HPV vaccine lack in Africa raises concern

80 percent of women diagnosed with cervical cancer reside in the continent

A serious shortage of the vaccine that prevents human papilloma virus, or HPV, has continued to delay a widespread campaign in Africa, denying millions of women the protection, experts have said.

They are now advocating for enhanced global research to make a stronger case for the introduction of single regimen against the recommended two-and-three-dose schedule. This will overcome significant hurdles associated with costs in manufacturing, purchasing and implementation.

The HPV vaccine is the first vaccine developed to protect against the main HPV strains that can cause cervical cancer, including HPV-16 and HPV-18.

But with only two globally-approved manufacturers, demand for the vaccine has outstripped supply. Recently, more countries have added the vaccine into the routine national immunization schedule to stem the rising tide of women succumbing to this disease.

According to UNICEF, demand was projected to reach 50 million doses this year, a jump from only 20 million in 2018.

Peter Dull, the deputy director of Global Health Program at the Bill and Melinda Gates Foundation, said 44 percent of countries worldwide have introduced the vaccine, but the majority do not have the highest burdens of cervical cancer.

He said that research is underway in five countries to produce a single-dose HPV vaccine.

About 80 percent of women diagnosed with cervical cancer reside in Africa. In particular, women in East African countries are more likely to be diagnosed with the deadly disease. The region has one of the highest incidence worldwide at 45 to 100,000 women.

Kenya has delayed an HPV vaccine program that was slated to begin in May. It is now expected to start in September, but scaled down significantly. It will only target 10-year-old girls, the health ministry said.

The country is under pressure to declare cancer a national disaster after report revealed that the disease kills 90 Kenyans every day, translating to 32,900 death annually. Cervical cancer accounts for the second greatest number of new cancer cases. A rise in deaths has been attributed to misdiagnosis and lack of diagnostic machines for early screening.

High-income countries with high coverage of the HPV vaccine have recorded a significant decline in the burden of the disease. There is a disconnect between where the vaccine can have impact and where it is currently being deployed, he said.

In a report last year, the USAID reported that fewer US women are dying of cervical cancer. Once the most-common cause of cancer-related death, it is now just the 12th-most-common cause, declining by 70 percent since the 1950s.

Costs and policies continue to be barriers to HPV vaccination. "We seriously need new HPV vaccines, which are affordable, reliable, sustainable. What we have available are good but, frankly, we need a more healthy vaccine market ecosystem. This would drive cost and economies of scale for cheaper vaccines," Dull said.

Some countries in Africa, such as South Africa, are recording significant declines of new HPV infections. "Vaccinating girls between 9 to 14 years has resulted to up to 90 percent fall in HPV infections," said Dull.

Cheaper vaccines will make HPV vaccine programs more standard, especially when subsidies are pulled out. Currently, GAVI, a public-private global vaccine alliance supported by the Gates Foundation, heavily subsidizes the price of the vaccine.

Dull is optimistic that the situation will improve within the next five years when two vaccines from China enter into the market. "I think we need to keep our eyes on these two together in additional to one from India. They will probably transform the cost and availability of HPV vaccine," he said.

lucymorangi@chinadaily.com.cn

(China Daily 08/05/2019 page11)