Jessica Pettway, a YouTube fashion and lifestyle influencer, died this month from cervical cancer at the age of 36. Her untimely death – and those of countless other women – probably could have been prevented, thanks to an effective vaccine for human papillomavirus (HPV), which is responsible for about 95 per cent of cervical cancers. But not nearly enough people are getting it.
A recent Public Health Scotland study shows just how effective the HPV vaccine is at preventing cervical cancer. Among the 40,000 women born between 1988 and 1996 who received the vaccine before turning 14, there has not been a single case of cervical cancer. This includes women who received only one or two doses, rather than the full three-dose protocol. The implication is clear: if all eligible girls and women are vaccinated globally, we could eliminate nearly all cervical cancers.
It is not just women who benefit from the HPV vaccine. Beyond cervical cancer, the vaccine protects against cancers of the head, neck, anus, penis, vagina, and vulva. Moreover, because HPV is typically transmitted sexually, protecting boys also means protecting girls. That is why all girls and boys aged 9-14 years – and, ideally, women and men until the age of 45 – should be getting the vaccine.
The good news is that HPV-vaccine programmes have been introduced in many countries across the Global North, including Australia, Canada, the United Kingdom, and the United States. Moreover, the Global South is starting to catch up: last year, Bangladesh, Cambodia, Eswatini, Indonesia, Nigeria, and Togo added the HPV vaccine to their immunisation schedules. But eliminating cervical cancer will require governments everywhere to get on board.
The top priority for effective HPV-vaccination programmes is to vaccinate girls before they become sexually active – the recommended age is 9-14 years. School-based programmes are a good place to start, but in many countries, one cannot expect all – or even most – girls to be in school. Nigeria, for example, has more than 12 million out-of-school children, some 60 per cent of whom are girls. Given this, governments must work with community leaders, community-based organisations, and community health workers to take HPV vaccine to people where they live.
But ensuring that girls get vaccinated is not just a logistical challenge; there is also an important social component. A recent Behavioral Insights Lab survey, in which I was principal investigator, showed that just 60 per cent of the male and female caregivers of girls aged 9-17 across six states in Nigeria would be willing to have these children vaccinated.
Community perceptions were a major determinant of respondents’ stances on the vaccine. Most caregivers (72 per cent) reported that they were very likely to discuss HPV vaccination with their family and friends, and those who perceived that their family and friends supported it were more likely to believe that their female child would get vaccinated. We thus concluded that interventions that leverage positive family and peer influences and encourage discussion of HPV vaccination within caregivers’ social networks are likely to boost vaccine uptake.
Knowledge about the HPV vaccine also makes a big difference, though the type of messaging used in any educational campaign is crucial. Depending on the context, a focus on the vaccine’s general health benefits, rather than its role in preventing sexually transmitted infections, can help to reduce stigma. In our study, caregivers were 30 per cent more likely to have their child vaccinated against HPV if they were exposed to messaging emphasizing the vaccine’s positive effect on girls’ future prospects.
And, again, vaccination programmes must not neglect boys, for whom the vaccine also represents a cost-effective – and potentially life-saving – intervention. Countries where HPV vaccines are already approved for males – including Australia, Canada, Hong Kong, Ireland, the Netherlands, New Zealand, Portugal, South Korea, Switzerland, the UK, and the US – should be leading the way. The US Centers for Disease Control recommends boys get the HPV vaccine between the ages of 11 and 12.
People who were not vaccinated in adolescence should also have access to the vaccine. In the Scotland study, women who received the three-dose protocol between the ages of 14 and 22 had significantly reduced incidence of cervical cancer compared to the unvaccinated. In fact, one can receive the HPV vaccine until age 45. (It is unclear whether the vaccine can help those older than 45 – who are likely to have been exposed to HPV already – not least because it takes a while for cervical cancer to develop.)
No one should die from a vaccine-preventable cancer. It is too late to save Jessica, but we can honor her memory – and those of all the people who have died of HPV-linked cancers – by radically expanding access to HPV vaccination. @Project Syndicate, 2024
Ifeanyi M Nsofor
The writer is a Senior New Voices Fellow at the Aspen Institute, is a Global Atlantic Fellow for Health Equity at George Washington University and an Innovation Fellow at PandemicTech
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