Cervical cancer is the second most common type of cancer in women, with more than 530,000 women around the globe receiving a diagnosis each year. Revolutionary vaccines, based on innovative “virus like particle” technology developed at The University of Queensland, are providing protection against the deadly disease to millions worldwide, and could have an even greater impact through increased access to developing countries, advocates say.
Vaccines based on technology created by university researchers Ian Frazer and the late Jian Zhou, and developed commercially as Gardasil and Cervarix, significantly lower the risk of human papillomavirus (HPV)-related cancers, including cervical cancer, with 205 million doses administered in 130 countries as of 2018.
Four out of five people are believed to become infected with one or more of the HPVs that cause genital warts and cervical cancer, and that are also linked to cancers of the anus, penis, mouth, and throat.
In girls and young women ages nine to 26, Gardasil 4 is a recognized bulwark against two types of HPV that cause roughly 70 percent of cervical cancer cases, and two more types that result in 90 percent of genital warts cases, while the more recently introduced Gardasil 9 increases the vaccine coverage to over 90% of cervical cancers. The University of Queensland breakthrough technology also guards against cancers of the vagina and vulva, demonstrating a promising progression in the ongoing research, says Frazer, a Scottish-born immunologist.
“The early figures are very encouraging,” he says. “The vaccines are safe, as effective as we expected, and can be delivered worldwide. The real success will be with universal adoption of immunization.”
While the developed world has easy access to vaccines, it’s poorer countries where cervical cancer deaths are most prevalent, due in part to the restricted availability of potentially life-saving Pap smear tests. About 275,000 women died from the disease in 2013, with approximately 85 percent of these deaths occurring in low- or middle-income countries, according to the World Health Organization. Failing vaccine-led intervention, WHO predicts upwards of 400,000 cervical cancer deaths in the world’s poorest nations by 2035.
In 2017, authorities in China verified the approval to sell one of The University of Queensland’s HPV vaccines domestically, marking a momentous step forward in Gardasil’s potential impact on the quality of women’s health, Frazer says.
“Introduction of the vaccines into China would demonstrate the commitment of the largest country on the planet to the eradication of a common preventable disease and would therefore set an example for other developing economies to follow,” he says.
In the beginning
Frazer and Zhou based their invention on the research of German physician and Nobel Prize winner Harald zur Hausen, who first mentioned HPV as possibly playing a role in cervical cancer during the mid-1970s. In the early 1980s, zur Hausen and colleagues identified that a specific type of HPV – HPV 16 – was likely a significant contributor to most cervical cancers, as well as other cancer types found in both men and women.
After emigrating to Australia, Frazer created a research group dedicated to developing a cervical cancer vaccine, running into a roadblock when growing the HPV virus in a laboratory setting proved impossible. Frazer teamed with molecular virologist Zhou at The University of Queensland to clone HPV surface proteins and, eventually, derive a vaccine that offers full protection from the most lethal HPV types.
[[video url="https://www.youtube.com/watch?v=IkSD4cGxn3U&index=2&t=0s&list=PLDw3kzJ-_eUAiGL7ehHoschCn4rQhq1MS” align="center” size="full-width” class="" starttime="" caption="" credits="Universities Australia”]] Since their introduction in Australia in 2007, the vaccines have reduced the rate of cervical cancer-causing infections in Australian women by almost 90 percent. In 2014, the U.S. Food and Drug Administration approved a follow-up vaccine, designed to safeguard users from nine different HPV strains.
Though Zhou died in 1999, his wife and fellow research team member Xiao Yi Sun says her husband would be happy to know of Gardasil’s overwhelmingly positive effect in the prevention of HPV-related illnesses.
“Jian was a very humble man and was happiest when working in his lab,” says Sun. “Were he alive today, he would simply be happy to have been part of something that saved lives.”
Sun lauds the Australian government for giving The University of Queensland’s research much-needed financial backing through the years, a level of commitment she wants to see replicated elsewhere.
“The benefits have been remarkable and I always had faith in the effectiveness of the vaccine, but the Australian government needs to be applauded,” Sun says. “I hope other governments will look at these results and realize that the investment in early prevention ensures significant savings in the long run, and less impact on the overall healthcare budget.”
What’s next?
Frazer is currently working on new vaccine technologies for herpes and for cancer treatment, while shepherding cervical cancer prevention programs in the South Pacific nation of Vanuatu. Supporters of Frazer’s research say affordable immunization protection is vital in the battle against cancer, especially for regions lacking basic healthcare and preemptive diagnostic procedures.
“The development of the (HPV) vaccines has meant a longer and healthier life for so many women,” says Sun. “This is thanks to the huge number of people devoting a large part of their lives to keeping the fight against this terrible disease at the forefront of government thinking all around the world.”
The vaccine’s decade-long success validates the power of teamwork in making a measurable difference to global health, research proponents note. Most countries in the developed world now have government-funded public health programs targeting 12- to 14-year-old girls. Australia also has a public health program for boys, as HPV causes some cancers in men, and immunizing boys also reduces the risk of girls acquiring the cancer-causing HPVs.
Karen Canfell, an epidemiologist and director of cancer research at Australia’s Cancer Council NSW, points to Gardasil’s considerable impact in her native country, where women who received three full courses of the vaccine experienced an 86 percent reduction in HPV infection, according to findings published in the journal Clinical Infectious Diseases.
“With the HPV vaccine program rolled out in 2007 and offered to all women up to 26 years of age, we have now reached a huge milestone where every woman in Australia aged 35 years and younger is better protected against HPV than ever before – a truly remarkable feat,” says Canfell.
