South Africa’s school-based HPV vaccination programme is paying off, protecting girls and young women from the cancer-causing virus even if they later become infected with HIV, new research led by Wits scientists shows.
The vaccine offers protection against two strains of the human papilloma virus, HPV-16 and HPV-18, which are responsible for about 70% of all cervical cancer cases. In sharp contrast to global trends, cervical cancer is the leading cause of cancer deaths among women in South Africa due to its weak public health services and the high prevalence of HIV, which increases the risk of HPV infection six-fold. South Africa has the world’s highest HIV burden, with an estimated 8-million people living with the disease.
The school-based HPV vaccination programme began in 2014, offering free shots to girls in grade 4 at public schools, provided they were nine years or older. As HPV is sexually transmitted, the vaccine is most effective if it is administered before girls begin having sex.
The researchers investigated HPV prevalence among girls aged 17 and 18 at two points in time: a 2019 cohort that would have been too old to receive HPV vaccines when the school-based programme began and a 2023 cohort that had received the shots. They found the prevalence of HPV-16 and HPV-18 was more than 80% lower among the 2023 cohort, irrespective of whether they had HIV.
“It is a good news story for the South African government, which made the decision in 2014 to invest in an expensive vaccine in the expectation that it would have long-term public health benefits,” said Wits RHI research director Sinead Delany-Moretlwe.
“It’s really important that we’ve been able to show that in a high HIV burden setting girls can benefit and be protected from HPV,” said Delany-Moretlwe, who co-authored a study describing the research published in the peer-reviewed journal The Lancet Global Health. The study was conducted in partnership with the Kirby Institute at the University of New South Wales.
Until now, most evidence on the effectiveness of HPV vaccines in people living with HIV has come from studies on people who were vaccinated after HIV infection, which means they may have already been exposed. The South African study has global implications, said Wits, as it provides evidence for countries with high HIV prevalence to implement and sustain early, school-based HPV vaccination programmes.
“Such programmes have the potential to dramatically reduce cervical cancer risk, improve women’s health outcomes and ultimately save lives worldwide.”
South Africa has the third-highest HIV prevalence among women of childbearing age in Africa. More than 10,500 new cervical cancer cases were diagnosed in 2022, and almost 6,000 deaths from cervical cancer were recorded.
The health department now gives the HPV vaccine to girls in grade 5 and recently expanded the programme to private schools.
The bivalent vaccine now on offer provides indirect protection to boys and unvaccinated girls, but greater impact could be achieved if the government switched to the latest nonavalent vaccine, which protects people against nine strains of HPV, said Delany-Moretlwe.
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