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All You Need to Know About HPV in the Developing World
Human papillomaviruses (HPV) are DNA viruses that infect skin or mucosal cells. Depending on the severity of the infection, HPV can lead to either cervical cancer and other head and neck cancers or low-grade cervical tissue changes and genital warts. Virtually all cervical cancer cases result from a sexually transmitted infection with HPV.

Cervical Cancer and HPV in the Developing World

Globally, cervical cancer is known as the second most common cancer among women, with about 500,000 new cases being diagnosed annually. Of the total deaths that occur due to cervical cancer each year, more than 80 percent are concentrated in developing countries.

Immunization coupled with regular screenings and consistent treatments are the best strategies for reducing the burden of cervical cancer and HPV in the developing world. In resource-poor countries that lack adequate access to cancer screenings and treatment services, it is even more essential that younger girls be immunized before they are sexually active and are exposed to HPV.

The HPV Vaccine

The HPV vaccine protects against the strains that cause up to 90 percent of cervical cancer cases. It is typically available in most routine immunization programs of high-income countries. Historically, the major barriers to reducing the burden of cervical cancer and HPV in the developing world are due to the high costs of the HPV vaccines and the difficulty of reaching adolescent girls.

The GAVI Alliance–formally known as the Global Alliance for Vaccines and Immunization–is a partnership of national governments, the World Health Organization (WHO), the World Bank Group, the Bill and Melinda Gates Foundation, the vaccine industry and many public health institutions. GAVI provides technical and financial support for vaccines in countries that have a gross national income of less than $1,000 per capita and other poverty-stricken countries including China, India and Indonesia.

Thanks to the efforts of GAVI, the HPV vaccine is at a record low price and the poorest countries are able to access it for as little as $4.50 per dose. Additionally, the WHO decided to change the recommended dosage of the HPV vaccine from three to two doses, which helped facilitate the country rollout of the vaccine as well as significantly reducing costs.

The first HPV vaccine demonstration program took place in Kenya in 2013, and since then, 1,000,000 girls have been vaccinated. By the end of 2016, GAVI had initiated HPV vaccine demonstration programs in 23 countries, which is the first step toward introducing the vaccine to national immunization programs. So far, Honduras, Rwanda and Uganda have introduced the HPV vaccine into their national immunization programs.

Potential Roadblocks in the Push for the HPV Vaccine

Unfortunately, the transition from the demonstration programs to national introductions is taking longer than expected for some countries. Consequently, GAVI has developed a new approach to HPV vaccine support, which draws from the valuable lessons learned from previous demonstration programs.

Some of these lessons include:

  1. The fact that school-based delivery works very well when administering the vaccine to young girls. It is more cost effective to integrate HPV immunization efforts into routine immunizations at existing health clinics and schools.
  2. When promoting HPV vaccination programs and cervical cancer prevention, the facilitation of effective and factual communication within the community is particularly critical.
  3. GAVI has made tremendous progress in reducing the prevalence of HPV in the developing world through its vaccination initiatives. Eight GAVI-supported countries have integrated the HPV vaccine into their national vaccination programs and 30 countries have started a demonstration program.

However, despite the strong signs of interest from GAVI-eligible countries and the rapid and effective integration of the HPV vaccine, GAVI’s original goal of immunizing 40,000,000 girls by 2020 may be at risk due to supply constraints.

GAVI chief executive Dr. Seth Berkley stated, “Scaling up cervical cancer prevention and control strategies should not be delayed, as we have the tools to achieve this goal. With the right commitment from vaccine manufacturers as well as political support, strategic partnerships and investments, this particular battle to improve women’s health can be won.”

Thus far, GAVI has helped low-income countries access the HPV vaccine at affordable and sustainable prices. Dr. Berkley is confident that the organization is capable of meeting its goal. GAVI is dedicated to ensuring that its progress is maintained and that millions of girls in the poorest of countries are protected from the perils of HPV and cervical cancer.

