How vaccines transform health care

April 29, 2020
Collage of HPV virus, influenza virus and SARS-CoV-2 virus
Existing vaccines for the HPV virus (left) and flu virus (top right) are a key part of the public health arsenal. Scientists are working to add a vaccine for SARS-CoV-2 (bottom right), the virus that causes COVID-19, to the mix. iStock/CDC

With scientists working worldwide to develop a vaccine for SARS-CoV-2, the virus that causes COVID-19, it has some cancer researchers posing an important question.

What can be done to educate the public about the lifesaving advantages of vaccines that already have been developed and proven to be safe and effective?

That’s been on the mind of Kathleen Cartmell, Ph.D., a Clemson University associate professor in the Department of Public Health Sciences. She is leading an initiative at Hollings Cancer Center at the Medical University of South Carolina to increase human papillomavirus (HPV) vaccination rates among kids. The vaccine prevents six types of HPV-related cancers.

“We have cancers that we know exactly how to prevent with the HPV vaccine, but there is no vaccine for COVID-19, and that's what we're wishing for with all of our hearts,” Cartmell said.

She hopes that all the news about developing a vaccine for COVID-19 will heighten interest in the vital role that vaccines play. 

“When it’s safe for our children to get back to going to their well visits and getting their recommended vaccines, I would love to see parents and health care professionals help us get a higher number of our children protected from HPV-related cancers,” Cartmell said.

Kathleen Cartmell 
Dr. Kathleen Cartmell leads the Hollings Cancer Center HPV initiative. She hopes news about a COVID-19 vaccine will increase awareness about the vital role of vaccines. Photo by Emma Vought

According to the Centers for Disease Control and Prevention (CDC), two doses of the HPV vaccine are recommended for all boys and girls at ages 11 to 12, and the vaccine can be given as early as the age of 9. Catch-up vaccination is also recommended for adolescents and young adults up to the age of 26 who missed getting the vaccine earlier. 

Each year, HPV is estimated to cause more than 580 new cancer cases in South Carolina. HPV can cause cancers that affect men and women, including cervical, oropharyngeal (throat) and other anogenital cancers (anal, penile, vaginal, vulvar). 

Denis Guttridge, Ph.D., interim director of Hollings Cancer Center, said many studies have shown the vaccine to be safe and effective. However, the state’s vaccination rate needs to be higher.

In 2016, the data showed that only 44% of adolescents had received their first dose of the HPV vaccine, and the state had one of the lowest vaccination rates in the nation. By 2018, the rate increased and 63% of teens in South Carolina had received their initial doses of the HPV vaccine.

Part of that increase comes from a Hollings Cancer Center HPV awareness campaign done in collaboration with statewide partners. The cancer center initiated a $700,000 three-year project in 2018, including a social and digital media campaign, to educate parents, adolescents and health care providers in the state about the HPV vaccination and to empower parents to be advocates for HPV vaccination. Health providers hope to reach at least 80% of young adults to protect the next generation of adolescents fully from HPV-related cancers. 

“This country is racing to generate a vaccine to control the COVID-19 pandemic because we know vaccines save lives,” Guttridge said. “Vaccination against HPV has shown to significantly reduce the risk of cervical cancer in women, and other cancers in both men and women, yet our vaccination rates in South Carolina are still some of the lowest in the nation. We are working to change that narrative.”

How vaccines work

Vaccines have been around since the 1700s but became more widely used in the 1950s when parents were encouraged to vaccinate their children to protect against smallpox and polio. In the 1960s, vaccinations emerged for illnesses such as the measles and mumps. Fast forward to 2006, and that’s when the HPV vaccine was added to the public health arsenal.

Vaccines help a person’s immune system recognize a similar virus or bacteria, ultimately allowing the immune system to fight possibly life-threatening infections. Designing a vaccine that grants immunity and causes minimal side effects is no simple task as researchers have found in trying to develop coronavirus vaccines.

Cartmell said we are fortunate with the HPV vaccine because it is a well-established vaccine that is safe and effective and provides long-lasting protection. Studies have followed people, for about 10 years, who received the HPV vaccine, and protection has remained high in those individuals. 

Only about a dozen of the more than 200 known strains of HPV carry the potential to cause cancer. Some types of HPV, called high-risk HPV, can lead to cancer. The cancer most commonly associated with HPV is cervical cancer. However, as of 2018, HPV-associated head and neck cancers have surpassed the incidence of HPV-associated cervical cancer in the United States.

Fortunately, the HPV virus is a DNA virus and is relatively more stable than other viruses, Cartmell said. A flu vaccine is needed each year because the flu viruses causing disease may be different each season. Every year, researchers develop flu vaccines to protect against the viruses they think will be most common. Some people don’t realize when they get their flu shots that it’s actually a vaccine.

“The best and most simple opportunity we have to prevent cancer is for parents to make sure their child receives the complete HPV vaccination series. We want it to be ingrained in everybody that they have the power to prevent six different types of HPV-related cancers.”
—Dr. Kathleen Cartmell

“The flu is notorious for constantly changing every year, which means there will be multiple strains of it that people need to be protected against,” Cartmell said. “HPV, fortunately, is a much more stable virus, and it doesn't mutate much.”

Research shows that the timing of HPV vaccination may matter in the kind of immunity a person receives. “A younger child, at the age of 11 and 12, has an immune system that is super strong and is able to mount the most robust response to the vaccine,” Cartmell said. For this reason, adolescents who start the HPV vaccine series before the age of 15 only need two doses, but if they start the vaccine series at age 15 or later, they need three doses. “It's also critical to make sure that kids get the vaccine before they are ever exposed to HPV.”

Unfortunately, there are still many parents who are simply unaware of the HPV vaccine or uneducated about this lifesaving vaccine.

“We want to be able to know if we're moving the needle and increasing vaccination and if people are starting the vaccine series and completing it,” Cartmell said. “If kids don’t complete the HPV vaccination series, they might not get full protection against HPV. So it’s important that we regularly keep track of our vaccination rates.”

According to the CDC, South Carolina ranks 18th in new cases of cervical cancer and 11th in cervical cancer deaths in the United States. Every year in the United States, HPV causes more than 30,000 cases of cancer in men and women, and the HPV vaccine can prevent about 90% of these cases from ever occurring.

“The best and most simple opportunity we have to prevent cancer is for parents to make sure their child receives the complete HPV vaccination series,” Cartmell said. “We want it to be ingrained in everybody that they have the power to prevent six different types of HPV-related cancers.”