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The human papillomavirus (HPV) is
a sexually transmitted infection (STI) which
most women
acquire at some point in their lives. It is the most common STI in the
United States. Some strains of HPV can cause cervical
cancer, which is the number
one cause of cancer-related
deaths among women in low-income countries. In
2005,
there were more than 270,000 deaths from cervical cancer worldwide, 85%
of which were in the developing world. Highest incidence
and mortality rates occur
in sub-Saharan Africa,
Southeast Asia, and Latin America. The majority of women
with cervical cancer in the developing world are diagnosed
at young ages and in
late stages of the disease, giving
them a low likelihood of long-term survival.
In June 2006, the United States Food and Drug
Administration (FDA) approved
Gardasil, Merck's HPV
vaccine, for sales and marketing to girls and women ages 9
to 26. The vaccine is currently approved for sale in 85
countries. Another HPV
vaccine produced by Glaxo-Smith
Kline, Cervarix, has been approved in the
European
Union, Australia, and Kenya, with applications pending elsewhere.
The vaccine is most effective if
administered in pre-adolescence prior to sexual
activity. The U.S. Centers for Disease Control and
Prevention (CDC) recommends
that girls ages 11 and12
receive the HPV vaccine. Both Cervarix and Gardasil have
been proven at least 95% effective in preventing infection
with HPV types 16 and
18, when administered prior to
sexual debut. These two types of HPV are
responsible for
about 70% of cervical cancer deaths. The vaccines do not protect
against all types of HPV. The U.S. cost for the vaccine is
$360 for the complete
series of three injections, plus
any administration charges.
THE HPV VACCINE IS A POSITIVE
DEVELOPMENT FOR WOMEN
The vaccine is not just a new tool for preventing a common
STI. Cervical cancer is
a serious and prevalent disease.
Screening and treatment options are uncommon in
the
developing world. The vaccine may also reduce vulval and vaginal cancers for
which no primary screening programs exist, as well as anal
cancer and certain head
and neck cancers.
VACCINES SHOULD BE PART OF A COMPREHENSIVE APPROACH
HPV vaccination programs
and funds must be linked with improved screening;
comprehensive sexuality education; and provision of
information and tools which
protect against all
STIs-including HIV-and pregnancy. Funds for vaccines must
not, by contrast, be diverted from these related and
equally pressing priorities.
THE VACCINE WILL NOT PROMOTE
UNSAFE SEXUAL BEHAVIOR
Evidence shows that withholding information and services
from young people only
increases the likelihood that if
and when sexual initiation occurs, it will be
unprotected. Vaccination programs provide an opportunity
for parents, teachers,
and health care providers to talk
with young people about how to stay safe once
sexual
activity is initiated.
MORE RESEARCH IS NEEDED
Little is known about the
vaccine's protective effects beyond the first six years after administration,
and the long-term effects of the vaccine for women have not yet been extensively
studied. There is no evidence that vaccinating males will reduce risk of HPV
transmission to female partners, and the cost-effectiveness of doing so remains
unclear.
ADOLESCENTS SHOULD HAVE THE OPTION TO CONSENT TO HPV
VACCINATION
Policies
on adolescent consent to be vaccinated should take into account their evolving
capacities to make decisions about their health, in accordance with
internationally agreed human rights statutes such as the United Nations
Convention on the Rights of the Child. Vaccination programs should be
voluntary.
AS THE VACCINE BECOMES WIDELY AVAILABLE, EQUAL ACCESS MUST
BE A PRIORITY
Cervical
cancer rates are highest among the poor, yet the current cost of the vaccine is
prohibitive for many people and all but the wealthiest countries. International
donors and the pharmaceutical industry have a key role to play in ensuring that
low-income countries can obtain and distribute the vaccine through comprehensive
programs, linked with screening, especially in the public sector.
INTRODUCING A NEW PUBLIC HEALTH TECHNOLOGY REQUIRES
THOUGHTFUL PLANNING
All countries, in addition to affordability, will have to
address challenges of acceptability, delivery, consent, confidentiality, and
ignorance about the link between HPV and cervical cancer-and will need to
continue screening programs for cervical cancer. Sustained advocacy for youth
health and rights, including by young
people themselves,
is needed to educate and engage with policymakers, health care providers,
educators, parents, and communities, among others.
Acknowledgments
We are grateful to
reviewers Sue Goldie (Department of Health Policy and Program in Health Decision
Science, Harvard School of Public Health) and Scott Wittet (Cervical Cancer
Prevention Programs, PATH).
Additional Resources
RHO Cervical Cancer
www.rho.org
PATH cervical cancer prevention
www.path.org/cervicalcancer
Alliance for Cervical Cancer Prevention
www.alliance-cxca.org
International Agency for Research on Cancer Screening
Group
www.iarc.fr/cervicalindex.php
World Health
Organization-Technical information on Human Papillomavirus and HPV vaccines
http://whqlibdoc.who.int/hq/2007/WHO_IVB_07.05_eng.pdf
United Nations Convention on the
Rights of the Child
http://www.ohchr.org/english/law/crc.htm
Overlooked & Uninformed: Young
Adolescents' Sexual and Reproductive Health and Rights
http://www.iwhc.org/resources/overlooked.cfm
"A Long and Winding Road: Getting
the HPV Vaccine to Women in the Developing World"
http://www.guttmacher.org/pubs/gpr/10/3/gpr100315.pdf
Page last updated
10/11/07.
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