Professor Ian Frazer is the latest interviewee in our Pieces of the Continent series
Q: Please introduce yourself and tell us a bit about your work.
I'm Professor Ian Frazer, and am a clinician scientist with a particular interest in how the body defends itself against cancer. I practised as a part time clinical immunologist and pathologist for 30 years, while building my research career, and have had my share of research administrative jobs, running labs and a research institute, but these days I head a research laboratory at the University of Queensland focussed on developing new therapies for cancer.
Q: What led you to being involved in the development of the HPV vaccine?
I met with Professor Harald zur Hausen, discoverer of the link between papillomavirus (HPV) and cancer), during a working visit to Germany in 1984 . At that time I was working on a different virus (Hepatitis B virus) in Melbourne, Australia. Prof zur Hausen told me about his work on cervical cancer and it set me thinking about how our body¹'s defences would deal with cancers that might be caused by virus infections. At that time I was also working with patients with damaged immune systems and realised that they had trouble clearing infection with the HPV that causes warts. As very little was known about the body¹s defences against HPV, I refocussed my research on this virus. In 1989 I visited a lab in Cambridge where Dr Margaret Stanley was interested in HPV, and there I met my late colleague Dr Jian Zhou. Together we decided to build an HPV in the lab, to find out more about the virus and the body¹s defences against it. This work was challenging as no-one could grow HPV in the lab. As part of the project to make a virus in the lab, we needed to build the shell of the virus. We managed to achieve that goal in 1990, using genetic engineering technologies that had then newly become available. We realised that the self assembling virus shell could be a potential vaccine to protect against HPV infection, which 15 years of work , mostly by others, including laboratory and industry partners, showed to be true.
Q: How have you seen your work impact global healthcare over the last ten or twenty years?
The HPV vaccine, on release in 2006, was new, and expensive, and although there was plenty of evidence of safety and efficacy, few countries started using it routinely. Australia was one of the first to offer, at the governments expense, routine immunisation of young girls. As more data on efficacy became available , more of the developed world countries have promoted vaccination. Early data from Australia showed steady elimination of the virus and, more significantly, of the pre-cancer that it caused, and this encouraged more widespread uptake where individuals or countries could affort the vaccine. However, the real challenge has been the developing world, where the burden of cervical cancer is greatest, little screening is available, and the vaccine is generally considered expensive. Pilot programs in developing world countries, sponsored by aid agencies, have encouraged uptake in countries as diverse as Rwanda and Bhutan. The adoption by the WHO of a strategy for global elimination of cervical cancer by 2100 through screening and vaccination is a major step forward for global health care.
Q: Is your current research still related to HPV?
Yes our focus now is on immunotherapy for HPV associated cancer, particularly head and neck cancer due to this virus, which is an increasing problem world-wide, with no available screening test comparable to the pap smear to enable early detection of disease.
Q: What are the main responses have you seen to the HPV vaccine?
I think it’s now widely recognised that the vaccine is safe, effective, and desirable as a public health measure. The anti-vaccine lobby and those that object to public health measures related to sexual activity have spread significant misinformation via social media, mostly as a measure of self-promotion, but their impact on vaccine uptake has steadily diminished through better education programs on the risks of HPV and the ease with which these risks can be safely prevented.
Q: How might gender neutral vaccination affect the HPV infection rate of high-risk groups?
Gender neutral vaccination is sensible from a public health perspective as it will result in more rapid elimination of HPV infection, which causes cancers in both men and women. Gender neutral vaccination also defuses the misinformation that the HPV vaccine programs might have some hidden purpose relating to fertility control.
Q: What do you see as the greatest obstacle to take up of the HPV vaccine? How can we overcome this?
The current challenges are the global shortage of HPV vaccine, and the cost of the current vaccines. Both of these problems will be overcome now that patent protection on the vaccines has largely expired (except in the USA), and emerging nation vaccine companies in China and India are accelerating development of vaccine programs.
Footnote: My university has benefitted from royalties on vaccine sales, and I receive a share of those. The university has waived royalty rights in the developing world, and I have donated a significant percentage of share of royalties I've received to the purchase of vaccines for developing world countries.