John Snow Professor of Epidemiology
The vaccine Gardasil 9 protects against nine types of the human papilloma virus (HPV), seven of which cause around 90 per cent of all cervical cancers.
Trials co-designed by Professor Jack Cuzick, Director of Queen Mary's Wolfson Institute, confirmed the safety and efficacy of the vaccine.
Professor Cuzick, as the only statistician appointed to the Study Scientific Advisory Committee, played a major role in the design, review and analysis of the trial's data. He also co-authored the resulting publications.
Gardasil 9, an improved form of the original vaccine Gardasil, also provides significant protection against other forms of cancer caused by HPV.
HPV is the most common sexually transmitted infection. There are hundreds of low-risk types of the virus – only around 13 types are known to be high-risk.
Most people who are infected by the virus are infected by the low-risk strains and don’t have any lasting issues.
Worldwide, HPV causes more than 630,000 new cancers annually, around 5 per cent of the global cancer burden.
Almost all cervical cancers are caused by high-risk types of the virus. In addition, high-risk strains of the virus are responsible for a range of other less common cancers.
These include around 90 per cent of anal cancers, 70 per cent of vaginal, vulvar and oropharyngeal (mouth and pharynx) cancer and 60 per cent of penile cancers. The virus also causes genital warts.
Cell structure of the human papillomavirus (HPV)
The first Gardasil vaccine became available in 2006. Originally designed for young women, the vaccine was used by 90 countries in their routine vaccination schedules. The original vaccine offers protection against two cancer-causing types of HPV (known as HPV 16 and 18).
Trials co-designed by Professor Cuzick confirmed that Gardasil 9 not only offered protection against the same two strains of the virus as the original vaccine but also protected against an additional five variants (known as types 31, 33, 45, 52 and 58). Taken together, these seven HPV types account for 90 per cent of cervical cancers.
Between 2007 and 2013, a study of 14,215 uninfected young women from 18 countries found that Gardasil 9 was 96.6 per cent effective in preventing high-grade cervical, vulval and vaginal disease caused by the five additional variants.
In 2016, Professor Cuzick assessed the safety of the Gardasil 9 vaccine in a combined analysis of seven phase III clinical trials. He found that the improved vaccine was safe and well-tolerated.
This means that Gardasil 9 is not only safe but also provides improved protection against cervical and other cancers.
Gardasil 9 offers the potential to increase overall cervical cancer prevention from 70 to 90 per cent, nearly eliminating this cancer among vaccinated women.— Professor Jack Cuzick
According to Professor Cuzick, "Gardasil 9 offers the potential to increase overall cervical cancer prevention from 70 to 90 per cent, nearly eliminating this cancer among vaccinated women."
"However, it’s crucial to remember that vaccination must be done before exposure to the virus."
The success of the vaccination programme also means that eventually less screening will be needed, as women will have greater protection against HPV from the outset.
As a result, Professor Cuzick's research has led to worldwide changes to vaccination programmes, not least as Gardasil 9 offers protection against multiple cancers.
From 2017, Gardasil 9 was the only HPV vaccine available in the US. The vaccine is routinely offered to school children (both boys and girls) in Canada, Denmark, New Zealand and Australia.
By 2020, Gardasil 9 had been approved for use in 83 countries.
Since the vaccine rollout in 2015, millions of doses of Gardasil 9 have been distributed globally.
Queen Mary has a lasting link with these patients: Professor Cuzick's work is explained to patients in the vaccine packaging leaflet, proof of the vaccine's effectiveness and safety and the reassurance of life-long protection.
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