Cervical cancer is the second most common cancer affecting women in less developed countries and it is preventable. The disease can also be cured with early detection.
Despite this, cervical cancer remains a major public health issue, especially in Africa. Almost in all cases, infection with the human papillomavirus is a major risk factor.
Human papillomavirus (HPV) infection is the commonest sexually transmitted infection of the reproductive tract. The disease often infects people shortly after becoming sexually active. As the name implies, the infection is caused by a group of viruses – the human papillomavirus – which are quite common globally.
HPV infection is sexually transmitted. However, penetrative sex is not always required for its transmission. It can also be transmitted through skin-to-skin genital contact with infected persons.
HPV infection often clears spontaneously without any intervention within a few months. In about 90% of cases, the infection persists and clears within 2 years.
However, in a small group of individuals and in infections with certain strains of the virus, the virus remains and causes cervical cancer.
According to WHO, “cervical cancer is the second most common cancer in women living in less developed regions with an estimated 570 000 new cases in 2018 (84% of the new cases worldwide).”
Not all HPV types cause cervical cancers. HPV types (16 and 18) are responsible for 70% of cervical cancers and pre-cancerous cervical lesions. There is also evidence that HPV infections are also associated with cancers of the anus, vulva, vagina, penis, and oropharynx.
Cancers are debilitating, usually terminal diseases that take their toll both on sufferers and family members. It is also a huge source of economic loss both to the individual and the nation.
Cancer of the cervix is curable when detected early. But the better thing is that it can be prevented all together because in about 99% cases, HPV infections have been implicated in its causation – and HPV infections can be prevented.
HPV Vaccine and Cervical Cancers
HPV infections, the major risk factor for the development of cervical cancers, are totally preventable with HPV vaccination.
While it is not part of routine vaccination in most countries, the vaccine is indeed readily available even in many less developed countries. The UN Health Agency says there is ample evidence to support the safety and efficacy of the HPV vaccine in humans.
Usually, two shots of the HPV vaccine confer sufficient protection on the receiver. But for those who fail to get the vaccine on or before their 14th birthday, three doses are recommended at 0, 2, 6 months: the second dose is given 2 months after the first and the third at 6 months after the first assuming the first month represents month 0.
According to the Centre for Disease Control and Prevention (CDC), the vaccine could be administered up to the age of 26 years. Adults, 27- 45 years who wish to take the vaccine should discuss the risks with their doctors.
Nevertheless, available evidence suggests that there is little or no benefit as most people are already exposed to the infection at this age range.
For those with persistent infection, progression to cervical cancer usually takes place 10-15 years after HPV infection.
Worldwide, the age at which both males and females start sexual intercourse is decreasing, occurring between 15 and 18 years in Sub-Saharan Africa. There is consensus among sexual and adolescent health experts that early age of onset of sexual intercourse increases young people’s risks of sexually transmitted infections, including HPV.
This means therefore that more and more people are getting exposed to HPV at younger ages. If this is so, given that the time from infection to cancer is about 10 to 15 years, then many more persons may get caught up and cut off in the prime of their lives – a scenario that is preventable.
Consequently, the need to start HPV vaccine at the recommended age cannot be over-emphasised, if the child must get the full benefits of the vaccine.
Cost of HPV Vaccine Out of Reach
HPV vaccine is not affordable to many. Even then, it is not part of the routine immunization schedule for most developing countries – and not subsidized by the governments.
A shot of HPV vaccine can cost up to $250.00 and an individual must take at least two doses ($500.00) if it is started early. For those who may require three doses, the cost will be more. That is so much for many in developing countries where the average people struggle with daily survival.
According to Gavi, the Vaccine Alliance, HPV vaccine is being subsidized for developing countries so that millions of girls can have access to it.
But that cannot be said to be a success story as many girls in developing countries still do not have access to the vaccines, even at these subsidized costs.
For example, Gavi projected that by 2020, 40 million girls will be protected from cervical cancers and 900,000 deaths averted. However, the organization also admits that the projection may be a mirage after all. Gavi says, “however, due to surging global demand, this goal is at risk with an estimated 13 million girls that may be reached by 2020 and 300,000 deaths averted.”
Perhaps for the same reason, among others, cervical cancer disproportionately affects girls in less developed nations.
It is clear that cervical cancer is linked with HPV infection. HPV infections can be prevented with the HPV vaccine. The HPV vaccine is safe and effective. Cervical cancer affects women in developing countries more than developed countries. The age of sexual debut is decreasing worldwide, thus meaning that many more people are getting exposed to HPV infection early and thus at risk of developing cancer of the cervix at their prime.
Given the benefits of the HPV vaccine to individuals and countries therefore, there is a need for concerted efforts on the part of government and partners to intensify efforts to improve the uptake of the HPV vaccine.