July 8, 2010 – Some 1,800 scientists and specialists from 93 countries gathered last week in Montreal for the 26e International conference on the human papillomavirus (HPV), the most common sexually transmitted infection in the world and responsible for cervical cancer and the development of warts.
Dr Marc Steben
Their goal? Share their knowledge in terms of screening, vaccination, research and education on this virus, so that scientists then engage in political activism to accentuate the prevention of infections and extend vaccination against HPV in the world1.
PasseportSanté.net spoke with Dr Steben, who is also a medical consultant at the Institut national de la santé publique du Québec (INSPQ).
What are the goals of the HPV conference?
“We want knowledge sharing to result in a rapid and concrete improvement in the health status of the world’s population. In his opening speech, Stephen Lewis, former UN special envoy for HIV / AIDS in Africa, denounced the fact that, unlike them, we have all the tools to fight HPV and that despite everything, this virus is a plague in Africa. This suggests that the life of an African woman is not worth as much as that of a woman from an emerging country. Which is unacceptable. It’s time to stop investing just in research and take action in the interests of global health. There is a need to reflect and decide on how to move forward in the field of HPV screening and vaccination, given the limited resources, the economic crisis, the health professionals – who are receiving more general training rather than specialist – and competition from other public health issues.
Besides emerging countries, what is the situation in industrialized regions and countries like Quebec and Canada?
The situation of indigenous people in Canada is similar to that of emerging countries. Inside big cities like Montreal, there are people who live on social assistance, who are illiterate, who have bad lifestyles who are more at risk of suffering from cervical cancer. . It’s not acceptable. The screening and vaccination program has dramatically reduced cancer rates, but much more can and must be done.
The National Vaccination Program was introduced in Quebec in the fall of 2008. Nearly two years later, what is your assessment?
Our immunization coverage amounts to 80% of girls, which places Quebec among the best countries in the world. But we should not be satisfied with this result. We need to improve our cervical cancer screening strategy because, weirdly enough, we are lagging behind globally. An improved screening program, with new practices and guidelines, should be launched next year.
When the vaccination program was launched, some denounced the government’s haste. Is it still allowed to doubt it?
No. The 13 countries participating in clinical trials as well as the ethics committees had judged at the time that the available data proved the efficacy and safety of this vaccination. Since then, 80 million doses of quadrivalent vaccine and 10 million doses of bivalent vaccine have been distributed, which means that around 30 million women have been vaccinated. No problem has been reported.
The most widely used vaccine, Gardasil®, protects against four strains of HPV, two of which are responsible for 70% of cervical cancer cases. Why not also vaccinate against the strains involved in the remaining 30% of cases?
These strains are also linked to other cancers, such as that of the vulva and anus. But more importantly, they are associated with an accelerated cancer risk. The time between infection and a high grade lesion is very short compared to other strains. There is much less time to get tested to find cancerous lesions and then treat them.
The vaccine is now available for boys. Is it necessary?
Once 80% of girls are vaccinated, there is no need to invest in vaccinating boys since they are indirectly protected.
The government justified the mass vaccination of the population against the influenza A (H1N1) virus under the pretext of an epidemic. Can we draw a parallel with HPV?
In the case of HPV, it is endemic, which is worse than an epidemic, because 80% of women have it at all times. There is no peak in seasonal infections, as with the flu. HPV has been present in the population for years.
Among the hundreds of studies presented at the congress, do some go against the relevance of mass vaccination against HPV?
None, and yet there are no exclusion criteria. The issue of HIV / AIDS has progressed a lot because people who had different ideas came to share them in the congresses. I am surprised that these people, who in the media claim to be experts, do not come to international congresses to share their knowledge. It is the clash of ideas that creates science.
Would hosting an HPV conference be possible without the support of the pharmaceutical industry? Should we be concerned about its influence?
The congress is subsidized up to 45% by pharmaceutical companies (GlaxoSmithKline, MSD, Roche, Gen-Probe, Hologic, Qiagen, Abbott Molecular). At the previous congress held in Malmö, Sweden, no emerging country was represented because the cost of travel was too high in the absence of pharmaceutical funders. Our objective was therefore to be accessible to all researchers. We have complete independence with regard to the content of the conferences. I myself am part of the scientific council of Merck Froost. We have published studies from very large databases that have enabled us to understand HPV infection. Fifteen scientific articles could never have been written, because they would have cost enormous sums to produce. It is certain that these companies have an advantage to ally themselves with people who have a lot of experience and who know where the problems and the stakes lie, so that their money is spent in the best way. But this can be done independently.
What are the consequences of the congress?
Political activism! We hope to sign the Montreal declaration in which the researchers will commit to pushing their government to invest in better screening and better accessibility of the vaccine to groups of isolated populations in developed countries and especially in emerging countries. We will be able to take stock of this during the next congress to be held in Berlin (Germany) in 2011.
|
HPV is the cause of anogenital infections that resolve naturally in 90% of cases in less than two years. However, these infections can develop into cervical cancer over the long term. In Quebec, there are 325 cervical cancers annually, a quarter of which are fatal. Located at 13e rank of cancers affecting Quebec women of all ages, it is the 2nde cancer in importance in women aged 20 to 44. In 2008, a vaccination program targeting mainly preadolescents was implemented in Quebec in order to prevent HPV infections as well as the risk of cancer. |
Louis Gagné – PasseportSanté.net
1. On this subject, read our dossier HPV and vaccination: what you need to know.
2. To access the 26e International HPV Conference: http://hpv2010.org/main/ [consulté le 8 juillet 2010].
