Thank you to "Jiayi Tumor" for providing professional information for the writing of this article, see the end of this article for details.
Last October, I graduated. Before that, there were only 3 graduates of our major in the world.
My name is Cecolin, and I am the fourth HPV (Human Papillomavirus) vaccine in the world to be pre-certified by the World Health Organization (WHO) and the first domestic HPV vaccine in China. Graduation means that I have obtained the pre-certification of the World Health Organization, and I can "hold a certificate" like the three foreign predecessors in this major and rush to the front line of the battlefield of eliminating cervical cancer.
That's me, the | WHO References[6]
The victory or defeat of this battlefield is of great significance to mankind. The fight against cancer has lasted throughout history, and it is only in recent decades that the situation has changed dramatically.
March 4 of each year is the International HPV Awareness Day. On this special day, as the first domestic HPV vaccine in the mainland, I have the obligation to introduce everything about the HPV virus to you.
The International HPV Awareness Day is | March 4 of each year IPVS
In 1983, scientists identified the cause of a cancer, cervical cancer, and subsequent ongoing studies confirmed that almost all cervical cancers are caused by persistent infections with the human papillomavirus (HPV). Moreover, everyone has the potential to contract HPV. A 2014 study found that more than 80 percent of women were infected with the HPV virus at least once in their lifetime, while men were more likely to be infected than women (91.3 percent) [1]. Persistent infection with HPV, especially high-risk hpv, can easily develop into cancer.
The structure of a certain type of HPV under cryo-EM | Wikimedia Commons，Opabinia regalis / CC BY-SA 4.0（https://creativecommons.org/licenses/by-sa/4.0/deed.en）
Since it is caused by a virus, in turn, to avoid cervical cancer, it is necessary to prevent the virus, especially the high-risk virus. HPV virus and you are familiar with the virus (such as the new crown virus), there are a variety of subtypes, of which HPV-16, HPV-18, HPV-31, HPV-33 and other high-risk subtypes, easy to cause cervical cancer, laryngeal cancer, rectal cancer and other cancers. In particular, HPV-16 and HPV-18, nearly 70% of cervical cancers are caused by these two subtypes. So, when scientists train our vaccines, we first have to see if we can fight these two high-risk subtypes of HPV. Only against HPV-16 and HPV-18 is the so-called bivalent or bivalent vaccine. The so-called quadrivalent vaccine fights two more low-risk virus subtypes than bivalent vaccines, and nine-valent vaccines fight five more virus subtypes than quadrivalent vaccines.
Nearly 70% of cervical cancers are caused by two subtypes, HPV-16 and HPV-18| Wikimedia Commons，www.scientificanimations.com/ CC BY-SA 4.0（https://creativecommons.org/licenses/by-sa/4.0/deed.en）
In 2006, the first HPV vaccine "graduated", and after that, research continued. In 2016, a study published in The Lancet Public Health predicted that when the HPV vaccine reached 80% of the population, the subtype of HPV virus targeted by the vaccine, the main cause of cervical cancer, could be eliminated [2]. The latest study, published in November 2021, shows that with the full coverage of the bivalent HPV vaccine in the UK, the incidence of cervical cancer in British women born after 1 September 1995 has dropped to 3 parts per million, and cervical cancer is almost eliminated in the UK [3].
In this context, WHO issued the Global Strategy to Accelerate the Elimination of Cervical Cancer, which clearly proposes the plan of "GlobalLy Striving for the Elimination of Cervical Cancer by 2030". For the first time, humans have a precise plan and a way to eliminate a cancer. If successful, it would be humanity's first comprehensive victory in the fight against cancer in thousands of years.
In 2020, WHO launched the Global Strategy to Accelerate the Elimination of Cervical Cancer, marking the first commitment by 194 countries around the world to eliminate a cancer | WHO
Victory means that many people's lives will survive. According to the Global Cancer Statistics Report released by the International Agency for Research on Cancer (IARC), in 2020 alone, there will be an estimated 604,000 new cervical cancer cases and 342,000 new deaths worldwide. That's not counting other cancers caused by HPV. Therefore, in order to protect yourself, protect your family and friends, it is especially important to build the "Great Wall" of immunity.
