March 2009

Meet Our Featured Guest Columnist:
Dr. Ian Frazer

was the leading researcher on the GARDASIL cervical cancer vaccine. He is based at the University of Queensland in Brisbane, Australia, and was named Australian of the Year in 2006 in recognition of his contribution.

Q: What does "health and human rights" mean to you?

A: I believe that we as individuals and as nations have a moral responsibility to ensure equitable access to health care across the planet, and particularly to ensure access to the benefits of publicly funded medical research.

Q: How/why did you get involved in global health issues?

A: As a clinician scientist I realized early in my career that if I were going to work in  medical research rather than direct patient care, my "patients" were really anyone in the world who might benefit from my research. I was, and remain, concerned that inequity of access to health care within my country (Australia) and globally is one of many issues that divides our population socially, creating tension between those who have and those who have not.

Q: How can scientific research help in the campaign against cervical cancer?

A: Scientific research provides knowledge, by testing hypotheses. Knowledge is the ONLY tool we have that allows us and governments to make informed decisions, rather than guesses, about the best solution to any problem, and the best way to deploy resources.

Q: Describe some of the successes you have seen in the work for a vaccine.

A: The defining success in the development of a vaccine to prevent cervical cancer was the definition by Zur Hausen and colleagues in the late 1970s that there were multiple human papillomaviruses, and that at least two of these seemed likely to be causally associated with cervical cancer. While it had been clear for many years that cervical cancer modeled epidemiologically as a sexually transmitted disease, previous attempts to define the causal agent had not been successful. The then new tools of molecular biology allowed the Zur Hausen group to categorize the human papillomaviruses and thus to link two virus types to cervical cancer. Once that link was proposed, the epidemiology of papillomavirus and cervical cancer, research on HPV virology and immunology, and eventually vaccine development was made possible.

Development in the 1980s of new tools for cloning viral genes (polymerase chain reaction) and for expressing these in eukaryotic cells using recombinant viruses (vaccinia, baculovirus) was a critical enabling step in the development of the HPV vaccines to prevent cervical cancer now available. The late Dr Jian Zhou, in my lab, and others elsewhere used these tools to make the papillomavirus virus like particles that form the basis of the cervical cancer vaccines now available.
Q: What are some of the challenges in preventing cervical cancer, worldwide?

A: Cervical cancer is the second commonest cancer amongst women worldwide, with the highest death rate in the developing nations. It presents insidiously in young middle aged women, and many women die of wasting illness and infection without the cancer ever being diagnosed. Screening for cervical cancer, widely if not particularly effetively used to prevent this disease in the developed world, is not feasible in countries with limited health care infrastructure.  Even if it were feasible, the resources to treat patients identified through screening simply don't exist in those countries. Further, the level of general knowledge about cancer, and about health care prevention, is not adequate to enable women to make an informed decision to participate in screening. So we need a universal safe and simple means of reducing the risk of cervical cancer. Fortunately we now have one--a vaccine that can significantly reduce the risk of cervical cancer by preventing infection with two viruses responsible for seventy percent of this disease. The challenge is to get this vaccine where it's needed.

There are three issues:
1) Education: people and countries need to know enough to make an informed decision to ask for the vaccine.
2) Delivery strategies: we have no public health measures currently delivered to young women after leaving school and before their first childbirth, and yet that's the target population for the vaccines. In Australia, vaccine penetration from the government program to schoolgirls has reached eighty percent, much more than has been managed by the volunteer program also funded by government for 18-25 year olds. We're currently undertaking research in Vanuatu and Nepal to work out strategies for vaccine delivery to young women.
3) Funding: the cervical cancer vaccines are expensive and many countries can't currently afford the much cheaper vaccines already used to prevent hepatitis B infection. The best short term strategy is likely to involve a partnership between governments, philanthropy, and the vaccine manufacturers. Longer term, ensuring that countries have economies soundly based on provision of materials, labour and expertise at world standard rates will be the only way to ensure equitable access to health care measures across the globe.

Q: How can young people make a difference?

A: Spread the word--educate people about looking after their own health.
Do the research--gather new knowledge to help solve health problems.
Tackle the issues of global inequality of resource allocation head on--ask politicians, and your friends, what they intend to do about these issues.  Try to let them see that this is their problem too, it won't go away, and it isn't solved for the longer term by handouts at any level.