A review of ethical and legal aspects of gender-neutral human papillomavirus vaccination

Knowledge, attitudes, and practices towards Human Papilloma Virus and uptake of HPV vaccine: A protocol for a systematic review

BACKGROUND

Despite a high burden of Human Papilloma Virus (HPV)-associated diseases, HPV vaccine uptake is disparate globally. The objective of this systematic review is to summarize the existing evidence on knowledge, attitudes, and practices (KAP) regarding HPV and the uptake of the HPV vaccine.

METHODS AND ANALYSIS

We will conduct a systematic review of observational studies that report data on HPV KAP and vaccine uptake among people aged 16 and above. We will search MEDLINE, CINAHL, Embase, Emcare, Web of Science, Cochrane Library, Global Health, and PsycInfo. We will conduct screening, data extraction, and assessment of the methodological quality of the included studies in duplicate. A random-effects model will be used to pool data. Subgroup analysis will be done for age younger adults (≤ 26 years old) and older adults (> 26 years old), sex (men and women), income level (as per World Bank), and WHO region. This systematic review will be reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The PROSPERO registration number for the review is CRD42024532230.

ETHICS AND DISSEMINATION

Ethical approval is not necessary as this study will review secondary published data. Our findings will be disseminated as part of a doctoral thesis and through peer-reviewed journal publications and conferences.

Scientific approaches toward improving cervical cancer elimination strategies

At the 2023 EUROGIN workshop scientific basis for strategies to accelerate the elimination of cervical cancer and its causative agent, human papillomavirus (HPV) were reviewed. Although some countries have reached key performance indicators toward elimination (>90% of girls HPV vaccinated and >70% of women HPV screened), most are yet to reach these targets, implying a need for improved strategies. Gender-neutral vaccination, even with moderate vaccination coverage was highlighted as a strategy to achieve elimination more rapidly. It is more resilient against major disturbances in vaccination delivery, such as what happened during the coronavirus pandemic. Further, an analysis of ethical/legal issues indicated that female-restricted vaccination is problematic. Extended catch-up of vaccination with concomitant screening, and outreach to vulnerable groups were highlighted. Although birth cohorts with high coverage of HPV vaccination at school are protected against HPV, and HPVs have a very low reproductive rate in women above age 35, adult women below age 30 have inadequate direct protection. In addition to herd protection from gender-neutral vaccination, this group can be protected by offering concomitant catch-up HPV vaccination and HPV screening. Furthermore, hepatitis B vaccination experiences indicate that elimination cannot be achieved without prioritizing vulnerable/migrant populations. The long-lasting durability of vaccination-induced antibody responses suggests prolonged protection with HPV vaccines when adequately administrated. Finally, cost-effectiveness modelling suggests that high-coverage HPV vaccination in multiple population segments will be resource-saving due to reduced need for screening. In summary, the workshop found that strategically optimal deployment of vaccination will accelerate elimination of HPV and cervical cancer.

Prophylactic Human Papillomavirus Vaccination: From the Origin to the Current State

Immunization is the most successful method in preventing and controlling infectious diseases, which has helped saving millions of lives worldwide. The discovery of the human papillomavirus (HPV) infection being associated with a variety of benign conditions and cancers has driven the development of prophylactic HPV vaccines. Currently, four HPV vaccines are available on the pharmaceutical market: Cervarix, Gardasil, Gardasil-9, and the recently developed Cecolin. Multiple studies have proven the HPV vaccines' safety and efficacy in preventing HPV-related diseases. Since 2006, when the first HPV vaccine was approved, more than 100 World Health Organization member countries reported the implementation of HPV immunization. However, HPV vaccination dread, concerns about its safety, and associated adverse outcomes have a significant impact on the HPV vaccine implementation campaigns all over the world. Many developed countries have successfully implemented HPV immunization and achieved tremendous progress in preventing HPV-related conditions. However, there are still many countries worldwide which have not created, or have not yet implemented, HPV vaccination campaigns, or have failed due to deficient realization plans associated with establishing successful HPV vaccination programs. Lack of proper HPV information campaigns, negative media reflection, and numerous myths and fake information have led to HPV vaccine rejection in many states. Thus, context-specific health educational interventions on HPV vaccination safety, effectiveness, and benefits are important to increase the vaccines' acceptance for efficacious prevention of HPV-associated conditions.