Vaccine Passport – Have You Got Your Cancer-prevention Stamp?

As our collective consciousness is focussed on coronavirus and the new COVID vaccines, it seems timely to remind New Zealanders about another effective virus-fighting vaccine that we should be thinking about too: Gardasil. This highly effective, safe vaccine fights the Human Papillomavirus, known as HPV, and massively reduces the risk of developing genital warts, as well as multiple different forms of cancer.

The 4th of March marks International HPV Awareness Day. HPV is one of the world’s most widespread viral infections, usually resulting from direct skin-to-skin contact during intimate sexual contact with someone who has HPV. The virus can be transmitted by penetrative as well as non-penetrative sexual contact and is thought to be the most common sexually transmitted infection in the world. The Head and Neck Cancer Foundation Aotearoa (HNCFA) and the Sexually Transmitted Infections Education Foundation (STIEF) want to take this opportunity to remind New Zealanders about the devastating health impacts that can result from HPV infection, and to encourage those that haven’t already had their Gardasil vaccine, to book in now!

For the majority of the population, it is not a case of if, but when, you get exposed to one or more of the over 40 different strains of HPV that infect the ano-genital and throat areas. It is considered the 'common cold' of being sexually active. In some people, the virus is harmless and causes no symptoms. In others, it will go on to cause genital warts, which are undesirable but not life-threatening. However, in a few people, HPV can cause abnormal cells to develop in different parts of the body, which can lead to cancer, sometimes decades later. It isn’t possible to predict which group you will fall into if you do get exposed to HPV, but it is possible to protect yourself by getting vaccinated.

If we look at cancer risks, HPV is associated with almost 100% of cervical “pre-cancers” and cancers, and the detection and treatment of these creates a huge health burden for affected women. Each year in New Zealand there are around 25,000 abnormal smear tests, many of which lead to invasive and unpleasant colposcopy and other procedures. HPV infection can also cause cancer of the vulva, vagina, penis and anus – and unfortunately condom use during sex doesn't reliably prevent transmission of this virus.

Aside from cancers of the cervix and genital regions, in recent years, there is a rapid rise in HPV-related throat (oropharyngeal) cancers in heterosexual men, which were historically largely related to smoking and heavy drinking. These types of cancers affect the throat, and unfortunately notoriously difficult to detect, meaning that they are often only discovered in advanced stages. This was the case for Whāngarei GP, Dr Andrew Miller, who was diagnosed with HPV-related oropharyngeal cancer in 2014 at the age of 50, after experiencing a few innocuous symptoms – occasional blood-stained mucous from his nose whilst running and slight numbness in one of his teeth. By the time the cancer was diagnosed, things had progressed, spreading into the jaw bone. A gruelling 16 months of treatment was required including radiotherapy, chemotherapy, and surgery to remove the jaw bone and reconstruction using his leg bone to rebuild the jaw. Listen to Andrew speak about his journey here.

The good news is that HPV infection and the resultant diseases are preventable. Vaccination against HPV infection has been available for many years and is highly effective and safe, with millions of doses administered worldwide. In New Zealand the HPV vaccine, known as Gardasil, is free for people aged from 9 years up to their 27th birthday. For those who have missed the school vaccination programme (year 8 students), the vaccine is available free of charge through their GP or health care provider. Dr Cathy Stephenson, a GP with a special interest in youth health, says “I truly can’t think of a single reason not to get this vaccine. It’s safe, it’s free, it’s been extensively used and analysed around the world, and it prevents cancer.” Dr Swee Tan, head and neck cancer surgeon and Chair of the HNCFA, says “HPV-related throat cancer affects both men and women. It is a devastating disease that can be prevented by HPV vaccination.”

It is of concern to the HNCFA and STIEF that vaccination rates against HPV in New Zealand are too low and that a significant cohort may have either missed out on the vaccine through the school-based programme and are unaware that it is available to them, or may be only partially vaccinated. We have yet to reach the target of 75% coverage across all DHBs, which the Ministry of Health hoped to achieve by December 2017. This is still less than recent modelling studies which suggest that vaccination rates may need to be at least 80% for herd immunity to be effective.

So, on Wednesday, as the world acknowledges the impact that HPV infection has had on so many lives, HNCFA and STIEF urge you to talk to the young people in your lives – if they haven't had their Gardasil immunisations, encourage them to do so. As Dr Miller, whose life has been dramatically changed by HPV infection, says, "it's an absolute no-brainer. If I had children – and declined vaccination on their behalf – I would struggle to explain that decision to them later on in life if they were facing the diagnosis that I have had to".

For more information visit NZ HPV Project website.

About the Sexually Transmitted Infections Education Foundation (STIEF):

The Sexually Transmitted Infections Education Foundation (STIEF) is a registered charity providing governance and project management to the New Zealand HPV Project, New Zealand Herpes Foundation and Just the Facts (about sexual health and STIs). The organisation provides medically accurate information, support, education and resources based on current international best practice, regarding the optimal management of HPV, herpes and other STIs.

About the Head and Neck Cancer Foundation Aotearoa (HNCFA)

The Head and Neck Cancer Foundation Aotearoa (HNCFA) vision is to promote prevention, early detection, and improved treatment of patients with cancer in the head and neck area.

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