Global Cervical Cancer: HPV Vaccination and Diagnostics

The risk of dying from cervical cancer is unequally borne by women in developing countries
Sun-Young Kim

In response to new etiologic evidence, improved technology, and promising HPV vaccine efforts, cervical cancer epidemiologic and preventive efforts are being reshaped throughout the world. The Harvard School of Public Health (Center for Health Decision Science), the International Agency for Research on Cancer (IARC), PATH, and the World Health Organization (WHO) are pursuing a coordinated strategy to make new diagnostics and HPV vaccines accessible, affordable, and sustainable in developing countries.  The objective of this project is to promote evidence-based decision making in a global effort to prevent deaths from cervical cancer, and to catalyze global cancer prevention efforts by synthesizing the best available data and identifying effective, cost-effective, and affordable strategies to prevent cancer-causing HPV infection using new vaccines, and to detect infection at a treatable stage using new diagnostics. Specific goals include:

(1) To develop regional and country-specific models representing different epidemiologic settings using empiric data from multiple study sites on cancer incidence, type-specific HPV prevalence and distribution across the disease spectrum, and key cofactors.

(2) To conduct comprehensive policy analyses to estimate the avertable burden of disease and cost-effectiveness of various HPV vaccination strategies, and identify potential synergies between vaccination and screening, and the most influential factors on the sustainability and affordability of different policy alternatives.

(3) To develop a Core Modeling Center that will analytically support partner activities (e.g., PATH operational research in four countries), assist with or conduct cost-effectiveness analyses for different stakeholders in the HPV vaccine initiative (e.g., analyses to support GAVI investment case), and inform country decision making with analyses that reflect local costs and regional priorities.

Our partners include:

(1) The International Agency for Research on Cancer (IARC), which coordinates and conducts epidemiological and laboratory research on the causes of cancer. In this partnership, IARC collates published data on HPV type distribution in cervical cancer around the globe and co-ordinates new studies in regions where such data are missing, with special reference to populations where HIV is common. IARC also conducts surveys to determine the age-specific and genotype-specific prevalence of HPV in populations where very little or no knowledge is available.

(2) PATH, an international nonprofit organization that improves the health of people around the world through sustainable and culturally-relevant health related solutions. PATH is organizing HPV vaccination operational research projects in four countries (India, Peru, Uganda, and Vietnam) to generate experience addressing the sociocultural, logistic, policy, and clinical needs related to HPV vaccine introduction. In addition, PATH is negotiating partnerships with HPV vaccine manufacturers to accelerate access to HPV vaccine in developing countries. PATH is working with the partners to develop an investment case for public-sector HPV vaccine financing by potential funders (the GAVI Alliance, bilateral donors, and countries), and will disseminate research project results and other educational and advocacy messages to global, regional, and national audiences.

(3) The World Health Organization’s Initiative for Vaccine Research (WHO-IVR), charged with reinforcing linkages between vaccine research and development and immunization. WHO-IVR focuses on harmonizing and standardizing laboratory procedures and creating a global HPV Laboratory Network to facilitate vaccine licensure and monitoring in developing countries. Additionally, WHO-IVR generates an enabling environment for HPV vaccine introduction by creating an international multidisciplinary policy platform and setting a global agenda for future HPV vaccine introduction in consultation with regions and countries.

(4) Catalan Institute of Oncology (ICO)’s Epidemiology and Cancer Registration Unit, in Barcelona, Spain, which has been involved in the design and development of research initiatives around the world related to the causes and prevention of cancer. ICO analyzes data to assess the prevalence and natural history of HPV infections, the etiology of cervical cancer, and the attributable risk due to cofactors. In partnership with WHO, ICO has created an Information Centre on HPV and Cervical Cancer to facilitate global, regional, and country-specific decisions on current and novel options for cervical cancer prevention.