The global supply of human papillomavirus (HPV) prophylactic vaccines has been constrained since 2020.Vaccine manufacturers have increased capacity and new HPV vaccines are now available. Vaccine supply is now able to meet the full HPV vaccine demand which has been achieved earlier than predicted.
We advise that only clinically validated HPV assays which have fulfilled internationally accepted performance criteria be used for primary cervical screening. Further, assays should be demonstrated to be fit for purpose in the laboratory in which they will ultimately be performed, and quality materials manuals and frameworks will be helpful in this endeavor. Importantly, there is a fundamental shortage of well validated, low-cost, low complexity HPV tests that have demonstrated utility in a near-patient setting; representing a significant challenge and focus for future development in order to reach the WHO's goal of eliminating cervical cancer.
Recently, the International Papillomavirus Society (IPVS) convened a working group on cervical HPV latency, which resulted in an updated understanding of the HPV natural history. While the previous HPV natural history model considered HPV detection a result of HPV acquisition or possibly re-infection, and loss of HPV detection a result of viral clearance, the updated understanding of the HPV natural history is more nuanced. Thus, HPV detection may occur as a result of autoinoculation, deposition from a recent sex act, or as a redetection of a previously acquired infection. Similarly, loss of HPV detection likely reflects immune control rather than complete viral clearance. As it is practically impossible to identify the "true" source of a new HPV detection or determine why HPV is no longer detectable, we propose that health care providers and researchers use the terminology HPV detected vs HPV not detected. Moreover, we describe the updated understanding in a clinical context. Specifically, we discuss the potential implications of the updated understanding on clinical counseling in screening, and recommendations on cervical screening and HPV vaccination. We also suggest key phrases health care providers may use when counseling women attending routine HPV-based cervical screening.
Cervical cancer has killed millions of women over the past decade. In 2019 the World Health Organization launched the Cervical Cancer Elimination Strategy, which included ambitious targets for vaccination, screening, and treatment. The COVID-19 pandemic disrupted progress on the strategy, but lessons learned during the pandemic - especially in vaccination, self-administered testing, and coordinated mobilization on a global scale - may help with efforts to achieve its targets. However, we must also learn from the failure of the COVID-19 response to include adequate representation of global voices. Efforts to eliminate cervical cancer will only succeed if those countries most affected are involved from the very start of planning. In this article we summarize innovations and highlight missed opportunities in the COVID response, and make recommendations to leverage the COVID experience to accelerate the elimination of cervical cancer globally.