Over the years, important advances have been made in medicine. One of the most important is related to the vaccine against the Human Papilloma Virus (HPV) and that is why new guidelines for its application were announced today. That is why it is essential that you know the changes proposed by the World Health Organization (WHO) due to its involvement with this disease and also with others for which it also protects.
The April 4-7 meeting of the WHO’s Strategic Advisory Group of Experts on Immunization (SAGE) assessed the evidence that has been emerging in recent years. Especially the reference with which a single dose provides comparable efficacy to two- or three-dose regimens.
Often referred to as the ‘silent killer’ and almost entirely preventable, cervical cancer is a disease of inequity in access. The new SAGE recommendation is based on concerns about the slow introduction of the HPV vaccine into immunization programs and low overall population coverage, especially in poorer countries.
New directions to follow
More than 95 percent of cervical cancer cases are caused by sexually transmitted HPV. It is the fourth most common type of tumor among women worldwide, and 90 percent of these women live in low- and middle-income countries.
“The HPV vaccine is highly effective in preventing HPV serotypes 16 and 18, which cause 70 percent of cervical cancer,” said Dr. Alejandro Cravioto, president of SAGE.
Based on all of the above, the group of WHO established new guidelines for the application of the HPV vaccine and it is the following.
- One- or two-dose schedule for primary target girls ages 9-14.
- Schedule of one or two doses for young women from 15 to 20 years old.
- Two doses 6 months apart for women over 21 years of age.
On the other hand, immunocompromised people, including those with HIV, should receive three doses if feasible, and if not, at least two doses. There is limited evidence regarding the efficacy of a single dose in this group.
The WHO recommendations will be updated following further consultation among stakeholders.
WHO Assistant Director-General Dr Princess Nothemba Simelela commented: “I firmly believe that the elimination of cervical cancer is possible. In 2020, the Cervical Cancer Elimination Initiative was launched to address several challenges, including inequity in access to vaccines. This single-dose recommendation has the potential to bring us faster to our goal of 90 percent of girls being vaccinated before the age of 15 by 2030.”
Advance in global immunization coverage
Globally, uptake of the life-saving vaccine has been slow, and coverage in countries is far less than the 90 percent target. Consequently, in 2020 the global coverage with 2 doses is 13 percent. Several factors have influenced the slow uptake and low coverage of HPV vaccines, including supply challenges, as well as programmatic challenges and costs related to delivering a two-dose regimen to older girls who are not typically part of childhood immunization programs. Added to this has been the relatively high cost of HPV vaccines, particularly for middle-income countries.
“We need political commitment complemented by equitable pathways for HPV vaccine access. Failure to do so is an injustice to the generation of girls and young women who may be at risk of cervical cancer.”
The single-dose vaccine option is less expensive, requires fewer resources, and is easier to administer. It facilitates the implementation of catch-up campaigns for multiple age groups, reduces the challenge link to tracking girls for their second dose, and allows financial and human resources to be redirected to other health priorities.