From The Straits Times    |

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Despite its proven efficacy in preventing cervical cancer and other Human Papillomavirus (HPV)-related diseases, myths and misinformation about the HPV vaccine continue to plague public perception. 

As we approach World Immunisation Week (24 to 30 April) tomorrow, it’s imperative to address these misconceptions head-on. 

To provide insights, we have sought the expertise of Dr. Amal El-Sisi. Dr. El-Sisi, a pediatrician and member of the Rotary Club of El Tahrir, Egypt, is one of six globally recognised Rotary members who’ve led projects that have had positive, long-term change toward fighting disease, growing local economies, and protecting the environment. Dr. El-Sisi will present her work in Singapore during the Rotary International Convention 26-29 May 2024. 

Together with the expertise of Dr. El-Sisi, we hope to debunk some of the most common myths surrounding HPV vaccination. 

Dr. Amal El-Sisi, Technical Coordinator for Maternal and Child Health, The Rotary Foundation Cadre of Technical Advisers and Director of the Rotary Program “United to End Cervical Cancer in Egypt” (Credit: Rotary International)

Why the HPV vaccine is often misunderstood

Despite the proven efficacy of the HPV vaccine in preventing various strains of the virus responsible for cervical and other cancers, misconceptions and barriers persist, hindering its widespread uptake. 

“The uptake of the HPV vaccine faces significant challenges globally due to cultural and social misconceptions,” agrees Dr. El-Sisi. 

“Stigmatising beliefs, which often link the vaccine to sexual promiscuity, and a general lack of information about its effectiveness in preventing cervical cancer, significantly hinder its acceptance.” This gap in knowledge highlights the importance of comprehensive education campaigns to dispel myths and provide factual information about the benefits of HPV vaccination.

Dr. El-Sisi notes that these barriers are particularly pronounced but not unique to countries such as Egypt, where less than 10 percent of women are screened regularly, leading to high mortality rates among those diagnosed with cervical cancer despite the availability of a vaccine. 

“Looking at Singapore’s approach to encourage the uptake of the HPV vaccine, national screening or immunisation programs are a good place to start. Physicians also play an important role in debunking deep-seated reluctance driven by these misconceptions and supporting parents in making informed choices for their children.”

The uptake of the HPV vaccine faces significant challenges globally due to cultural and social misconceptions

Dr. Amal El-Sisi

The effectiveness of vaccinations for those over 26 but under 45

Despite common misconceptions that the vaccine is only effective if administered before the age of 26, individuals between 27 and 45 can still derive significant benefits from vaccination.

“Research shows that the vaccine promotes better immunity than the infection itself, with benefits of cross-immunity among different HPV types, suggesting that even those previously infected can gain from vaccination,” explains Dr. El-Sisi. “Extending HPV vaccination to older age groups can significantly decrease the incidence of new HPV infections and related cancers, even among those past the typical age of initial exposure.” 

“Rotary’s strategy for the HPV vaccination aligns with World Health Organization (WHO) recommendations, focusing primarily on girls aged 9-14. While this age range is our main priority, the vaccination of secondary targets such as boys, older women, and men is recommended where feasible and affordable.”

What if you’re over 45?

What about those who are above 45? “Regular cervical cancer screenings, such as Pap tests and HPV tests, are not just important – they are potentially lifesaving, especially for individuals over 45 or those who may have missed the vaccination window,” advises Dr. El-Sisi. “These screenings are crucial for detecting precancerous changes that, if left untreated, could develop into cancer.”

For those who may be at higher risk due to age or prior exposure to HPV, “advancements in medical technology, including new diagnostic tools and therapeutic vaccines, offer significant hope”. 

“Notably, the development of the nine-valent HPV vaccine represents a major step forward. This vaccine, launched in Singapore in 2017, targets nine different strains of HPV, significantly expanding its protective coverage compared to earlier vaccines that covered fewer types. This broader protection is crucial because it covers the types of HPV most associated with cervical cancer and other HPV-related diseases. While primary prevention through vaccination offers up to 90 percent protection against infection, Rotary’s comprehensive approach includes screening women of all ages to detect any changes early (secondary prevention) and employing the latest treatments for detected cancers (tertiary prevention).”

