At the start of this week's annual Cervical Cancer Prevention Week, from 23-29 January, the UK Health Security Agency (UKHSA) beseeched young people to catch up on missed human papillomavirus (HPV) vaccinations. The Agency expressed "concern" over a drop in coverage among secondary school pupils last year, noting that while the vaccine is offered to all 12- to 13-year-olds in school years 8 and 9, coverage has "yet to return to pre-pandemic levels".
According to the UKHSA's December Health Protection report, the school-based immunisation programme delivery, which had been extended to 12- to 13-year-old boys in September 2019, was disrupted by pandemic measures. School closures during the 2019-20 academic year had the biggest impact, compounded by staff absences in both schools and school-aged immunisation services.
Throughout the 2020-21 academic year, school attendance rates in England were lower than normal, the Agency said, with further closures between January and March 2021, and attendance remained below normal until restrictions were lifted in February 2022. While vaccine coverage improved significantly in the 2020-21 academic year compared with the previous year, it was still not back up to pre-pandemic levels.
COVID and Flu Jabs Impacted the HPV Immunisation Programme
Published last month, the 2021-22 academic year figures covered the period when the offer of COVID-19 vaccination was extended to all children aged 12-15 years in September 2021 and when the influenza immunisation programme was extended to all children in secondary schools.
"It is likely that all of these factors combined impacted on the delivery of the routine adolescent immunisation programmes, including the HPV programme," the Agency said.
During the 2021-22 year, HPV vaccine coverage decreased by 7% in year 8 females and 8.7% in year 8 males compared with the previous academic year. Dose 1 and completed course coverage increased in year 9 students, although the overall rate remained below pre-pandemic levels.
Local Catch-up Increasing Coverage
The report included year 10 data for the first time, and showedimproved coverage in that birth cohort compared with measurements when the same students were in year 9 the previous year. This suggested that "local catch-up activities have been increasing coverage" and that the NHS has already caught up many children who missed HPV vaccination during the pandemic, UKHSA said.
Specific statistics in the report showed that HPV immunisation coverage for the last academic year was 69.6% for dose 1 in year 8 females, compared with 76.6% in 2020-21 and 59.2% in 2019-20. In contrast, pre-pandemic levels had been 88.0% in 2018-19, 86.9% in 2017-18, and 87.2% in 2016-17.
Dose 1 coverage for females by year 9 was 82.2%, a 5.6% increase from coverage of 76.6% for the same cohort when they were in year 8, while dose 2 coverage for these year 9 females was 67.3% last year, up from 60.2% in 2020-21 and 64.7% in 2019-20, but below levels of 83.9% in 2018-19 and 83.8% in 2017-18.
The first data collected for year 10 females showed 86.5% coverage for dose 1 and 76.9% for dose 2. For all years, boys generally had slightly lower coverage figures than girls.
The UKHSA cited a Lancet study from 2021 that found 87% lower cervical cancer rates among young women now in their 20s who had become eligible for HPV vaccination aged 12-13 years, "clearly showing the programme is preventing cervical cancers", they said. The vaccination programme, combined with cervical screening and colposcopy services, offers the potential to make cervical cancer "a thing of the past", according to charity Jo's Cervical Cancer Trust.
A World Without Cervical Cancer Not a Pipe Dream
Samantha Dixon, chief executive at Jo's Trust said this week: "A world without cervical cancer doesn’t have to be a pipe dream. The UK has the tools to make it a reality, which is incredibly exciting."
Commenting on the UKHSA's analysis, she told Medscape News UK: "We have the evidence that shows the HPV vaccine is stopping young women from developing cervical cancer, and that's an incredible thing. I'd urge anyone who is eligible to take up the offer."
UKHSA said parents and guardians should "ensure eligible young people are caught up with their HPV vaccine before they leave school". Dr Vanessa Saliba, consultant epidemiologist at the UKHSA, noted that young people remained eligible for the vaccine until their 25th birthday.
From age 25, women in England are offered cervical screening, yet nearly a third of them, around 4.6 million women, failed to take up the offer for their latest test. 'Senior NHS medics' at NHS England issued a new call for anyone eligible to come forward for the test. Ms Dixon said women should take up this offer: "Whether you have been vaccinated or not, going for cervical screening remains important to help further reduce your risk of cervical cancer."
The NHS achieved an increase in cervical screening in 2021-22, with 3.5 million women aged 25-64 being screened, up 9.4% from 2019-20, when 3.2 million women were screened.
Improving the Screening Process
Minister for Women's Health Maria Caulfield said: "We're improving the cervical screening process, including opening up 24/7 laboratory screening and expanding the locations options available – so people can get their results faster and their tests easier."
The NHS is also running pilot trials of home self-screening for cervical cancer, with the results set to inform whether it should be rolled out nationally. A survey by Jo's Trust showed that HPV self-sampling was considered "one of the biggest opportunities to eliminate cervical cancer in the UK" by more than 70% of professionals working in the field.
A study last year showed that over half of women would choose self-sampling if it were offered, and the idea was particularly appealing to irregular and never attenders. Jo's Trust added: "HPV self-sampling could provide a step change for many who find the existing test inaccessible."
The Cervical Cancer Prevention Week is run by charity Jo's Cervical Cancer Trust.