HPV Vaccines – The Journey So Far And Long Road Ahead
Executive Summary
HPV vaccines have come a long way since their launch in 2006, though not without their share of bumps and misinformation campaigns. US pediatric infectious disease specialist, Dr Kenneth Alexander, talks to Scrip about how data has evolved, why the US may not be the best example to emulate for HPV vaccination and new products on the horizon, among other topics.
“What we've got now is a vaccine with 17 years of data,” said Dr Kenneth Alexander, chief, Division of Infectious Diseases and vice-chair for research at Nemours Children’s Hospital-Florida, reflecting on the journey of human papillomavirus (HPV) vaccines and the evolving efficacy and safety data over the years.
“It's old enough to have a driver's license,” said the pediatric infectious disease specialist in jest in a wide-ranging interview with Scrip.
Dr Kenneth Alexander
MSD
Merck & Co., Inc.’s Gardasil, a quadrivalent vaccine, was first to market making its US debut in 2006, followed by GSK plc’s rival bivalent vaccine, Cervarix.
Dr Alexander, who is in India to address pediatricians and gynecologists in the country on a series of topics related to the HPV disease burden and prevention, referred to the big transition of HPV vaccines from new vaccine in 2006 to now “talking about eliminating a disease”.
Countries like Australia and Canada, among others are seeing impacts of national programs around HPV vaccination, he noted.
“We're talking about getting rid of cervical disease in women altogether, ”said the physician, who has also served as a speaker or consultant for Merck & Co.
The World Health Organization had, in 2020, launched the global Cervical Cancer Elimination Initiative to accelerate the elimination of one of the most preventable and treatable forms of cancer if detected early and managed effectively. The initiative aims to reduce the incidence below a threshold of 4 cases per 100,000 women-years in every country and thus narrow international disparities associated with the disease. The 90–70–90 (vaccination-screening-treatment) target set by the initiative to be achieved by 2030 would require 90% of girls to be vaccinated by the age of 15.
Countries like India, however, have a long road ahead to tackle cervical cancer - the second most frequent cancer among Indian women that is estimated to claim approximately 77,348 lives each year. Inclusion of HPV vaccines in India’s universal immunization program (UIP) could, however, change that trajectory, with all eyes now on Serum Institute of India Pvt. Ltd.’s recently launched quadrivalent HPV vaccine (a topic that Alexander weighed in on) and imminent competition with Gardasil.
MSD, as Merck is known outside the US and Canada, had in 2021 launched its gender-neutral HPV vaccine, Gardasil- 9 in India, while GSK had last year eased out Cervarix from the country amid changing market dynamics and low demand.
Dr Alexander also touched upon other topics including the low rate of HPV immunization among adolescents, tackling vaccine misinformation, childhood cancers and the risk for subsequent malignant neoplasms in sites susceptible to HPV-associated malignancies as well as the promise of the mRNA platform. Listen to this and more in this podcast.
Podcast Time Stamps
0.10: Introduction
3.07: Familiarity breeds complacency
3.24: Covid endemnicity is not tantamount to mild disease
4.15 : Long COVID is a complicated question
7:45: Pandemic influenza knocking at the door
10: 14: HPV vaccine with 17 years of data.
11:37: Transition from a new vaccine to talking about eliminating a disease.
14:36: HPV vaccination in the US
17: 12 Importance of adolescents as patients
19:13: Elevator speech to parents on HPV vaccination
20:56: US hasn’t done a good job on HPV immunization
23:00: Decision to immunize is made in your heart, not always the brain
24:05: Failing to foresee ‘anti-vax things’ that that came to bear
24:44: Prep to respond to anti-vax misinformation
25:33: Oropharyngeal cancers linked to HPV virus infections
27:15: Childhood cancer survivors and risk of HPV-associated malignancies
29:45: Golden age of vaccine development
32:34: HPV vaccines from India, China
34:01: mRNA platform – exciting time to be in the vaccine world
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