From cervical cancer elimination to eradication of vaccine-type human papillomavirus: Feasibility, public health strategies and cost-effectiveness

Abstract

The Director-General of the World Health Organization has called for global action towards elimination of cervical cancer as a public health problem. Cervical cancer is caused by human papillomavirus (HPV), an infectious agent with no non-human reservoir. One way to achieve this is through very high levels of vaccine coverage that could enable global eradication of vaccine-type HPV. Using the case study of India, we show that HPV eradication can meet all the Dahlem and Strüngmann criteria for feasibility of eradication. It can be achieved with 90% gender-neutral HPV vaccine coverage together with 95% coverage in high-risk groups such as female sex workers. Such a strategy would likely be cost-effective compared to no vaccination. Although it would be more costly in the short-term than achieving cervical cancer elimination alone, it would save costs in the long-term by removing or at least sharply reducing the need for preventive measures.

Optimal human papillomavirus vaccination strategies to prevent cervical cancer in low-income and middle-income countries in the context of limited resources: a mathematical modelling analysis

“…When examining different vaccination strategies of girls aged 9-14 years, our model predicted that, compared with no vaccination, all vaccination strategies were highly efficient and cost-effective and led to very similar NNVs and ICERs (figure 6; appendix 4 pp [10][11][17][18][19][20]. Nonetheless, our model predicted that routine vaccination of girls aged 14 years, with or without a later switch to routine vaccination of girls aged 9 years, and routine vaccination of girls aged 9 years with an extended interval between doses and catch-up vaccination at age 14 years were the most efficient and cost-effective strategies.…”

“…The main difference between HPV-ADVISE LMIC and HPV-ADVISE for HICs is that we included female sex workers and their clients in HPV-ADVISE LMIC because the proportion of men who declare they have paid for sex is higher in some LMICs than in HICs, 17 male clients of female sex workers have been shown to be bridge populations for sexually transmitted infections, 18,19 and female sex workers, as a core group for HPV transmission, might have a role in whether elimination of cervical cancer can be achieved. 20 In HPV-ADVISE LMIC, individuals are attributed one of four mutually exclusive levels of sexual activity: level 0, including women and men who are married and remain married to a single partner throughout their life; level 1, including women who get married and then divorce or whose partner has a concurrent partner during their marriage (excluding female sex workers) and men who get married and then divorce or have a concurrent partnership during their marriage (excluding female sex workers); level 2, including women and men who never get married; and level 3, including female sex workers and men who pay for sex. Notably, men who pay for sex can also have concurrent long-term partnerships with level 0-1 women.…”

Cervical Cancer Prevention in the Era of the COVID-19 Pandemic

“…In the era of the COVID-19 pandemic, it may prove extremely difficult to achieve the WHO's goal of eliminating CC as a global public health problem. It is predicted that this goal can be achieved with 90% HPV vaccination coverage in the general population and 95% in high-risk groups [65]. The level of global coverage in 2019 was estimated to be 15% [66].…”

Non-Functionalized Gold Nanoparticles Inhibit Human Papillomavirus (HPV) Infection

“…Vaccine cost, inadequate healthcare infrastructure and socio-cultural issues are some of the main reasons for this apparent lack of effectivity. Hence, there is still a pressing need for new and efficient strategies for HPV transmission control, detection and treatment [ 1 , 2 ].…”