The President of the Republic announced on Tuesday February 28 the implementation of a “generalized” free vaccination campaign in colleges for 5th graders in order to eradicate the papillomavirus, responsible each year for more than 6,000 new cases of cancers. On this occasion, we offer you this article from The Conversation and published in 2019.
In December 2019, the High Authority for Health (HAS) published a recommendation to “extend vaccination against human papillomaviruses to young boys”. In a press release, the Ministry of Health said it wanted “this recommendation to be incorporated into the 2020 vaccination schedule for implementation by the summer”. In September, the Academy of Medicine had also officially declared itself in favor of vaccinating girls AND boys against the papillomavirus, and on March 20, already, a group of 50 learned societies and medical unions had sent an appeal to the public authorities asking the “free or reimbursed universal vaccination, without distinction of sex or risk”, against these viruses.
But why also vaccinate boys against the papillomaviruses which are known to be responsible for almost all uterine cancers? Because they don’t just affect women, but actually threaten both sexes: a third of cancers and half of genital warts they cause are in men! Reminders.
Papillomaviruses are responsible for nearly 100% of cervical cancers.
Every year, 3,000 French women learn that they have cervical cancer. And every year, 1,100 of their fellow citizens die of this disease, making it the tenth leading cause of death from cancer among women in France.
Over the past twenty years, screening for precancerous lesions of the cervix has halved the number of new cases, as well as the number of deaths. It’s good. But it could be much better.
However, there is a preventive vaccine that protects against most of them, making it possible to prevent 2 out of 3 cancers of the cervix. Can we imagine having a vaccine available that provides protection, even imperfect, against a cancer that kills more than one in three patients, and refuse to use it? Yet this is what is happening in France.
Between the deadly communications of the anti-vaccine which misinform the population, with scientifically false arguments, and the reluctance of the authorities on this subject, the vaccination coverage does not increase. A proactive policy combining vaccination and screening could, however, save millions of lives worldwide, as confirmed by a study published on February 19 in the prestigious medical journal The Lancet.
Kate Simms and her colleagues modeled the cumulative effects of the global expansion of vaccination coverage and screening (which still remains beyond the reach of many countries) on the number of cases of cervical cancer. Their work has focused in particular on the frequencies of these cancers in low- and middle-income countries.
Their conclusion is clear: if, by 2020, a rapid increase in vaccination achieved 80-100% vaccination coverage (via a broad-spectrum HPV vaccine), nearly 7-8 million cases cervical cancer could be prevented globally. In the most advanced industrialized countries, such as the United Kingdom or Australia, coverage is greater than 85%, which suggests that HPV-induced cancers will disappear by 2030.
If, in addition to this vaccination, 70% of women in low- and middle-income countries were screened twice in their lifetime, at ages 35 and 45, between 12 and 14 million cancers of the cervix would could be avoided in the next 50 years.
Unfortunately, in France, the lack of solid scientific and medical information and the audience of fake news disseminated on the subject via social networks result in particular in reducing the vaccination coverage against the papillomavirus below 20% for young women. This level is dramatically lower than the 70% target theoretically set by health authorities and shows no progress.
By the end of 2015, less than 20% of girls had received at least 1 vaccine dose by age 15 (compared to 86% in the UK, 76% in Denmark, 71% in Italy, 73% in Spain and 87% in Portugal). After a modest increase (in 2017, 26% of 15-year-old girls had started vaccination, 21% had received the full regimen of the recommended two doses), the rate started to fall again in 2018, and fell back to a dismal 19%.
In terms of public policy, it is also regrettable that the recent marketing of the nine-valent HPV vaccine in France (Gardasil 9, protecting against nine different HPVs) was not accompanied by a withdrawal of the less protective older vaccines ( Gardasil with four valences, or even Cervarix protecting against only two viruses).
This lack of prophylactic action by the public authorities, combined with the lack of information of the population and practitioners, results in less than half of the young women vaccinated in 2019 benefiting from the most protective nine-valent vaccine!
The maintenance of obsolete less protective vaccines therefore further aggravates the absurdly low rate of overall vaccination coverage in France, which is at the level of that of the low- and middle-income countries of the Lancet study.
It is also essential to emphasize that human papillomaviruses do not only cause cancers of the cervix. They are also the cause of many other scourges: cancers of the vagina, vulva, ENT sphere or anus (in both men and women), as well as cancer of the penis.
Logic therefore dictates that vaccination coverage should also be extended to boys. Agnès Buzyn questioned the High Authority for Health on this subject, whose recommendation is eagerly awaited. In this context, the Grand-Est and Auvergne-Rhône-Alpes deserve a tip of the hat: at the forefront, these two French regions are trying to promote the vaccination of boys and girls. At the end of January, the Belgian Federal Center for Health Care Expertise gave the go-ahead for HPV vaccination for boys. According to some estimates, in Europe, vaccination with the nine-valent vaccine could prevent more than 350,000 condyloma (genital warts) in men each year, nearly 5,500 oropharyngeal cancers, more than 2,300 anal cancers or more than 1,100 penile cancers.
The positive effects of a well-affirmed health policy, like that of some of our European neighbours, are nevertheless visible. Thus, the legal obligation to vaccinate young children with vaccines combining 11 valences is already producing beneficial effects.
We can now hope to better protect the population against the most frequent infectious diseases and, incidentally, against the cancers that can result from them, sometimes years later, as in the case of hepatitis B or papillomaviruses. The WHO estimates that an improvement in global vaccination coverage, all vaccines combined, could prevent 1.5 million deaths each year.
Much remains to be done, particularly in France where inconsistencies remain in terms of vaccination policy. At a time when infectious diseases and cancers remain major scourges and when the efficiency of health expenditure is sought, an active prevention policy today can only reduce health expenditure tomorrow and contribute to the well-being of all citizens.
*Michel Cogné, Professor of Immunology at the Faculty of Medicine of Limoges, Member of the Institut Universitaire de France, Inserm U1262, University of Limoges