Our latest Pieces of the Continent interview is with Dr Kevin Pollock, who leads the HPV vaccine surveillance programme for Scotland; a country with one of the highest HPV vaccine rates in the world.
Please introduce yourself and tell us a bit about your background
I lead the HPV vaccine surveillance programme for Scotland. My background was primarily from academia where I assessed how vaccine adjuvants can be manipulated to affect immune response. Thus, I feel qualified to discuss both the safety and efficacy of current and future vaccines. I have led the HPV vaccine surveillance programme since 2012 and I am also a Board Trustee for Jo’s Cervical Cancer Trust. The latter is an amazing charity full of incredibly diligent individuals.
What sort of research into HPV have you recently conducted?
We have examined population-based data ascertaining impact of the HPV vaccine on HPV prevalence and cervical abnormalities. We have also assessed HPV prevalence in a number of other sites including vulval, oropharyngeal, and rectal mucosa. We have also conducted qualitative studies exploring disparities in vaccine uptake.
How do you carry out your work? (i.e. how do you monitor the HPV vaccine programme, what methods and tools do you use?)
Population-based data in Scotland can be linked. So, using a unique identifier for every woman born in Scotland, we can link immunisation registry data and attendance at first smear. This allows us to evaluate how effective the vaccine is at both prevalence and cytology level, for both individual- and population-based data.
How popular has the HPV vaccine been in Scotland?
For girls, the uptake has generally been as high as 90% since 2008. In Scotland, a programme for men who have sex with men (MSM) was commenced in July 2017. Provisional vaccine uptake for one dose has been 64%, which is very encouraging.
What has the effect of the vaccine been on incidences of cervical cancer in Scotland? How might these results be translated to other HPV-related cancers?
Cancer registry data for Scotland has shown a gradual decline in cervical cancer for those aged 20-24 (from 13 cases in 2012 to 4 cases in 2016). Although these numbers are small, they strongly relate to the 71% reduction in high-grade disease previously published. Given that HPV16 is responsible for 90% of vulvovaginal cancers, 60% of oropharyngeal cancers, and 90% of anal cancers, the potential impact of the vaccine will be profound.
What, do you believe, will be the effect of introducing boys to the HPV vaccination programme in 2019?
No date has been finalised as yet although September 2019 has been mooted. Gender-neutral vaccination will remove the stigma attached to this vaccine. It will also provide an equal opportunity for both boys and girls to be vaccinated, which is likely to augment the elimination of clinically-relevant HPV.
Any final thoughts? Anything we haven’t covered that you would like to mention?
To date, the HPV vaccine has been shown to be very effective in preventing infection with high-risk HPV with consequent reduction in both low- and high-grade cervical disease. Data on the impact of the vaccine on cervical cancer are now becoming available but it will really be next year when we start to virtual elimination of HPV-driven cervical cancer in women under 25, in countries that have high uptake of the vaccine. High uptake = high impact. This is a key message that must be promulgated.
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