Every year, cervical cancer claims the lives of more than 300,000 women in the world. These are alarming figures considering that it is a preventable cancer and that, if it is diagnosed on time and treated promptly, it can be cured. In most cases it is caused by certain strains of the human papillomavirus (HPV), which are transmitted through sexual contact and can affect both men and women. However, cancers caused by HPV affect many more women than men.
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The HPV vaccine is the safest and most effective tool available to prevent cervical cancer and prevent the deaths of thousands of women each year. But even though its administration was authorized in 2006, the slow pace at which it is being adopted is unacceptable. To date, only 15% of 15-year-old girls have received the full dose globally. As might be expected, coverage rates are related to global socioeconomic inequality. More than 85% of high-income countries have introduced the vaccine into their national immunization programmes, compared to less than 25% in low-income countries. 90% of deaths occur precisely in low- and middle-income nations. This situation reveals the disproportionate burden of this public health problem on women living in developing regions.
The urgency to expand access to HPV vaccines has reached its tipping point in recent years. In 2020, the World Health Organization (WHO) launched the Global Strategy to Accelerate the Elimination of Cervical Cancer, the first of its kind aimed at eliminating a cancer. The goal is to achieve the 90–70–90 targets by 2030. That is, 90% of girls are fully vaccinated against HPV by the age of 15, 70% of women have access to screening tests high-precision screening for cervical cancer and that 90% of women diagnosed with this cancer receive quality treatment.
More than 85% of high-income countries have introduced the vaccine into their national immunization programmes, compared with less than 25% in low-income countries.
Two years later, the WHO Strategic Advisory Expert Group on Immunization (SAGE) completed a comprehensive evaluation of the HPV vaccine data, concluding that a single dose was sufficient to prevent HPV infection. in girls and women between the ages of 9 and 20. This raises the hope of achieving elimination targets and contributes to the effort in the fight against cervical cancer.
Following this momentum, and recognizing that the HPV vaccine is one of the most effective in its vaccine portfolio, the Global Alliance for Vaccines and Immunization (GAVI, for its acronym in English) has recently relaunched its HPV vaccination program. Over the next three years, GAVI, together with other partner organizations such as WHO and UNICEF, will focus on supporting the introduction of the vaccine into routine immunization programs and on recovering vaccination coverage in light of the decline suffered during the covid pandemic. -19. HPV vaccination coverage rates depend on the administration of the vaccine in schools, a mechanism that was affected by the lockdowns during the pandemic.
Fears, misconceptions, mistrust
There are multiple reasons that can lead to uneven uptake of HPV vaccination programs or low vaccination coverage rates, especially in low-income countries. Apart from the pandemic-induced disruptions to vaccine introduction, along with its limited supply and production costs, HPV vaccination rates can also be significantly affected by other social and behavioral factors: knowledge, attitudes and practices related to cervical cancer, HPV infection and vaccines; local conceptions of prevention and health care; sociocultural norms; religious beliefs…
The covid-19 pandemic revealed the phenomenon of vaccine reluctance, although public health experts had been warning about this increasingly worrisome problem for years. This is a complex phenomenon that has affected the acceptance of numerous vaccines, including HPV, even before the introduction of the covid-19 vaccine.
The case of Japan is an example of how concern about a vaccine can spread and pose significant difficulties for the health systems in charge of implementing it. Japan suspended the recommendation of the HPV vaccine for nine years (2013-2022) due to the cases of adverse reactions that were circulating in the news and due to the great distrust of parents.
Behind the reluctance to the vaccine for the human papillomavirus lies the fear of long-term side effects, especially with regard to fertility
It is not an isolated case, it is part of a global movement against these vaccines that aroused reluctance in countries as diverse as Denmark, Colombia or Ireland. Typically, behind this resistance is fear of long-term side effects, especially with regard to fertility, as well as misconceptions about the health benefits of the vaccine and distrust of health authorities. . However, the concrete form that these concerns take depends on the moment and the sociocultural context that surrounds them.
In the context of new global efforts to eliminate cervical cancer through access to HPV vaccines, it is essential that bespoke strategies are widely reached among girls and young women. In addition, governments and their partners (GAVI, UNICEF, and civil society organizations) tasked with introducing the HPV vaccine or strengthening existing national programs should also work to identify and understand the attitudes and receptivity of their citizens. It is crucial to involve the local population to address potential challenges in a proactive and practical way, thereby ensuring adherence and high uptake of HPV vaccines.
Yara Alonso y Cristina Enguita-Fernández They are social anthropologists and researchers at the Maternal, Child and Reproductive Health Initiative of the Barcelona Institute for Global Health (ISGlobal), a center promoted by the “la Caixa” Foundation.
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2023-07-28 03:30:01
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