However, it is not easy to get the HPV vaccine to more than 80%, especially before I "graduate". If you had followed the HPV vaccine a year ago, or even earlier, you know how hard it is to get an injection. Because of the limited production capacity, the vaccine is difficult to make an appointment and the price is high, and many people are prohibitive. My "graduation" has largely solved the "difficulty of injection". From the beginning of research and development, scientists wanted to develop an affordable vaccine, so in terms of production process, I and my predecessors were different.
The essence of our HPV vaccine is HPV virus-like particles, which you can understand as proteins that look a lot like HPV shell proteins. Because we are only proteins and do not contain the genetic material of the virus, the inoculator will not really be infected with HPV, but the immune system can recognize virus-like particles and produce antibodies against the HPV shell protein, which will play a role in the subsequent real infection of HPV in the body, providing immune protection.
HPV virus-like particles are empty shells without DNA, which is | of its electron microscopic photographs References[3]
In the beginning, scientists could only express HPV virus-like particles in eukaryotic cells, and the three HPV vaccines that came out before me were "made" in eukaryotic cells such as insect cells and yeast cells. What makes me special is that I "make" it in prokaryotic cells like E. coli. Compared with insect cells, E. coli is obviously cheaper to cultivate, so Chinese scientists have overcome technical difficulties and allowed HPV virus-like particles to be expressed in prokaryotic cells, which is actually developing a more efficient and lower-cost HPV vaccine.
E. coli is a type of prokaryotic cell that is less expensive to culture | Wikimedia Commons，public domain
Only when production increases and prices fall can HPV vaccination be widely available. According to China Women's Daily, before I "graduated", the actual coverage of the HPV vaccine in China was very low, with a population-wide vaccination rate of less than 6% and a vaccination rate of less than 3% for adolescents of appropriate age [3]. With my joining, local governments in many chinese cities have begun to procure domestic HPV vaccines and provide free vaccinations for teenagers. For example, in Guangdong Province, starting from the fall semester of 2022, girls under the age of 14 in Guangdong Province who have newly entered the first grade of junior high school and have not been vaccinated against HPV can voluntarily receive HPV vaccine free of charge.
Although the vaccine is immune to a limited subset of HPV, it is not necessarily possible to prevent HPV by vaccination, but universal HPV vaccination is the first step. In the Global Strategy to Accelerate the Elimination of Cervical Cancer, WHO sets three specific targets: by 2030, 90% of girls will have been vaccinated against HPV by age 15; 70% of women will be screened for cervical cancer by age 45; and 90% of women with confirmed cervical diseases will be treated.
However, WHO reports indicate that only 13% of girls aged 9-14 years worldwide will be vaccinated against HPV in 2020, and there is still a long way to go before the target of 90% vaccination rate. You may recall the above mentioned that hpv vaccination has long been fully popularized in high-income countries such as the United Kingdom, why is the global vaccination rate still so low? Because low- and middle-income countries bear nearly two-thirds of the world's cervical cancer patients, their vaccination rates are very low, and 90% of cervical cancer deaths occur here [4].
A girl in Africa is receiving HPV vaccination | Gavi, The Vaccine Alliance (GAVI)
Inequality in medical resources is a major challenge in the global battle to eliminate cervical cancer. Today, scientists are also working on new HPV vaccines. There are not only bivalent, quadrivalent, and ninth-valent vaccines like me and my predecessors, but also 14-valent and 20-valent vaccines that can fight more HPV subtypes. More diverse vaccines and more efficient production capacity will certainly benefit more people and narrow the gap in medical resources, as the theme of this year's fifth International HPV Awareness Day - "Let the world have one less worry".
I am Xinkoning, an affordable HPV vaccine that has been given the mission of universal immunization. I sincerely invite you to get vaccinated and ask you to help share my message with your relatives and friends around you, so that more people will know about HPV and know that we will be able to defeat a cancer – and this requires everyone's participation.
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Author: Cecolin
EDIT: Matrix star
Typography: Yin Ningliu