. They will be the ones to benefit most from affordable prices and access to this vaccine.”
Mobilizing resources for strengthening health systems and purchasing HPV vaccines, both nationally and internationally, must be a priority and there must be innovative ways to finance HPV introduction. At an international level, partnerships will be needed to try to reduce the usual time-lag between formal registration and availability in developed countries, and establishing a negotiated price and adequate production capacity to supply developing countries.
In addition to being a new tool for the prevention of a very common form of cancer, the introduction of effective HPV vaccines has other potential benefits for health systems in general. The roll out of such vaccines could help build synergies among immunization, cancer control and sexual and reproductive health. It also has the potential to provide valuable experience for the introduction of any future vaccine against HIV.