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Human Papillomavirus vaccine: one that can prevent a cancer

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This article has been written as a fervent plea to the parents of little girls of the eligible age group. Please make sure that your precious daughters get this vaccine. It will be an investment for their happiness in the future.

By Dr B. J. C. Perera

All vaccines by definition are substances that are used to stimulate immunity against a particular infectious disease or a specific causative organism. Such vaccines are used to prevent the occurrence of the said diseases in humans and animals. Several vaccines have been introduced to combat such infectious diseases over the last few decades. In some countries, the use of some of these vaccines has led to the elimination of dreaded diseases like Diphtheria, Tetanus, Whooping Cough or Pertussis, Polio, Measles, German Measles or Rubella, just to name a few.

Sri Lanka has a very efficient and inherently equitable system that looks after the Expanded Programme of Immunisation (EPI) for children and young people. In general, we have been extremely successful in this programme and can boast of over 90 per cent coverage for the vaccination of all children. We have successfully eliminated polio, the last case being confirmed as far back as 1993, and we are free of diphtheria, tetanus, measles and German measles or rubella. The success of the EPI is due to many factors that include government commitment, the unstinted dedication of parents, the promotion of the programme through all media channels and the dedicated work of all grades of healthcare personnel. The very high literacy rate of the populace of our country enables all information regarding vaccination to be most conveniently conveyed to the population. Sri Lanka has been hailed as a country that has achieved so much in this field, but with so few resources. It has been cited as a model to the entire Asian region as well as even the world.

In addition to their undoubted effectiveness in protecting against infective microorganisms, some of these vaccines have other bonus effects. At least two of the vaccines in use today have telling effects in preventing certain cancers. One is the Hepatitis B vaccine. It provides protection against liver cancer. The other is the more recent Human Papillomavirus vaccine (HPV vaccine) which protects females against cancer of the neck of the womb, which is also referred to as the cervix of the womb. That disease is generally referred to as Cervical Cancer.

The Human Papillomavirus (HPV) is sexually transmitted and most people become infected sometime during their lifetime. In the majority, it is soon after becoming sexually active. Most infections are asymptomatic and usually clear up spontaneously, accounting for remission in 90% within two years. Only 10% of persistent HPV infections with certain genotypes of HPV can persist and progress to changes in the cervix. If infection from cancer-causing HPV types persists over 10-15 years, women can go on to develop precancerous lesions that, if left untreated, develop into cervical cancer. This process takes an average of 20-30 years from infection to the development of cervical cancer.

In 1995, Dr Anne Szarewski, a renowned researcher from the United Kingdom, led a team who outlined the role of human papillomavirus in uterine cervical cancer detection and screening. Then the researchers began work on an HPV vaccine. Szarewski was also a chief investigator, principal investigator and author of key HPV vaccine trials and publications, who helped to develop the bivalent HPV vaccine. The word bivalent is used to indicate that it contains two strains of HPV. HPV infections are very common, often with minimal symptoms, but high-risk HPV strains can go on to cause other medical conditions, particularly cervical cancer.

In 2006, the first vaccine for Human Papillomavirus (HPV) to be used globally was approved. HPV vaccination has now gone on to become a key part of the effort to eliminate cervical cancer. According to the available research results, HPV vaccination could reduce the lifetime risk of cervical cancer by 35–80%; the rather wide range being due to several studies with different methods. The vaccine was initially promptly snapped up in the West, especially in the Scandinavian countries. In Sweden, the coverage of the vaccine is over 80 per cent. However, according to the data put out by the World Health Organization (WHO) in November 2022, the human papillomavirus vaccine against cervical cancer has been introduced in just 41 per cent of low-income countries, even though they represent much of the disease burden, compared to 83% of high-income countries. We have a set of 10-year data on the benefits of the vaccine and in certain Western countries, a significant drop in the morbidity and mortality rates of cervical cancer is already evident.

