A new cervical cancer vaccine, proven highly effective in preventing transmission of the two strains of human papillomavirus (HPV) responsible for 70% of cervical cancer cases, is poised to become available in the United States later this year, according to "The Public Health Promise and Potential Pitfalls of the World’s First Cervical Cancer Vaccine," by Cynthia Dailard, which appears in the March 2006 issue of the Guttmacher Policy Review (formerly The Guttmacher Report on Public Policy). Widespread vaccination could reduce cervical cancer deaths worldwide by as much as two-thirds; however, implementation may be difficult both in the United States and in the developing world.

In the United States, cervical cancer is relatively rare because of the widespread availability of Pap tests. Nevertheless, nearly 10,000 cases of invasive cervical cancer will occur among American women in 2006, resulting in 3,700 deaths. Virtually all cases of cervical cancer are linked to HPV, an extremely common, typically asymptomatic sexually transmitted infection (STI). Because HPV is transmitted sexually, experts say the vaccine will be most effective if it is administered to adolescent females before they first have sex.

Yet ensuring widespread vaccination of teenagers before they become sexually active raises both logistical and ideological issues. Reaching adolescent females at the optimal age of 10–12 and providing the vaccine’s three required doses over a six-month period will prove challenging. In addition, some conservative groups have raised the not unexpected objection that vaccinating teenagers against an STI will encourage promiscuity, despite a lack of evidence to support this claim. Although these groups are not opposing federal approval of the vaccine outright, it is likely that they will oppose the most effective way to ensure the vaccine’s universal uptake—namely, school-based immunization requirements (which make the vaccine mandatory for school enrollment).

In resource-poor developing countries, the incidence of cervical cancer is much higher than it is in the United States and other developed countries. In addition, the disease is far more deadly: Of the 225,000 annual deaths from cervical cancer globally, 80–85% occur to women in developing countries. Indeed, cervical cancer is usually fatal in the developing world because women typically do not receive care until their disease is well advanced.

The challenges presented by the roll-out of the cervical cancer vaccine in developing countries are especially acute. Key among them is the need to raise awareness of the importance of this vaccine where knowledge of HPV and its relationship to cervical cancer is low. Other challenges include delivering a series of three doses to a population with minimal contact with health care facilities and ensuring that the vaccine, which is expected to be relatively expensive in the United States, is affordable in low-resource settings. And, as in the United States, health care professionals abroad will need to educate parents, providers and policymakers to ensure the acceptability of the vaccine within cultural and political contexts that are particularly sensitive to teenage sexuality.

"We have the opportunity to dramatically reduce cervical cancer-related deaths worldwide," says Cynthia Dailard, senior public policy associate with the Guttmacher Institute. "We can only hope that political sensitivities will not sabotage the will to overcome practical challenges or thwart the enormous potential of this new vaccine to save women’s lives."

Also in this issue:

"Toward Making Abortion ‘Rare’: The Shifting Battleground Over the Means to an End," by Susan Cohen.

"Working to Eliminate the World’s Unmet Need for Contraception," by Adam Sonfield.

"Environmental Justice Campaigns Provide Fertile Ground for Joint Efforts with Reproductive Rights Advocates," by Chinué Turner Richardson

Roe or no Roe, Right to Abortion Seen Eroding Under Newly Constituted Supreme Court" by Susan Cohen.

"The Other Shoe Drops: Federal Abstinence Education Program Becomes More Restrictive," by Cynthia Dailard.