A World Without Cervical Cancer

HPV (human papillomavirus) is a group of related viruses that consists of almost 200 types, among which 40 are spread through sexual contact with someone who has the virus (MedlinePlus). Nearly all people will get HPV at some point in their lives (CDC 2020). Although many types of HPV do not cause sickness, high-risk HPV can cause various cancers. More than 95% of cervical cancer can be attributed to HPV infection (WHO 2022).

Cervical cancer is the third most common cancer and the second leading cause of cancer deaths among women aging from 15 to 44 years old in China. It is estimated that China accounts for 20.2% of the global burden of cervical cases, while still seeing a significant rise of up to 10.5% per year. Among all cervical cancer patients in China, HPV prevalence was 97.6%, with the most significant types being HPV-16 (59.5%) and HPV-18 (9.6%) (Xia et al 2021). The cost of cervical treatment is US$4,342–11,230 in 2017 (Internal data), which is especially unacceptable considering that the mean per capita income is only $4,708 (China National Bureau of Statistics 2022).

There are three types of HPV vaccines (bivalent, quadrivalent, and nonavalent). All of them work extremely well and are effective against types 16 and 18, the most dangerous types of HPV that leads to cervical cancer (CDC 2021). However, while most of the world has introduced HPV vaccination into their national immunization programs (NIP), China is not one of them (Kane 2006). As a result, the immunization cost ranges from US$102 (domestic bivalent) to US$597 (imported nonavalent). Although HPV vaccine demands have increased by 647.36% from 2017 to 2019, 95% of which were paid out-of-pocket by women over 20 years old (Internal data). Women for whom the HPV vaccines would be most effective (adolescents younger than 15 years old) and those most at risk (adolescents from lower socioeconomic backgrounds) are excluded, highlighting inequality and inefficiency in vaccine distribution and disease prevention efforts.

In August 2020, I interned as a research assistant at the cancer epidemiology department at the Cancer Hospital - Chinese Academy of Medical Sciences (CICAMS) with a group of Master and Ph.D. students under the supervision of several professors. On the biochemistry side, the department was charged by the National Medical Products Administration (NMPA) to conduct post-market clinical trials for the Merck nonavalent vaccine. On the policy side, the department oversees the pilot program of universal HPV vaccine coverage in selected Chinese cities.

Soon after I joined, I was asked to assist with the HPV vaccine clinical trial. The learning curve was steep as I had no background in biology or chemistry beyond my middle school education. However, the students I worked with were extremely patient and helpful. They walked me through the clinical trial process, answered my many clueless questions, and suggested ways in which I could help with the process.

I was soon involved in many other different projects. In preparation for the HPV vaccine pilot program, the department was charged to assess the level of vaccine hesitancy in those cities. Working with a Ph.D. student, we prepared a set of surveys for the general public, healthcare workers, and government officials. Having taken the class Social Science Inquiry, a quantitative research class, I found myself implementing techniques I learned in this class to the survey.

For eight months in 2021, I interned at the vaccine team at the Bill and Melinda Gates Foundation (BMGF) China office. My work involved several areas including COVID-19 vaccine R&D, a women leadership empowerment project, and the inclusion of HPV vaccine in China’s NIP. The Foundation’s strategy include (1) engaging national decision-maker and enhancing regional advocacy capacity, (2) supporting the pilot project expansion, (3) engaging with vaccine manufacturers and removing regulatory hurdles, and (4) enhance vaccine safety surveillance and conducting delivery science studies.

I mainly support the HPV initiative strategy of the foundation through conducting desktop research, writing reports and creating powerpoint decks. Among the projects I was involved: I wrote a HPV fact sheet for future internal/external communication use, drafted strategic memo for the HPV initiative, and created several advocacy decks for presentations to universities, legislators, and researchers. Besides raising awareness and highlighting urgency on the issue, these presentations advocate for the adaption of one-dose vaccine schedule, increase of the prevalence of the cost-efficient bivalent vaccine, and change of clinical trail endpoint to speed up R&D.

I am more than grateful for my experience at the CICAMS and Gates Foundation. I have not only learned about the bioscience aspect of public health (the clinical trials), but also the health advocacy process. I was able to implement the theoretical classwork in sociology and public health to the practical experiences. It also was a fascinating experience to get involved in the national health advocacy process, including communication with lawmakers, vaccine manufacturers, researchers, and NGOs.