In Sri Lanka, the National Vaccine Summit in January 2015 recommended the usage of the HPV vaccine and the government introduced it in 2017 for girls within the age range of 10 to 13 years. That age group was decided on the premise that to get the best results, we need to introduce the vaccine before sexual activity starts. The vaccine was to be administered to the selected age groups in the schools free of charge and in the fee-levying private sector. To date, the vaccine is not available through the Immunisation Clinics of the Provinces and the MOH Clinics.

NOW HERE IS THE REAL CRUX OF THE MATTER. For a variety of reasons, the coverage of the HPV vaccine in the entire cohort of eligible girls in Sri Lanka is somewhere between 30 and 40 per cent. This is woefully inadequate coverage to get the best possible results, especially when looked upon in the light of over 90 per cent coverage of the other vaccines in the National Expanded Programme of Immunisation. Cervical cancer ranks among the five commonest cancers in women in Sri Lanka. HPV vaccine is just one of two vaccines that can prevent cancers. All children have had the Hepatitis B vaccine which protects against liver cancer, as it is given through the National Programme of Immunisation. But, and this is a BIG BUT, the only other vaccine, the HPV vaccine that can prevent cervical cancer, shows a rather low uptake.

We do need to escalate the uptake rate of the HPV vaccine to at least around 80 per cent to get reasonable benefits in the reduction of the morbidity and mortality that is currently seen in cervical cancer. I think we have to admit that due to very many reasons, the message has not gone through to the general population in the country. When inquiries are made from the mothers of eligible girls, the vast majority of them are not even aware of the existence of this vaccine and more importantly, the future beneficial potential of this endeavour. The age group selected is a rather tricky cohort. They get upset at the drop of a hat. The last thing they want is an injection. They will run away, as fast as possible, to avoid it. Some are so frightened that it is not uncommon to see them faint even at the sight of the syringe and the needle. One way of getting the cooperation of these little girls is to allow either the mother or the father to be present to hold her hand most reassuringly when the vaccine is administered. An additional initiative would be to make it widely available through the Immunisation Clinics for it to be administered to all those who have missed it when it was given in the school. This is particularly important as the vaccine is quite expensive when administered in the private sector.



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US’ drastic aid cut to UN poses moral challenge to world

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An UN humanitarian mission in the Gaza. [File: Ashraf Amra/Anadolu Agency]

‘Adapt, shrink or die’ – thus runs the warning issued by the Trump administration to UN humanitarian agencies with brute insensitivity in the wake of its recent decision to drastically reduce to $2bn its humanitarian aid to the UN system. This is a substantial climb down from the $17bn the US usually provided to the UN for its humanitarian operations.

Considering that the US has hitherto been the UN’s biggest aid provider, it need hardly be said that the US decision would pose a daunting challenge to the UN’s humanitarian operations around the world. This would indeed mean that, among other things, people living in poverty and stifling material hardships, in particularly the Southern hemisphere, could dramatically increase. Coming on top of the US decision to bring to an end USAID operations, the poor of the world could be said to have been left to their devices as a consequence of these morally insensitive policy rethinks of the Trump administration.

Earlier, the UN had warned that it would be compelled to reduce its aid programs in the face of ‘the deepest funding cuts ever.’ In fact the UN is on record as requesting the world for $23bn for its 2026 aid operations.

If this UN appeal happens to go unheeded, the possibilities are that the UN would not be in a position to uphold the status it has hitherto held as the world’s foremost humanitarian aid provider. It would not be incorrect to state that a substantial part of the rationale for the UN’s existence could come in for questioning if its humanitarian identity is thus eroded.

Inherent in these developments is a challenge for those sections of the international community that wish to stand up and be counted as humanists and the ‘Conscience of the World.’ A responsibility is cast on them to not only keep the UN system going but to also ensure its increased efficiency as a humanitarian aid provider to particularly the poorest of the poor.