– Lolontika Hoque
Photo: Flickr

Cancer in Resource-Poor Countries
In 2012, 3.5 million women died from cancer. Women are diagnosed with cervical and breast cancer at a rate of about 2 million per year, and the diseases’ outcome can largely be predicted by geography. According to The Lancet, 62 percent of deaths resulting from breast cancer occurred in low- and middle-income countries. Similarly, 87 percent of deaths due to cervical cancer occurred in resource-poor countries. Clearly, fighting cancer in resource-poor countries can be difficult.

These trends are even more concerning given that the number of cancer-related deaths among women is expected to increase to 5.5 million by 2030. Over this same time period, the number of women diagnosed with breast cancer is expected to nearly double, and the number of women diagnosed with cervical cancer is expected to increase by 25 percent.

Most global health efforts targeted toward women focus on sexual and reproductive health. However, non-communicable diseases like cancer, cardiovascular disease, respiratory disease, diabetes, dementia, depression and musculoskeletal disorders constitute the greatest threats to women’s health. Indeed, breast cancer and cervical cancer result in three times as many deaths as childbirth and pregnancy complications do.

Further, the global economic burden of cancer is sizable ($286 billion in 2009), primarily because it keeps people out of the workforce and can lead to premature death. Addressing the burden of cancer on women’s health could lead to increased female participation in activities that benefit countries’ economies.

Even in more developed countries, cancer screenings and appropriate treatments are not equally available to all groups. Women belonging to ethnic and cultural minorities, in particular, may not have access to essential health care.

However, cancer screening and treatment is not as costly as is often assumed. As little as $1.72 per person could provide essential medical interventions to diagnose and treat cancer effectively. This amount is about 3 percent of current health care spending in resource-poor countries.

Mammograms for breast cancer screening and radiography for cancer treatment are not often available in low- and middle-income countries. A series of articles from The Lancet recommended increasing the availability of the HPV vaccine for girls and providing cost-effective screening procedures like clinical breast examinations and cervical cancer screenings through visual inspection with acetic acid.

The articles also called for mastectomy and tamoxifen treatments to be made available to people fighting cancer in resource-poor countries by 2030. The Lancet cited Mexico and Thailand as examples of countries where universal health care coverage has improved the diagnosis, treatment and outcome of cancer in women.

Madeline Reding

Photo: Flickr

kenya_girls_students_smiling_cervical_cancer_opt
Every year, approximately 275,000 women lose their lives to cervical cancer. The vast majority of these women live in developing countries where it is difficult to access the necessary healthcare, and where the ability to screen, diagnose and treat the life-threatening cancer is rarely available. However, the fight against cervical cancer in developing countries received an unprecedented boost when the GAVI Alliance announced recently that it had guaranteed a record low price of $4.50 per dose for the human papillomavirus (HPV) vaccines.

For the first time, the GAVI Alliance will make the vaccination available to girls of a school age on a widespread scale, and at an affordable price. The GAVI Alliance has already begun their vaccination program in Kenya where cervical cancer is responsible for the deaths of more Kenyan women than any other cancer. In the past, most of the HPV vaccine programs have only been available in richer countries despite the fact that the need for these programs has always existed in developing countries. Dr. Seth Berkley, CEO of the GAVI Alliance, said that through their partnership with WHO and UNICEF, their support for HPV vaccines is “bridging the gap between rich and poor countries, enabling HPV vaccines to reach girls no matter where they live.”

The vaccine is distributed in three doses, and since Kenya has high enrollment rates among girls, schools will become the main centers for the HPV vaccines. With the support of community health workers, the treatment will also be available to girls who are unable to attend school, and who are often at higher risk of contracting the disease.

Seven other sub-Saharan countries will also receive support from the GAVI Alliance in the near future; Ghana, Lao PDR, Madagascar, Malawi, Niger, Sierra Leone and Tanzania. The GAVI Alliance estimates that by 2020, it will have immunized more than 30 million girls in 40 countries. In these countries, where access to diagnosis and treatment is seldom available, providing a preventative vaccine is the clearly preferred option. This news provides hope to millions of girls and women in developing countries who remain at risk of contracting cervical cancer.

– Chloe Isacke
Source: GAVI Alliance,Impatient Optimists
Photo: WUSC