The cancer is caused by an infection with a virus called papilloma virus and when I was first interested in that field what we were trying to do was to develop therapies to treat people with cervical cancer by attacking the virus but along the way we developed the technology for building the shell of the virus which has become the basis of the vaccines now available to help prevent cervical cancer.
You must be very gratified to see the way it’s rolling out.
The vaccine is making a big impact on HPV infection and the risk of developing cervical cancer, particularly in the developed world countries where we have data on its efficacy. It has shown that over eight years of use in Australia we’ve managed to virtually wipe out the virus amongst the age group that have been immunised.
And developing countries?
The big challenge for cervical cancer is global. Most of the cervical cancer, most of the 270,000 deaths from cervical cancer are currently in the developing world. Of course in the developing world we have no screening programmes for cervical cancer, we have no effective means of treating it and therefore the vaccine is the only hope. But getting the vaccine out there is the big challenge.
How do you call people in? How do you tell people that this is a preventable disease? How do you not scare the hell out of them?
We’ve had to do a lot of education about cervical cancer and about its connection with the virus and infection. There was a lot of misinformation at the beginning and people were naturally nervous about the idea that you could catch a cancer through an infection. But when you explain that these infections are very common, that for most of us we never even know we have them and we just get rid of them ourselves, but for the unlucky few people who get persisting infection there’s a risk of cancer, then it becomes easier to explain why a vaccine would work in the same way as other vaccines that we use to prevent other common infections.
So we need a big public education programme.
Education is the key to success for every public health measure and particularly for cervical cancer we need to get the information out there that this is a common disease, it’s a disease that we can prevent through vaccination. It’s also a curable disease if we can get the resources where they’re needed.
And pricing, a big issue in developing countries is it? You’re winning the discussion there?
The vaccine was expensive to develop, largely because fifteen years of work had to go in to proving that it was safe and effective. Someone has to pay that development cost, they’re estimated at between $2-4 billion. So basically the vaccine is expensive in the developed world because we are paying the development costs in arrears. In the developing world the companies that make the vaccines have made them available at a much reduced cost, basically the cost of manufacture. That has been helped extensively by Gavi, the Global Alliance for Vaccines Initiative, basically they have agreed to buy the vaccine for developing world countries at cost, $5 a dose, and make it available to countries that commit to introducing vaccine programmes that are sustainable.
And you’ve been doing studies on two shots instead of three shots of the vaccine?
There have been a number of studies looking to see whether two shots of vaccine is as good as three. Now at the moment we only have data to say it’s as good at producing an immune response, we do not yet have data on whether it is as effective as a three dose regime. But there are data hints from the big phase III clinical trials that were done that those people who only got two doses during the trials where they should have got three seem to be as well protected for the first five years at least as those who got three doses.