HPV vaccine uptake is falling worldwide

Doctors around the world are raising concerns about falling vaccination rates for the Human Papillomavirus, or HPV - the viral infection that causes cervical cancer. The HPV vaccine is typically offered to adolescents in school and has been a massive public health success story, cutting cervical cancer rates by up to 99% in countries with high uptake. But recent data from Scotland, echoed in other countries, shows a worrying decline in vaccination rates, particularly among young people in more deprived communities. Public health officials warn that this could reverse the earlier gains and undermine efforts to eliminate cervical cancer as a global health threat. Margaret Stanley is Emeritus Professor of Epithelial Biology at the University of Cambridge; she’s an internationally recognised expert on HPV and cervical cancer prevention, and helped to develop the cervical cancer vaccine we now use…

Margaret - HPV vaccine was introduced in the UK in 2008. The Scots evaluated its impact over the 10 years of vaccination up to about 2020. What they found was in the 13 year olds who had received the full vaccine dosage, when they arrived for their first smear at the age of 25, there were no invasive cancers. Let me put that in context. The highest number of invasive cervical cancers, the real thing that kills you is in the 25 to 35 age group. And so the fact that this group was showing such a massive reduction, I tell you, this is a real public health triumph. HPV causes 5% of all cancers globally. Now, across the world, where you've had high coverage of this vaccine, 80 to 90% of girls immunised, then you've had reductions in cancer. If the coverage drops, then that possibly will disappear.

Chris - What sorts of rates are we now seeing then? And what sorts of rates of vaccine uptake were we seeing?

Margaret - Scotland before COVID had 90 to 92% coverage of girls. And the boys were coming in and they were getting high coverage too. Since the lockdown and COVID, when the schools closed and therefore the programme was tremendously effected, then it's dropped to about 65%, 70%. In some parts of the country, you're looking at 40%.

Chris - Why in the particular groups that we're seeing this drop though? Because specifically, it's not across the board, is it? It's certain communities where the uptake appears to have really plummeted. So why is that? And is there anything that can be done about that?

Margaret - This is a sexually transmitted infection. And particular religious groups, Islamic, Orthodox Jews, Orthodox Catholics, they are reluctant because they're worried about the sexual transmission and the possibility that this will make the teens more promiscuous. Although I have to say all the evidence says that's rubbish, that it doesn't change their behaviour. And then COVID did all sorts of dreadful damage. And one of the damage was to the trust that people have in medicine and in science. And so they're a significant tranche of the population, which is very uncertain about the benefits of a vaccine you're delivering to a 13-year-old. For a disease, they're not going to get until they're 30, 35.

Chris - Are you expecting then, off the back of this, to see in subsequent years, a resurgence of cervical cancer cases from a near suppression to zero to cases emerging again?

Margaret - I hope not. We've tried to fireproof the programme in the UK as much as possible, because we immunise boys. So the transmission between the two sexes is blocked. So because we've fireproofed it, I'm hoping that we won't see significant failure to fall.