It is unfortunate that the US is increasingly opting for a position of international isolation. Such a policy position was adopted by it in the decades leading to World War Two and the consequences for the world as a result for this policy posture were most disquieting. For instance, it opened the door to the flourishing of dictatorial regimes in the West, such as that led by Adolph Hitler in Germany, which nearly paved the way for the subjugation of a good part of Europe by the Nazis.

If the US had not intervened militarily in the war on the side of the Allies, the West would have faced the distressing prospect of coming under the sway of the Nazis and as a result earned indefinite political and military repression. By entering World War Two the US helped to ward off these bleak outcomes and indeed helped the major democracies of Western Europe to hold their own and thrive against fascism and dictatorial rule.

Republican administrations in the US in particular have not proved the greatest defenders of democratic rule the world over, but by helping to keep the international power balance in favour of democracy and fundamental human rights they could keep under a tight leash fascism and linked anti-democratic forces even in contemporary times. Russia’s invasion and continued occupation of parts of Ukraine reminds us starkly that the democracy versus fascism battle is far from over.

Right now, the US needs to remain on the side of the rest of the West very firmly, lest fascism enjoys another unfettered lease of life through the absence of countervailing and substantial military and political power.

However, by reducing its financial support for the UN and backing away from sustaining its humanitarian programs the world over the US could be laying the ground work for an aggravation of poverty in the South in particular and its accompaniments, such as, political repression, runaway social discontent and anarchy.

What should not go unnoticed by the US is the fact that peace and social stability in the South and the flourishing of the same conditions in the global North are symbiotically linked, although not so apparent at first blush. For instance, if illegal migration from the South to the US is a major problem for the US today, it is because poor countries are not receiving development assistance from the UN system to the required degree. Such deprivation on the part of the South leads to aggravating social discontent in the latter and consequences such as illegal migratory movements from South to North.

Accordingly, it will be in the North’s best interests to ensure that the South is not deprived of sustained development assistance since the latter is an essential condition for social contentment and stable governance, which factors in turn would guard against the emergence of phenomena such as illegal migration.

Meanwhile, democratic sections of the rest of the world in particular need to consider it a matter of conscience to ensure the sustenance and flourishing of the UN system. To be sure, the UN system is considerably flawed but at present it could be called the most equitable and fair among international development organizations and the most far-flung one. Without it world poverty would have proved unmanageable along with the ills that come along with it.

Dehumanizing poverty is an indictment on humanity. It stands to reason that the world community should rally round the UN and ensure its survival lest the abomination which is poverty flourishes. In this undertaking the world needs to stand united. Ambiguities on this score could be self-defeating for the world community.

For example, all groupings of countries that could demonstrate economic muscle need to figure prominently in this initiative. One such grouping is BRICS. Inasmuch as the US and the West should shrug aside Realpolitik considerations in this enterprise, the same goes for organizations such as BRICS.

The arrival at the above international consensus would be greatly facilitated by stepped up dialogue among states on the continued importance of the UN system. Fresh efforts to speed-up UN reform would prove major catalysts in bringing about these positive changes as well. Also requiring to be shunned is the blind pursuit of narrow national interests.

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Egg white scene …

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Hi! Great to be back after my Christmas break.

Thought of starting this week with egg white.

Yes, eggs are brimming with nutrients beneficial for your overall health and wellness, but did you know that eggs, especially the whites, are excellent for your complexion?

OK, if you have no idea about how to use egg whites for your face, read on.

Egg White, Lemon, Honey:

Separate the yolk from the egg white and add about a teaspoon of freshly squeezed lemon juice and about one and a half teaspoons of organic honey. Whisk all the ingredients together until they are mixed well.

Apply this mixture to your face and allow it to rest for about 15 minutes before cleansing your face with a gentle face wash.

Don’t forget to apply your favourite moisturiser, after using this face mask, to help seal in all the goodness.

