The remarkable impact of bivalent HPV vaccine in Scotland

It was initially believed that prophylactic human papillomavirus (HPV) vaccines were probably type specific and provided protection only against infection with, and disease due to, the types of HPV the vaccines were targeted against. Given the predominance of the two most oncogenic HPV types (16 and 18) across all HPV related cancers, the two first generation vaccines (a bivalent vaccine targeting types 16 and 18 and a quadrivalent vaccine targeting types 6, 11, 16, and 18) offered important potential for meaningful cancer prevention even with no cross protection.1

Initial findings from the bivalent HPV vaccine trial, suggesting substantial cross protection against HPV types related to 16 and 18, were therefore met with some scepticism.23 In a linked paper, Palmer and colleagues (doi:10.1136/bmj.l1161) report findings from Scotland, where the combination of high coverage with bivalent HPV vaccine, young age of screening initiation, and high quality individual level data across the population, unequivocally show high vaccine effectiveness …