Let’s talk about HPV vaccination
The human papillomavirus (HPV) is responsible for the majority of cervical cancer cases affecting women. In Malaysia, cervical cancer is the third most common cancer among women.
HPV infection is very common; according to Britain’s National Health Service, more than 70% of unvaccinated people will contract it. However, most HPV infections go away on their own without resulting in any symptoms or health problems. There are, however, some types of HPV that can cause serious problems if they are not detected and treated early. Early stages of cervical cancer may not even have noticeable symptoms.
HPV infections, including the most common cancer-causing HPV, are preventable with vaccination. The HPV vaccination is the only immunisation available at the moment that can prevent and eliminate cancer, specifically cervical cancer. As there is an opportunity to protect against cervical cancer, there should be more discussion about it.
Fortunately, the HPV vaccine is prescribed under the National Immunisation Programme (NIP) in Malaysia. This programme is being administered in schools, but only to girls in Form 1, given in two doses, six months apart. The NIP started in 2010.
The number of cervical cancer cases in Malaysia is low — it happens to 1% of the population of women aged 15 and above. It is estimated that out of 1,740 cervical cancer cases annually, the death rate is 56%. The current cervical cancer incident rate is approximately 6.2 per 100,000 women in Malaysia. The goal is to achieve a rate of 4 per 100,000 women, at which point the World Health Organization (WHO) would categorise it as having been eliminated.
Medical technology has improved since the start of the HPV vaccination programme. The vaccine that is available on the market now covers a wider spectrum of HPV. It is recommended for women aged 26 and younger, and is more effective for both men and women who are not yet exposed to the virus. It can be administered to women up to the age of 45 and as early as nine years old. However, the US Centres for Disease Control and Prevention recommends that it be done at the age of 11 to 12 years. HPV infections happen to both men and women, though in women they can lead to a more serious problem and manifest as cervical cancer. Other types of cancer related to the HPV infection that affect both men and women are cancers of the mouth, throat, genital areas and anus.
The Ministry of Health (MoH) has developed the Action Plan towards the Elimination of Cervical Cancer in Malaysia 2021-2030, which is part of the concerted effort worldwide to tackle cervical cancer. The plan’s goals are that by 2030, 90% of 13-year-old girls will be covered under the HPV vaccination plan, 70% of women between 30 and 65 will have available HPV screening and 90% will have treatment for precancerous lesions. This 90-70-90 target for 2030 is a standard set by WHO as part of the global strategy to eliminate cervical cancer.
The biggest concern at this juncture, setting back the 2030 goals, is the budget that is available to the MoH and the distribution of the vaccines. Evidently, 567,151 girls missed out on the HPV NIP over the past three years due to the shortage of the vaccine during the pandemic and school closures. The challenge now is to ensure that those who did not get vaccinated will still have the opportunity to do so at school or government clinics.
An even bigger stumbling block is the cost of the vaccine. In 2022, the global price of the HPV vaccine increased sixfold, making it the most expensive vaccination in the NIP. The government has allocated RM120 million in Budget 2023 for this purpose. However, it has only managed to procure 100,000 doses to date. There is a serious backlog. There are approximately 200,000 girls in Form 1 each year. A total of 567,151 girls have missed their turn and are waiting to be vaccinated, but there are only enough doses for 50,000 girls since each person requires two doses. To put things in perspective, in the 2021 cohort of Form 1 (now in Form 3), only 12.7% have received the first dose, and 6.4% have received both doses. But our target as we progress is 90%!
For parents with daughters and sons, and young adults who have missed their HPV vaccination in school, there are other options. One can get vaccinated at private clinics and hospitals, although the price per dose varies. The current price is slightly over RM500 per dose.
HPV vaccination is a must. If you are hesitant, we urge you to read up on the statistics and talk to your doctor. The numbers do not lie. HPV infections happen on a large scale and a small number lead to serious problems. Be part of the plan to eliminate the only cancer we can.