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HPV vaccination: a decade on

Tuesday, 2nd of August 2016

HPV vaccination: a decade on

Also at

http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31206-5/fulltext

The Lancet

Human papillomavirus (HPV) causes almost all cervical cancers and most other anogenital cancers and warts in both men and women. Worldwide prevalence is 11·7% in women, causing 4·5% of new cancers in women each year. Despite an effective vaccine being licensed in 2006, only last week was itapproved for girls in China and endorsed for boys in the USA.

In China, this unacceptable drug approval lag is not limited to HPV vaccination—the problem is deeply rooted in the Chinese drug approval system. Trial registration is lengthy, with no prioritisation mechanism in place. Additionally, similar to some other countries, no drug can be licensed in China until clinical trials have been done in the country. Trials were done between 2002 and 2005 in other Asian countries but were not accepted by the Chinese Government, with a Chinese trial started in 2008 finally leading to approval this year. Travel agencies even offer package deals from the mainland to Hong Kong for HPV vaccinations to circumvent the problem. Improvement efforts are underway, such as a so-called four-colour light strategy for prioritisation and hiring of more staff to wade through the application backlog.

In the USA, despite approval for girls in 2006 and boys in 2011, uptake has been shockingly low. In 2014, just 37% of girls received the three-dose course compared with 13% of boys. Misconceptions have driven the low uptake, including the belief that vaccination is only needed for sexually active individuals or that vaccination of preteens will cause them to become sexually active. These misunderstandings have weakened political will to mandate the vaccine. Often, parents have not heard about the vaccine or believe that it is not needed. Politicians, health-care professionals, and parents all need to understand the importance of the vaccine. To deny girls and boys the full protection of the vaccine can no longer be tolerated.

The HPV vaccine has proven efficacy. But a decade on, its uptake has been poor, with a worldwidecoverage of only 1·4% of women. Vaccines are one of the strongest levers to improve public health; their study, licensing, and implementation require more urgency than China and the USA have so far displayed.