Friday, June 2, 2023

HPV vaccine back on track after pandemic

The HPV vaccine has had a chequered history in Ireland, but now we are back on track in the goal to eliminate cervical cancer and reduce other cancers caused by the virus writes Michael McHale

It’s been a bumpy twelve years for the HPV vaccine in Ireland. Since it was first introduced in a national immunisation programme here for girls in their first year of secondary school, uptake of the inoculation has fluctuated significantly.

The vaccine – which prevents cancers caused by the human papilloma virus – proved popular in 2011-2012, the first academic year it was offered here, with 87.7 per cent of eligible girls receiving at least one dose. However, a stream of online misinformation about the safety of the vaccine severely impacted uptake in following years, leading to vaccination rates dropping to just 58.8 per cent in 2016-2017.
Thankfully, health officials had a secret weapon in the fight against misinformation, restoring public trust in the inoculation which has been proven to be safe and effective.

Laura Brennan was diagnosed with cervical cancer at a young age and died from the illness in March 2019 aged just 26. In the year before her death she spent much of her time advocating for the HPV vaccine which, if available to her when she was in school, would have likely saved her life.

Her efforts proved to be powerful in convincing parents of the value of the vaccine and led to first-dose uptake reaching 82.8 per cent in 2019-2020.

Since then, the HPV vaccine programme has been rolled out to boys as well as girls. However, Covid disruptions saw uptake levels fall slightly in recent years and were down to 78.4 per cent in 2021-2022. In response, the HSE has opened up a new pathway for this cohort to avail of the vaccine.

“At the end of 2022 we launched the Laura Brennan catch-up programme, which is another opportunity for people to come forward who were previously eligible,” Dr Lucy Jessop, the Director of the National Immunisation Office, told IMT.

“Basically that’s girls from second year and above and women under the age of 25. And then also boys who would have been in first year from 2019-2020 when it was first offered – these boys would now be in either second year, third year, fourth year or, if they skipped transition year, fifth year.”

The catch-up programme is being run through clinics being set up across the country, as well as by immunisation teams carrying out the service in secondary schools.

“There was a slight decrease in the uptake in the last few years – but it’s really more that it hasn’t increased as we might like it to have. To meet the WHO target we need to get 90 per cent of women vaccinated by the age of 15. We’re certainly not at 90 per cent yet, but we are getting there.

“I think lockdown did obviously have an effect on our uptake – that’s really why this catch-up is a great idea now

HPV is known to cause one-in-20 cancer cases worldwide. In Ireland around 400 HPV-caused cancers are diagnosed each year.

Up to 290 of these are cervical cancers, but cancers affecting men and women, such as head and neck, mouth and anorectal cancers can also be caused by the virus.

HPV is also a leading cause of penile cancer in men, and vulvar and vaginal cancers in women.

While at the beginning of the immunisation programme three doses were offered to each student, this was later reduced to two, and new international evidence taken up by the country’s National Immunisation Advisory Committee means that just one dose now needs to be administered to most people under 25 to experience the full effect of the vaccine.

Anyone with a weak immune system will require three doses.

“When you look at the uptake rate from the last few years the first dose is quite a bit higher than the second dose. Now we don’t need to go in and offer those people a second dose, in the main, so that should help us in this catch-up programme,” Dr Jessop added.

“Even those who think ‘I didn’t have all three doses’ at the beginning of the programme, they don’t need to come back and have another dose. As long as you’ve had one dose under the age of 25, we consider you to be fully vaccinated now.”

While the impact of the vaccine in reducing cancers will take some years to see, the effect it is having in preventing HPV-caused genital warts is already evident.

The rollout of the vaccine to boys as well as girls will reduce incidents of this infection further, and figures suggest a strong willingness among parents to give their sons that protection.

“We can see that the uptake in boys and girls is actually very similar – maybe slightly lower in boys, but I think parents have good confidence in the vaccine now.”

As the immunisation programme has evolved, the HSE has been keen to keep the frontline medical community informed and educated.

GPs and pharmacists in particular have been targeted, with information about the vaccine and catch-up clinics being disseminated through physical mailouts and an online immunisation bulletin

Dr Jessop is hopeful that these frontline healthcare professionals can encourage eligible people to come forward for their HPV vaccine and direct them to, where they can fill in their details, and find out about local clinics in their area and available appointments.

“Once you’ve got your details in there, it (the online system) can look up your previous record. I think, particularly women who are 23 or 24, they may not remember whether they had a vaccine in first year. So it will check if we already have a vaccination record for you, and only offer you an appointment if we don’t have a record.”

While the oldest cohort of women who received the vaccine in the immunisation programme’s first year of operation are only now reaching the age of eligibility for cervical screening, evidence from countries where the programme has been running longer show a marked decrease in cases of cervical cancer and pre-cancers among vaccinated women.

Such positive results have opened up the possibility of eliminating cervical cancer in many countries around the world, including Ireland.

In January the HSE published a roadmap to eliminating the cancer, which involves reaching three targets as outlined in the World Health Organisation’s strategy to accelerate elimination: 90 per cent of girls being vaccinated by the age of 15; 70 per cent of women receiving a cervical screening by 35 and again by 45; and 90 per cent of women with cervical cancer or pre-cancer receiving treatment.

While elimination does not mean a complete eradication of the cancer, it does mean that incidence rates would be reduced to just four per 100,000 women – currently, Ireland is experiencing an incidence rate of 10.7 per 100,000

Working with international colleagues, the HSE is developing a cervical cancer elimination action plan, and has set November 17 this year – the third anniversary of the WHO’s commitment to eliminate cervical cancer – as the day when Ireland will announce its own target date for the elimination of the disease here.

“We want to increase our uptake as best as we can in Ireland and try and do that as quickly as possible,” Dr Jessop added, “so we’re always working to try and communicate to parents the importance of the HPV vaccine.”

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