Human papillomavirus vaccine effect against human papillomavirus infection in Rwanda: evidence from repeated cross-sectional cervical-cell-based surveys

A new study by researchers from the International Agency for Research on Cancer (IARC), in collaboration with the Ministry of Health of Rwanda and partner institutions, has shown that vaccination against human papillomavirus (HPV) has more than halved the prevalence of high-risk HPV types in Rwanda in less than 8 years.

The research team evaluated the efficacy and effectiveness of HPV vaccination in Rwanda, where cervical cancer is the second most common cancer type. The effectiveness and efficacy of HPV vaccination have been repeatedly shown in high-income settings. This new article, which was published in The Lancet Global Health, is the first of its kind to evaluate HPV vaccination in Africa.

Between 2013–2014 and 2019–2020, this study found a substantial overall reduction of 52% in the prevalence of four high-risk vaccine-targeted HPV types (HPV6, 11, 16, and 18); an indirect effect from herd immunity contributed significantly to these results. The total effectiveness of HPV vaccination was lower than in clinical trials, because the average age at vaccination was 14 years and hence some girls were already sexually active when vaccinated; this reiterates the known prophylactic role of HPV vaccines.

Importantly, the findings highlight differences according to education level and HIV status. Vaccine effectiveness was lower in girls who were not enrolled in school, and was also lower in girls living with HIV. This information is essential for national public health authorities to be able to adapt programmes to increase vaccination coverage. HPV infections can almost be eliminated through high coverage of HPV vaccination, and because oncogenic HPV infection is the necessary cause of cervical cancer, HPV elimination is the route to cervical cancer elimination.

These findings encourage increased vaccination coverage and improved cancer control in Rwanda. They can also help to enable wider implementation of HPV vaccination across sub-Saharan Africa, strongly contributing towards the World Health Organization goal of eliminating cervical cancer as a public health problem.

In 2011, Rwanda became the first country in Africa to implement a national HPV vaccination programme. This study, funded by the Bill & Melinda Gates Foundation, aimed to estimate the population-level effect of HPV vaccination on HPV prevalence (the proportion of individuals with HPV infection at a given time) over a given period.

Sayinzoga F, Tenet V, Heideman DAM, Sibomana H, Umulisa MC, Franceschi S, et al.
Human papillomavirus vaccine effect against human papillomavirus infection in Rwanda: evidence from repeated cross-sectional cervical-cell-based surveys
Lancet Glob Health, Published online 16 May 2023;
https://doi.org/10.1016/S2214-109X(23)00193-6

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