this page two weeks ago, we discussed the advantages of getting a Pap smear and what the test represents. This week, we shall be going one step further to discuss how to prevent even the need for having a Pap smear done in the majority of vulnerable women. The way to achieve that is by getting the Human Papilloma Vaccine, designed to prevent infection by the Human Papilloma Virus, the organism that leads to the development of cervical cancer. So, while Pap smear provides a method for the early detection of the disease condition, which exerts a significant burden on women especially in developing countries, this vaccine may help prevent the disease altogether.
Today, the World Health Organisation recommends that this vaccine, which is actually a group of vaccines, should be made to become a part of the routine vaccinations offered to young people in all countries. The available vaccines currently deployed for this purpose are able to prevent the development of cervical cancer by two, four or nine types of HPV. It is believed today that these vaccines may be able to prevent as much as 70 per cent of these cancers. There are other benefits too, as these vaccines may also prevent about four out of every five cases of anal cancer and nearly two-thirds of vaginal cancer. In HPV-positive oropharyngeal cancers, the vaccines show direct prevention ability in nine of every 10 cases.
As in many other aspects of modern medical care, a specific medication or vaccine developed for the treatment or prevention of a certain disease condition has found effectiveness against a host of other disease conditions, all of which benefit mankind. The administration of these vaccines is offered in addition to other preventive measures such as young girls not starting sexual activities before they are sufficiently mature, and when they have reached maturity, they should avoid having multiple sexual partners.
These vaccines offer protection for young women for a period of five to 10 years and require the administration of two or three doses depending on the age of the recipient and her immune status. The usual recommendation is to have girls between the ages of 9 and 13 years obtain this vaccine, which is very safe actually with only occasional pain and redness at the injection site developing in nearly three-quarters of vaccine recipients. The first HPV vaccine became available in 2006, and by last year, about 125 countries had included this vaccine in their routine immunisation programmes for girls. About one-third of these countries also offer these vaccines for boys. Generally, girls aged nine to 13 are recommended to have two doses of the vaccine six months apart. From 15 years, three doses are recommended. On the whole, males and females aged between 9 and 26 years can be given the vaccine.
Even more to the point is the fact that older women aged between 27 and 45 years can also be given the vaccine. We hope that these figures supplied in this essay will be enough to allay the fears of so many women who have lately inundated our messaging/chat platforms with these inquiries. It was decided to devote last week’s essay and this one to explaining the rationale behind the advisory that women who fall in those age brackets take the vaccine as being in the overall health interest of the nation as a whole. While the efficacy of these vaccines has received widespread endorsement, it is still recommended that routine Pap smear be performed on the women who are thought to be at some risk of developing cervical cancer. In a country like Australia, this requirement has undergone a profound change from a two-yearly Pap smear to one that is adjudged necessary only when the HPV DNA examination is positive for the virus in a specific woman. In males, this vaccine is now known to reduce the risk of developing genital warts and other precancerous lesions that are linked to HPV. Some of these infections are already thought to be responsible for the reduction in the incidence of penile cancer and anal cancer in males. There are several types of these vaccines available for use in different countries.
There is Gardasil and Gardasil-9 which protect boys as well. The third one, Cervarix, does not protect boys but is available only for females. Now the evidence out there is that the widespread vaccination with these vaccines can potentially reduce cervical cancer deaths around the world by as much as two-thirds if all women get vaccinated and the protection the vaccines offer prove to be long-term. In our country, over one-third of all women with cervical cancer do not receive any medical treatment. Therefore, just like the national programme on immunisation proved to be a major turning point in the prevention of unnecessary deaths in infancy and childhood, widespread prevention of HPV by vaccination of all the ‘at risk’ women will be a more effective way of preventing cervical cancer than the burden of Pap smear-based screening.
However, not everyone is eligible for this vaccination and it is important to elicit a history of hypersensitivity to any of the components used in the production of this vaccine such as yeast. Therefore, people who are allergic to yeast should not take the vaccine because this compound is deployed in its production. Besides, individuals who are ill at the time of vaccination should simply have their doses postponed as is done in childhood immunisations. Sadly, even with support from the Global Alliance for Vaccines and Immunisation, nearly a dozen African countries have begun to roll out the implementation of this vaccine mandate on a national basis but Nigeria is not one of them.
Today, evidence suggests that the HPV vaccines can prevent cervical cancer in women up to the age of 45 years. While this is now advocated as the primary prevention against cervical cancer, this and routine cervical cancer screening as described two weeks ago can combine to provide the most effective protection against this deadly disease. If a similar vaccine against breast cancer was available, the huge benefits to the health of women everywhere can be imagined. As always, there are those people who would always work against the deployment of vaccines despite their proven efficacy and relatively low risks as demonstrated in their low side effect profile. Even a country as advanced as Japan suspended the administration of these vaccines on her women in 2013 over concerns about its overall safety. The programme was restarted in 2022 in the midst of fierce criticisms that during the nine years it was not actively recommended for use in teenage girls and young women, more than 26,000 new cases were expected to be diagnosed with just under half of that number dying despite excellent medical care available in that country. All of these events go to prove that as in all things affecting human health, prevention is always better than cure. It is cheaper to do so and, in the case of cervical cancer, a deadly disease has got a credible means of prevention. Nigeria should wake up and seek actively to prevent unnecessary deaths among our women.
