South Africa's school HPV vaccine cuts key cancer-causing infections by 83%
South Africa's HPV vaccination in schools has reduced infections with cancer-causing HPV types by over 80%, including among girls with HIV.
South Africa's school-based human papillomavirus (HPV) vaccination programme has significantly reduced infections with the HPV types that cause most cervical cancers. A study comparing adolescent girls who were vaccinated with those who were not found an 83% drop in HPV types 16 and 18 infections among vaccinated girls, including those living with HIV.
Introduced in 2014, the programme targeted grade 4 girls aged nine years and older, achieving high uptake with about 87% receiving at least one vaccine dose in the first year. The programme operates in a country with one of the world's highest burdens of cervical cancer and a high HIV prevalence, which increases the risk of HPV persistence and progression to cancer.
The HPV One and Two Dose Population Effectiveness (HOPE) study, conducted in 2019 and 2023, involved 2,357 adolescent girls aged 17-18 from four provinces. About 25% of participants were living with HIV, allowing assessment of vaccine impact in this vulnerable group. Infections with HPV types 16 and 18 fell from around 20% to 3% among vaccinated girls. Among girls with HIV, infections dropped from 29% to 4%, an 82% reduction.
The study also found reductions in related high-risk HPV types, indicating cross-protection, and evidence of herd protection as unvaccinated girls in the post-vaccine group also showed lower infection rates. Other HPV types not targeted by the vaccine did not decline, supporting that the reductions were due to vaccination rather than changes in behaviour.
Since October 2024, South Africa has adopted a single-dose HPV vaccination approach following World Health Organization recommendations. Continued monitoring will assess long-term protection, especially in people living with HIV.
In our view, the reported 83% reduction in HPV infections among vaccinated girls is promising, but we need to see how the new single-dose approach performs in real-world conditions, especially for those living with HIV. It will be important to monitor whether this simplified schedule maintains protection without adding costs or logistical challenges that could affect uptake in more rural or under-resourced areas.
The results provide important evidence for cervical cancer prevention in high HIV prevalence settings and offer a model for other African countries.
Sources
Source: Wits University
