IPVC 2020

Last week NOMAN attended the International Papillomavirus Conference & Basic Science, Clinical and Public Health Workshops (IPVC). The 33rd edition of the event, originally intended to be held in Barcelona, was held virtually and gathered researchers, clinicians and other health professionals to share knowledge and ideas on papillomaviruses and their associated diseases, from basic science to global health impact.

By harnessing the power of innovation from HPV-research, we can deliver on global prevention and control of HPV-related disease.

Below are some of our key takeaways from the conference:

The true burden of HPV-related cancers is 'grossly underestimated'

We are lacking a lot of high-quality population-based cancer registry data – this means that the worldwide burden of approximately 650,000 HPV-related cancers is grossly underestimated.

We know that rates of HPV-related anal, penile and head & neck cancers are increasing. For example, rates of anal cancer in the USA is increasing by 3.4% per year in women, and 2.9% per year in men.

The number of men in the USA diagnosed with HPV-related head and neck cancers doubled between 1999-2015

The incidence of HPV-related cancers in men is rising by 2.7% per year in the USA – similar increases are occurring in many countries including Germany, UK, Australia and Canada.

The case for vaccinating men as well as women is stronger than ever and gender-neutral vaccination is a crucial pathway to disease elimination.

Genital HPV prevalence is higher in males than females and does not decrease with age

Oral HPV prevalence is significantly higher in men than women

Following acquisition of HPV infection, approximately only 20% of men seroconvert (ie. form antibodies)

Men experience high rates of recurrent genital warts. 44% of men (1 recurrence), 22% (2 or more recurrences)

HPV transmission is higher from females to males (12.3%) than from males to females (7.3%). Men therefore need protecting.

Modelling shows that Gender Neutral Vaccination (GNV) programmes provide greater reduction in HPV prevalence

We should vaccinate boys against HPV:

- To prevent disease and cancers

- As it reflects gender responsibility of men in HPV-related diseases

- To provide them the benefits of HPV vaccination

- To help us reach endpoints quicker, such as the WHO goal to eliminate cervical cancer

- To protect men who have sex with men (MSM)

- Because there are no recommended screening programmes for HPV-related cancers which affect men.

Data emerging from single dose HPV vaccination trials is very encouraging (but the full impact of such measures will be seen at the conclusion of trials in 2021-23)

Numerous studies of dosage are underway at present including ESCUDDO, Primavera and KENSHE among others. (For the most part, current vaccination programmes consist of 2 doses, or 3 doses for those over the age of 15)

There are a significant number of new HPV vaccines in development

These include bivalent (protect against 2 strains of HPV) quadrivalent (4 strains) and nonavalent (9 strains) vaccines. Three new vaccines could be approved in the next 3 years including ‘Cecolin’ and vaccines by Walvax Zerun (2021) and the Serum Institute of India (2022)

There are many tools and strategies available to effectively prevent HPV, however without effective communication these tools have little impact on the disease burden.

We need to empower individuals and communities to take action and improve their lives as without acceptance and demand from the public, investment in HPV vaccines, logistics and health worker training is wasted.

It is vital that clear, easy to understand information is available to our target audience (parents) and community leaders

There are lots of myths and misconceptions which surround HPV, such as:

- HPV is rare

- Boys don’t need the HPV vaccine

- HPV only causes cervical cancer

- Young people don’t need a vaccine protecting against an STI

- The HPV vaccine has harmful side effects

- You can only get HPV if you have sex

Common reasons for not receiving the vaccine include:

- Not knowing about the HPV vaccine

- Not having received medical advice about the HPV vaccine

- Having to pay for the HPV vaccine

Parents that are strongly advised by Health Care Practioners (HCPs) to vaccinate their children accept immunisations and have fewer dosages and concerns about the vaccine. Professionals with greater knowledge are more likely to discuss or recommend HPV vaccination.

Vaccination rates

Without HCP practioner recommendation: 35%

With HCP practioner recommendation: 65%

Barriers related to HPV vaccination which should be considered in our education:

- HPV is not a topic that people are comfortable discussing

- Beliefs that sex education leads to more sex – this is scientifically proven to be false

- Feminization of the HPV vaccine

- Identification as female specific disease (puts disease burden on females).

- Cervical cancer being the main burden of infection and therefore biggest responsibility lies in its prevention.

- Social embarrassment that adults feel talking about sex with children.

We need to have a better system to listen to the conversations online around HPV vaccination if we want to have a chance of responding.

Users who post negative tweets about HPV vaccines often belong to communities of users who also post negative tweets. This is useful for helping identify at risk groups for negative or false information

Increase in social media use among HCPs could help us minimise the impact of misinformation shared, without diluting the participants process for individual users

Australia is on track to eliminate cervical cancer by 2028

Canada may also achieve this goal within the decade.

61% of current cervcial cancer cases occur in countries that have not yet introduced HPV vaccination.

At least 40 new countries are considering introducing some form of HPV vaccination programme (either female only or gender neutral) in the next 3-5 years.

Around 131 countries and territories have introduced HPV vaccination programmes (either female only or gender-neutral). 80% of these countries are considered high income countries.

The covid 19 pandemic presents a series of questions and potential issues to our HPV vaccination programmes:

- What are the implications for funding and infrastructure for existing HPV vaccination programmes?

- What does this mean for the introduction of new HPV vaccine programmes?

- What will the impact be on school based HPV immunisation programmes?

- Does the interruption mean we will have more supply than demand in the short term of the HPV vaccine?