Regular cervical cancer screenings, such as Pap tests and HPV tests, are not just important – they are potentially lifesaving, especially for individuals over 45 or those who may have missed the vaccination window

Dr. Amal El-Sisi

Rotary’s efforts to help promote HPV vaccination globally

Organisations like Rotary International have been instrumental in promoting HPV vaccination globally, particularly in underserved communities where access to healthcare services may be limited. Through initiatives aimed at raising awareness, providing resources, and collaborating with local healthcare providers, Rotary has contributed to increasing HPV vaccination rates and reducing the burden of cervical cancer worldwide.

As a technical coordinator for maternal and child health of The Rotary Foundation Cadre of Technical Advisers, Dr. El-Sisi is deeply involved in leading global efforts to advocate for and implement HPV vaccination programs, leveraging her background as a pediatrician. 

“In this role, I also serve as the lead coordinator for Rotary members who volunteer in the maternal and child health sector, guiding them in their efforts to enhance health outcomes worldwide.”

Working alongside a diverse network of over 500 members from 75 countries, they utilise their collective expertise to significantly impact projects tailored to the specific needs of communities. Their efforts in guiding Rotary members through project planning and grant applications ensure these initiatives are sustainable. Their mission to improve health and prevent disease globally is powered by their ability to mobilise significant resources and knowledge. They facilitate webinars and virtual meetings to share updates on their progress and foster collaboration and knowledge exchange among Rotary members globally, enhancing their collective impact on public health initiatives.

One Rotary-led initiative Dr. El-Sisi works on include the “United to End Cervical Cancer in Egypt” program, which emphasises the importance of these screenings by empowering women to maintain regular health check-ups. “Our goal is not only to detect and treat cervical cancer early, but to educate on the importance of regular health checks. This effort is especially critical in regions where screening rates have been historically low and where cultural and logistical barriers often prevent people from seeking care. Additionally, findings from these initiatives can be used to inform or improve upon existing national programs, accelerating the progress towards WHO’s Cervical Cancer Elimination Initiative and significantly reducing the risk of cervical cancer across the population.”

“I’m excited to share our work and accomplishments with some of the 13,000 people from around the world that will attend Rotary International Convention in Singapore from 26-29 May and hope to inspire others to join us in the fight towards cervical cancer vaccination and elimination.”

Rotary is also a partner with the Singapore Cancer Society (SCS), which dates back to the latter’s establishment in 1964, with key members of the Rotary Club of Singapore West playing instrumental roles in its formation and governance. 

“Today, SCS is the largest cancer support and cancer care organisation in Singapore and while independently managed, the club continues to lend its support through a wide range of activities – from being a part of its council to participating in fundraising efforts,” says Wee Leong How, Rotary Club of Singapore West and Former Chairman (April 2018-2023) of the Singapore Cancer Society. 

Recognising that education, screening, and vaccination will help Singapore move towards eradicating cervical cancer in the long term, SCS has multiple initiatives over the years.

This includes the HPV Education and Immunization Program (HEIP) launched in 2018 to increase awareness of the HPV vaccination among females above 13 years old and their parents, as well as the HPV Immunization Program in 2018. 

This hallmark program, in partnership with Temasek Foundation, looks to reach women aged 18 to 45 years, increasing their awareness of cervical cancer prevention, encourage the up-take of HPV vaccination, and even provide subsidies to those from low-income backgrounds.

More than 20,000 women are expected to benefit from this program. Echoing the sentiments of other Rotary-led initiatives from around the world, SCS offers cervical cancer screening tests at no cost, encouraging regular screening for women aged 25 to 69 years old. 

These programs, along with the annual Women’s Gynecological Cancer Awareness event, align with the Singapore Government’s Healthier SG plan, focusing on preventive care and empowering citizens to take charge of their health.