Closing editorial: processes, opportunities and challenges after introduction of human papillomavirus vaccine

Abstract

This issue of Sexual Health has reflected on processes, opportunities and challenges that human papillomavirus (HPV) vaccines have created for the prevention of cervical cancer and other HPV-related diseases. Having been in development for over a decade, it is notable how rapidly HPV vaccines have been implemented in developed countries worldwide after registration for use. It is fair to note that this reflects a wave of enthusiasm for a preventive strategy for cervical cancer which, unlike cervical cytology screening, does not rely solely on the use of a test that many women find awkward and which requires an enormous sustained, and often unfeasible, commitment to quality and resources in all steps of the screening process.There are substantial challenges in moving forward: at least with the current generation of prophylactic HPV vaccines, cervical screening programs remain necessary to detect cervical HPV and related lesions due to HPV types not covered by vaccination or which were present at the time of vaccination in catch up cohorts. Close monitoring of participation in cytology screening is required, as is further work investigating the strong potential, and acceptability of, screening using primary HPV DNA testing as a more sensitive way to check, among both vaccinated and unvaccinated women, whether oncogenic HPV infection is currently present at the cervix as a predictor of pre-neoplastic lesions. 1 This approach will allow, in combination with cytological assessment of HPV positive women and perhaps the use of other biomarkers of the potential for progression, a stratification of the future risk of cervical cancer and appropriate management.Australia is in a unique position to observe potentially rapid changes in the epidemiology of HPV infection and disease following the implementation of the National HPV Vaccination Program, which has achieved high coverage in a large section of the female population (aged 12-26 years) over a short time frame. 2 While the speed at which the program was implemented created perhaps unprecedented challenges for success (including political, logistic and communication challenges [3][4][5][6] ), the substantial vaccination coverage achieved is notable. More work is now needed to maintain and improve coverage in the ongoing school programs, through a sustained commitment to education around the complex messages that need to be conveyed about HPV, continuing responsiveness to community concerns about vaccination safety as they arise and through careful examination of coverage data to allow identification of communities where coverage is lower. The National HPV Vaccination Program Register (NHPVR) will facilitate these latter evaluations and is also needed to facilitate evaluation of the impact of the vaccine on Pap screening behaviour and disease incidence. The Register was established with a clear intent that the vaccination data held on the register would be linked with Pap screening data to assess vaccine effectiveness. Logistically the next steps are to develop the syst...

Human papillomavirus (HPV) vaccine implementation in low and middle-income countries (LMICs): Health system experiences and prospects

“…The HPV vaccine has progressed relatively rapidly through research and development and commercial availability [49]. Four KIs, primarily from international perspectives, attributed this success to cervical cancer advocacy groups, and suggested that advocacy will continue to play a key role in influencing implementation and policymakers:

“ I think cervical cancer advocacy has been quite good…they’ve been able to mobilize themselves quite effectively and the vaccine certainly has moved through its systems of development quite fast ” (KI-E).

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