Egg White, Avocado:

In a clean mixing bowl, start by mashing the avocado, until it turns into a soft, lump-free paste, and then add the whites of one egg, a teaspoon of yoghurt and mix everything together until it looks like a creamy paste.

Apply this mixture all over your face and neck area, and leave it on for about 20 to 30 minutes before washing it off with cold water and a gentle face wash.

Egg White, Cucumber, Yoghurt:

In a bowl, add one egg white, one teaspoon each of yoghurt, fresh cucumber juice and organic honey. Mix all the ingredients together until it forms a thick paste.

Apply this paste all over your face and neck area and leave it on for at least 20 minutes and then gently rinse off this face mask with lukewarm water and immediately follow it up with a gentle and nourishing moisturiser.

Egg White, Aloe Vera, Castor Oil:

To the egg white, add about a teaspoon each of aloe vera gel and castor oil and then mix all the ingredients together and apply it all over your face and neck area in a thin, even layer.

Leave it on for about 20 minutes and wash it off with a gentle face wash and some cold water. Follow it up with your favourite moisturiser.

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Confusion cropping up with Ne-Yo in the spotlight

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Ne-Yo: His management should clarify the last-minute cancellation

Superlatives galore were used, especially on social media, to highlight R&B singer Ne-Yo’s trip to Sri Lanka: Global superstar Ne-Yo to perform live in Colombo this December; Ne-Yo concert puts Sri Lanka back on the global entertainment map; A global music sensation is coming to Sri Lanka … and there were lots more!

At an official press conference, held at a five-star venue, in Colombo, it was indicated that the gathering marked a defining moment for Sri Lanka’s entertainment industry as international R&B powerhouse and three-time Grammy Award winner Ne-Yo prepares to take the stage in Colombo this December.

What’s more, the occasion was graced by the presence of Sunil Kumara Gamage, Minister of Sports & Youth Affairs of Sri Lanka, and Professor Ruwan Ranasinghe, Deputy Minister of Tourism, alongside distinguished dignitaries, sponsors, and members of the media.

Shah Rukh Khan: Disappointed his fans in Sri Lanka

According to reports, the concert had received the official endorsement of the Sri Lanka Tourism Promotion Bureau, recognising it as a flagship initiative in developing the country’s concert economy by attracting fans, and media, from all over South Asia.

Nick Carter: His concert, too, was cancelled due to “Unforeseen circumstances

However, I had that strange feeling that this concert would not become a reality, keeping in mind what happened to Nick Carter’s Colombo concert – cancelled at the very last moment.

Carter issued a video message announcing he had to return to the USA due to “unforeseen circumstances” and a “family emergency”.

Though “unforeseen circumstances” was the official reason provided by Carter and the local organisers, there was speculation that low ticket sales may also have been a factor in the cancellation.

Well, “Unforeseen Circumstances” has cropped up again!

In a brief statement, via social media, the organisers of the Ne-Yo concert said the decision was taken due to “unforeseen circumstances and factors beyond their control.”

Ne-Yo, too, subsequently made an announcement, citing “Unforeseen circumstances.”

The public has a right to know what these “unforeseen circumstances” are, and who is to be blamed – the organisers or Ne-Yo!

Ne-Yo’s management certainly need to come out with the truth.

However, those who are aware of some of the happenings in the setup here put it down to poor ticket sales, mentioning that the tickets for the concert, and a meet-and-greet event, were exorbitantly high, considering that Ne-Yo is not a current mega star.

We also had a cancellation coming our way from Shah Rukh Khan, who was scheduled to visit Sri Lanka for the City of Dreams resort launch, and then this was received: “Unfortunately due to unforeseen personal reasons beyond his control, Mr. Khan is no longer able to attend.”

Referring to this kind of mess up, a leading showbiz personality said that it will only make people reluctant to buy their tickets, online.

“Tickets will go mostly at the gate and it will be very bad for the industry,” he added.

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