The World Health Organization (WHO) made a historic decision: it recommended reducing the vaccination schedule against the Human Papillomavirus (HPV) from two doses to a single dose. The measure seeks to improve access to this vaccine in poor countries and could impact the lives of millions of women and girls in Colombia.
Although men can contract and transmit the virus, they are not at the same risk as women. Therefore, vaccination is essentially recommended for them and the health system does not cover them.
“HPV is a sexually transmitted viral infection and, according to the WHO, it is very common for most men and women who have not been vaccinated to contract this virus at some point in their lives,” explained Viviana Noreña, regional medical director. of Profamilia for Antioquia and Santander.
Noreña added, however, that like other viruses, HPV has subtypes whose risk to the population may vary.
According to the Ministry of Health, the HPV vaccine that is applied in the national territory is tetravalent: it protects against four of the more than one hundred subtypes of that virus. This protection is very important, especially for HPV subtypes 16 and 18, because they produce genital warts and are responsible for 70% of cases of cervical cancer (of the cervix), which produces up to 2,490 deaths each year in Colombia, according to data. of the WHO.
Currently, the Colombian health system provides a free vaccine to patients between the ages of 9 and 17. This vaccination scheme contemplates two doses that are applied six months apart.
However, these application guidelines could change if the Ministry of Health decides to follow the conclusions of a recent scientific review exercise carried out by the WHO.
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After a meeting that lasted more than three days in the city of Geneva (Switzerland), the Advisory Group of Experts that advises this multilateral entity concluded that a single dose of the quadrivalent vaccine can offer sufficiently good protection against HPV.
“This could become a turning point for the prevention of the disease by having more doses for a greater number of girls,” the Advisory Group noted in a statement that was shared by way of conclusion after the meeting ended.
This is because the HPV vaccine is quite expensive, which has meant that a large number of low-income countries do not have guaranteed access to doses and therefore have not been able to protect their populations.
“There is a slow introduction of the HPV vaccination program in the world. Is this recommendation feasible in a context like Colombia’s? Yes, it is, because the application of a single dose will achieve protection against HPV in the population”, Noreña indicated.
The statement from the WHO expert advisers also comes with different indications for each age. They point out that the target population should be girls and adolescents between 9 and 14 years old, since the idea is that they can be immunized before they start their sexual life. To them, they recommend, one or two doses of the vaccine can be applied, depending on the possibilities of each country.
The same indication is given for young women between 15 and 20 years of age. But for women 21 and older, they did recommend sticking with the two-dose schedule.
In Colombia, however, the doses are only free for girls and young people between the ages of 9 and 17. “Why is one or two doses recommended for girls? Because their immune system is very competent, they react much more easily and produce more antibodies,” explained Natascha Ortiz, a gynecologist at the San Ignacio Hospital of the Javeriana University.
As for women facing diseases that affect their defenses, Ortiz noted that the recommendation is still to apply three doses. In fact, this is in line with the recommendations shared by the WHO. “Immunocompromised people, including those with HIV, should get three doses if possible, and if not, at least two. There is limited evidence on the efficacy of a single dose in this group,” the WHO noted.
For the rest of the women, at least in Colombia, frequent DNA/HPV tests and having a cytology done at least once a year are recommended. Should cervical cancer be detected, this will allow for an earlier diagnosis.
Ortiz said that several sexual and reproductive health experts are promoting that men with conditions that affect their immune system also have access to free HPV vaccination.
If we switch to the single-dose schedule of the vaccine, this could become a possibility, since fewer vaccines would be needed and coverage could be expanded.
Currently, young men in Colombia can apply the drug, but they have to pay for it.
It is a safe vaccine
Due to the fact that it is one of the most recent vaccines included in the Expanded Program on Immunizations (EPI) –it began to be applied in 2012–, this vaccine has been the subject of questioning that, however, does not have scientific evidence.
Public health experts and health authorities stress that it is much safer to be vaccinated against HPV than to develop uncomfortable symptoms such as genital warts or cervical cancer, in the case of women.
“This vaccine has been the product of long and rigorous scientific research that today guarantees its efficacy against HPV infection and therefore against cervical cancer,” they have pointed out from the Ministry of Health.
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