Cervical cancer vaccination levels are on the rise and experts are “highly optimistic” the disease can be eliminated in a little more than a decade, despite the pandemic and interference from “highly religious” schools.
Australia will become the first country in the world to eliminate cervical cancer if it hits its 2035 target.
Prior to the vaccine, it is estimated up to 90% of Australians were infected with the human papillomavirus (HPV) at some point. HPV causes almost all cervical cancers, as well as a range of other cancers. The free school vaccination program, which began in 2007, has reduced the HPV infection rate by 92%, which in turn has reduced the rate of cervical abnormalities.
The executive director of the Australian Centre for the Prevention of Cervical Cancer, Prof Marion Saville, said the latest statistics – up to and including 2020 when the first Covid lockdowns began – show “coverage has been stable and slowly rising”.
“Despite the pandemic, we’re seeing pretty good coverage,” she said.
Asked if pandemic-related vaccine misinformation had affected those rates, Prof Karen Canfell, the director of the Daffodil Centre, a joint venture between Cancer Council NSW and the University of Sydney, said the program has always had to deal with vaccine hesitancy but that the rates of coverage have continued to increase over time.
This week, a Four Corners episode aired claims that the Opus Dei-affiliated Tangara School for Girls discouraged students from getting the vaccination, claiming it would promote promiscuity.
Opus Dei is a small, controversial group within the Catholic church.
Former students told the ABC hardly any of their classmates received the vaccine. In a statement, Tangara said it “was attempting to ensure parents were fully informed about the vaccine and its potential risks by sharing medical and other information from the media with them”. It said its advice was now in line with the medical advice.
Saville said it wasn’t too late for those who missed out at school. The Pharmaceutical Benefits Advisory Committee has now recommended the vaccination be available on the Pharmaceutical Benefits Scheme for men and women up to 25 years of age.
“We see people who’ve been to Opus Dei schools who weren’t vaccinated … That may also be true for highly religious schools,” Saville said.
“To people who might have been at Opus Dei and told the vaccine wasn’t for them, they should have a conversation with their practitioner.
“We’re hoping the minister will approve the PBAC recommendation so they can have a funded vaccination up to the age of 25.”
The health minister, Mark Butler, is now considering the advice, which also includes a recommendation to reduce the doses needed from two to one.
Canfell said the increase in age for funded vaccinations and the reduction in doses were a “huge opportunity for Australia”.
She said Australia had led an international process of public health innovations on HPV.
“From a national screening program to vaccination, then the second generation vaccines, then changing to HPV screening, and now cervical sample self collection,” she said.
Saville said Aboriginal and Torres Strait Islander communities had done an “amazing job” engaging with the program, with very high first-dose coverage, although the second-dose coverage was somewhat lower.
Only needing one dose would help, Saville said, especially if the vaccinations were still offered twice a year at schools to maximise uptake.
“We would like to see maintenance of those two visits to maintain and build on the equity,” she said.
While the vaccination is funded up to age 19, it can be prescribed for men up to 26 and women up to 45, if they are willing to pay for it. But while vaccinations at older ages may be beneficial – especially for those at higher risk of abnormalities – Saville said “the older you get the less likely it is to be effective”.
In many cases, HPV goes away within a couple of years. Vaccination after that may prevent HPV reinfection, and may reduce but will not eliminate the chance of abnormalities.
“At a certain point our message is that your better protection is screening rather than vaccination,” Saville said.
Canfell said it was an exciting time and that Australia was well positioned to meet its target, but that it was important it did so “equitably” and while maintaining communication about lifesaving interventions.
“It’s really important to communicate well that the vaccine is the best intervention for females under the age of 25 and cervical screening is the best intervention for women over 25, and even in that age group it’s important to have HPV screening, even if they’ve been vaccinated,” she said.
Cervical cancer will be considered to be eliminated as a public health problem when there is only a four in 100,000 chance of invasive cancer.
