The Australian Experience With the Human Papillomavirus Vaccine

Objective: The goal of this study was to review the current human papillomavirus (HPV) vaccine program and its outcomes to date in Australia. Methods: This was a review of the published data relating to the introduction and subsequent measurable outcomes of the quadrivalent vaccine, which became part of the Australian national HPV immunization program in 2007. Australia commenced an ongoing, schoolbased, government-funded, HPV vaccination program using the quadrivalent vaccine from April 2007 for adolescent female subjects aged 12 to 13 years, together with a catch-up program for female subjects 13 to 26 years of age from July 2007 to December 31, 2009. Results: The Australian community (lay and clinical) have embraced the program, resulting in high coverage with >70% for 3 doses in the 12- to 13-year-old ongoing target population. Vaccine effectiveness (outcomes of vaccination in a real-world setting) is already being seen. This effectiveness has been noted in significant reductions in HPV vaccine related infections in vaccine eligible age female subjects (77% fall in prevalence), rapid reduction of >90% in genital warts (first marker of disease reduction, as well as herd immunity), and reduction in high-grade cervical lesions in this age group. These remarkable changes so soon after implementation of the vaccine in the country occurred faster, and to a greater extent, than anyone could have predicted. Conclusions: These findings from Australia should encourage other countries to follow suit, with the ultimate aim of translating treatment into reductions in HPV-related neoplasia globally. The greatest success from such an approach will only be realized when prophylactic vaccines are rolled out effectively, with high coverage and at affordable costs, to those areas of the world with the highest burden of disease. To achieve this outcome requires government endorsement and commitment; education of the community at large; realization of the safety, efficacy, and immunogenicity of the available prophylactic vaccines in reducing HPV-related infections and disease, especially neoplasia; and governments procuring vaccines at affordable prices through the various options now available (eg, support from the GAVI Alliance to eligible countries, tiered pricing, negotiation with pharmaceutical manufacturers). We have the tools to reach this goal, and it is time these tools were implemented. (C) 2014 Elsevier HS Journals, Inc. All rights reserved.