The human papillomavirus (better known as HPV by its acronym in English) is the main cause of cervical cancer. It is the fourth most common cancer in women. This virus is also associated with a large proportion of other cancers and genital warts in men and women. It is that it is a very common virus: it is estimated that 90% of people will be infected with HPV during their life. After decades of scientific research in various countries around the world, 4 effective vaccines against the human papillomavirus have already been developed. With access to vaccination, screening and treatment, It seeks to eliminate the incidence of cervical cancer in the world by the year 2030.
In 1976, the scientist Harald zur Hausen published the hypothesis that the human papillomavirus played an important role in causing cervical cancer. Later, identified with his collaborators that some subtypes – HPV16 and HPV18 – were responsible for cervical cancer. These findings earned him one of the winners of the Nobel Prize in Medicine in 2008 shared with co-discoverers of HIV. Both HPV and HIV are transmitted through sexual intercourse.
The first HPV vaccine was available in 2006. As of 2017, 71 countries include it in their vaccinations within the official calendar, at least for girls. It is on the World Health Organization’s Essential Medicines List, and there is evidence that vaccination is a cost-effective public health measure in low- and middle-income countries. However, there are still barriers to access for many women.
The first inoculant against HPV authorized in the world was Gardasil, which was developed by the MSD laboratory. It is a recombinant vaccine that protects against types 6, 11, 16, and 18. That is why it is said to be a quadrivalent vaccine. These types of the virus cause 70% of cervical cancers. In 2014, the United States Vaccine and Drug Regulatory Authority (FDA) approved a different version. It is Gardasil 9, a nonavalent vaccine, which serves to protect against the types covered by the first generation of the inoculant and against types 31, 33, 45, 52 and 58.
Another vaccine developed against VIPH was Cervarix. It was studied by researchers at Georgetown University Medical Center, the University of Rochester, the University of Queensland in Australia, and the American National Cancer Institute, and marketed by GSK. While, the last vaccine was developed in China and recently also received the endorsement of the World Health Organization. It is a bivalent vaccine and is called Cecolin. It is produced by Innovax, a subsidiary of the Wantai Biological Pharmacy Enterprise of China. It works against the two types of highest risk of causing cervical cancers, 16 and 18.
Consulted by Infobae, Dr. Princess Nothemba Simelela, special advisor to the director general of the World Health Organization In strategic priorities, he explained that the efficacy of the 4 vaccines against infection by vaccine types 16 and 18 is very high: between 95 and 100%. The 9 nonavalent protects against 90% of cervical cancers. “Cross-protection against the type of vaccine in bi and quadrivalent vaccines has led the WHO to conclude that these vaccines can protect up to 84% of cervical cancers. Therefore, all available vaccines are considered excellent protection against infection, and will support the elimination of cervical cancer. “
Regarding the last vaccine to be prequalified by the WHO, Dr. Simelela pointed out that it will be provided “with a new and important capacity and volume for both the Chinese and world markets. It will be important that this new volume – which will be available from 2022 – is used to protect more than two-thirds of the global cohort of girls who today do not have access to the vaccine ”.
In Latin America, approximately 5 million girls should have access to the HPV vaccine each year. More than 90% of these girls live in countries that have introduced the HPV vaccine (all except Cuba, Nicaragua and Venezuela) in their official immunization schedule. “Unfortunately, coverage in many Latin American countries has been declining in recent years, and this has been exacerbated by the coronavirus pandemic in 2020. In 2017-2019, HPV coverage was between 68-70%” , affirmed the doctor. In some countries, such as Honduras, Nicaragua, El Salvador, Bolivia, Paraguay, and Ecuador, cervical tumors are still the leading cause of cancer death in women.
The World Day of Action for the Elimination of cervical cancer was celebrated yesterday and there is hope in the medical field that in 2030 a great goal can be reached at the global level. A year ago, the United Nations health agency launched a 90-70-90 strategy to achieve this elimination. It means that by 2030, 90% of girls should be fully vaccinated before their 15th birthday with the human papillomavirus vaccine. In addition, 70% of women must be screened before age 35 and again before age 45 using a high-precision test. 90% of women who have been diagnosed with cervical cancer should have received treatment (90% of women with precancerous lesions and 90% of women with invasive cancer).
It is estimated that For every dollar invested in the strategy through 2050 and beyond, $ 3.20 will return to the economy thanks to increased participation of women in the workforce. The figure rises to $ 26 if one considers the benefits of improving women’s health for families, communities and societies, according to WHO.
“With a lot of effort in the different sectors of the health system and with the support of the population, the 90-70-90 goal is achievable by 2030. I hope it will be realized,” he told Infobae one of Latin America’s experts on infection, Dr. Silvio Tatti, who is head of the obstetrics and gynecology department of the Hospital de Clínica of the University of Buenos Aires and president of the Argentine Society for the Study of Human Papilloma Virus. “In order to reach the incidence of 4 cases of cervical cancer per 100,000 inhabitants in the world, More education and vaccination campaigns will be needed to bring girls closer to vaccinating. TThere is also a lack of more action for women to agree to take the HPV test at 35 years of age and after 45 years, and to guarantee care and treatment if they are diagnosed with cervical cancer ”.
But Dr. Tatti raised the reduction in vaccination coverage during the coronavirus pandemic as a concern. “In countries like Argentina, HPV vaccine coverage in 11-year-old girls was 80% and dropped to 46% in 2020. Also children born after 2006 should be vaccinated against HPV and coverage dropped from 70% before the pandemic to 39% in 2020. This is alarming. It also happened in other countries with the HPV vaccine and with immunization for other diseases, “he said. All 11-year-old girls born after the year 2000, and all 11-year-old boys born after 2006 must receive the HPV vaccine according to the Ministry of Health of the Nation.
In Argentina, the HPV vaccine was incorporated into its vaccination schedule in 2011. Since then, it has been applied to 11-year-old girls. In 2017, coverage was extended to 11-year-old men, for the prevention of other cancers (anus, penis, head and neck). A work on the impact of vaccination on women has already been published. It was published in the magazine Papillomavirus Research.
It was carried out in health centers in the Federal Capital and in the provinces of Misiones, Santiago del Estero and Buenos Aires. The research led by Alejandra Picconi, from the ANLIS / Malbrán Institute, which has a reference center in HPV worldwide, analyzed the presence of HPV in the cervix of adolescents between 15 and 17 years of age, and compared results. It was found in the real world that the vast majority of vaccinated girls are not infected with types 16 and 18. The efficacy of the vaccine is greater than 93% for these genotypes.
Also in the UK, another study published last November 3 in the journal The Lancet showed that the HPV vaccination program works and saves lives, according to research funded by Cancer Research UK. Cervical cancer rates fell by almost 90% in women in their 20s who were offered the vaccine between 12 and 13 years of age.
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How the 4 vaccines developed to prevent HPV work