Aspects of Prophylactic Vaccination against Cervical Cancer and Other Human Papillomavirus-Related Cancers in Developing Countries

Abstract

Cervical cancer and other human papillomavirus- (HPV-) related cancers are preventable, but preventive measures implemented in developing countries and especially in low-income rural regions have not been effective. Cervical cancer burden derived from sexually transmitted HPV infections is the heaviest in developing countries, and a dramatic increase in the number of cervical cancer cases is predicted, if no intervention is implemented in the near future. HPV vaccines offer an efficient way to prevent related cancers. Recently implemented school-based HPV vaccination demonstration programmes can help tackle the challenges linked with vaccine coverage, and access to vaccination and health services, but prevention strategies need to be modified according to regional characteristics. In urban regions WHO-recommended vaccination strategies might be enough to significantly reduce HPV-related disease burden, but in the rural regions additional vaccination strategies, vaccinating both sexes rather than only females when school attendance is the highest and applying a two-dose regime, need to be considered. From the point of view of both public health and ethics identification of the most effective prevention strategies is pivotal, especially when access to health services is limited. Considering cost-effectiveness versus justice further research on optional vaccination strategies is warranted.

Vaccine Strategies against Human Papillomavirus: A Discussion Focused on Developing Countries

“…According to reports from the major phase III trials, the vaccines prevent from 97 to 98% of infections caused by HPV-16 and -18 [27]. Investigators from the FUTURE (Females United to Unilaterally Reduce Ecto/Endocervical Disease) II study found a 98% protection rate after a 3-year follow-up period.…”

“…Similarly, the incidence of cervical cancer and mortality rates sharply declined in Europe (particularly in Nordic countries) and Canada due to the implementation of cervical cytology in health care, most notably in population-based screening programs [27]. The establishment of cervical cancer trial programs requires a large number of well-trained professionals and persistent public funding to support the requisite infrastructure [30,89].…”

“…The accessibility of health services in these areas is far too low to guarantee desired impact overall [27]. At the same time, it should be noted that the conventional methods of detection, such as Pap smears and liquid based cytology, have been found to yield contradictory results.…”

“…In particular cases of HPV, attitudes toward vaccination tend to be more positive among people who have more information about the vaccine, and the causal link between HPV and cancer. People with a low social status in developing countries, living in the rural regions, are the least well off in the case of HPV-related diseases [27]. Although some experts regard HPV vaccination as a prevention strategy in low-income areas, a campaign to heighten awareness among the people is needed by the authorities to ensure it is provides effective coverage.…”

“…Additionally, delivering HPV vaccines effectively in primary prevention programs raises various issues and challenges, ranging from financial constraints regarding access to questions of cultural or religious acceptability, unlike those faced by other routine childhood vaccination programs [27,90].…”