Australia’s big bang approach to HPV vaccination is paying off – and the improvements in health will last decades

Australia’s world-first human papillomavirus (HPV) vaccination program will dramatically reduce the incidence of cancer of the cervix for several decades, according to new research published in the Journal of Infectious Diseases.  

In 2007, Australia introduced a fully funded HPV vaccination program – a program which remains unique in its ambitious scale, offering the vaccine to all females aged 12 to 26 years in a mass catch-up program. 1.5 million girls and women were vaccinated in the first three years. According to the research, a collaboration between Canadian and Australian researchers, Australia’s approach of vaccinating large portions of the population at once is far superior to approaches in other countries where the vaccine is offered at school to only a single year cohort at a time.   

Study co-author Associate Professor Julia Brotherton, Director of the National HPV Program Register, said “One of the major benefits of vaccines is their ability to provide herd protection. This means that even those who are not vaccinated are protected because the vaccine prevents the spread of infection in the population. Our research shows just how good herd protection effects are for the HPV vaccine. By vaccinating so many women at once, the spread of the virus to unvaccinated women and men was dramatically reduced.”  Vaccination data from the HPV register was used in the study.

Professor Basil Donovan, from the Kirby Institute at UNSW Sydney, is also a co-author on the study. Professor Donovan’s world-first data showing a rapid reduction in genital warts following the vaccination program were also used in the study. Genital warts are caused by HPV and monitoring the prevalence of warts in a population is an early indicator for the reduction in prevalence of HPV. “It was staggering how rapidly warts began to disappear. These results confirm that the Australian approach to HPV has been highly effective. Importantly, we found that the expansion of HPV vaccination to males will produce greater benefits than more gradual approaches vaccinating just one school year of children at a time,” said Professor Donovan. 

The study used a mathematical modelling platform previously used to predict the impacts of HPV vaccination in Canada, the US and in Australia developed by senior author Professor Marc Brisson of the University of Laval, Quebec. The modelling found that five years after vaccination, genital warts declined by nearly 90% in women under 21, compared to only 38% if a single 12–13 year old cohort vaccination program had been implemented. The model also showed that the benefits of the catch-up program for prevention of cancer of the cervix will continue to accrue for 70 years. 

Professor Brisson and his team’s work has informed the new 2017 World Health Organisation recommendations that HPV vaccination is best delivered initially as mass catch-up to age 18 where affordable, rather than in single year cohorts, given the evidence that this will bring the benefits of vaccination forward. “The Australian experience is the world’s clearest demonstration of the substantial benefits of this approach,” said Professor Brisson. “It’s the first country in the world to document substantial declines in HPV infection, genital warts and in cervical pre-cancer following HPV vaccination.”

At the time the Australian program was first being considered, Professor Ian Frazer, one of the vaccine’s inventors, was Australian of the Year. In 2013, HPV vaccination of boys commenced and coverage is now close to 80% in girls for all three doses and 75% for males. The government recently announced the introduction of the next generation HPV vaccine, which extends protection to another five HPV types, in time for the 2018 school year.

Contacts:

Associate Professor Julia Brotherton E: jbrother@vcs.org.au T: contact Ieva Ozolins, +61 3 9250 0360 

Professor Basil Donovan E: bdonovan@kirby.unsw.edu.au T: +61405143061

Date published: 
Wednesday, 22 November 2017

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