Epidemiological features, national burden of several HPV-related diseases and estimation of cost-effectiveness of HPV vaccines in Vietnam

This project is designed to collect the evidence that will be needed to support the introduction of the cancer-preventing vaccine HPV (Human Papillomavirus) into the national immunization program of Vietnam. HPV is the second vaccine that has been developed that can prevent cancer (the first being Hepatitis B vaccine which prevents liver cancer). HPV vaccine prevents HPV infection, which is responsible for almost all cases of cancer of the cervix in women. In Western countries cancer of the cervix is much less common than in developing countries, because the regular cervical screening (Pap smears) identifies and treats very early cases. HPV is very common in developing countries like Vietnam, and the cancers that it causes are usually detected late, leading to high mortality. HPV is also responsible for a variety of other cancers affecting both men and women, including penile cancer, anal cancer and throat cancer. The vaccine is used is most industrialized countries, and is given to girls, and in some countries to boys as well. It has been introduced into very few developing countries, because of its high price, and the lack of evidence about HPV infection and disease in those countries. Vietnam is a rapidly modernizing country, with a booming economy and a population that is becoming increasingly westernized. HPV is spread by unprotected sex, and rates of infection are very high among sex workers and men who have sex with men. This project will study the rate of HPV infection among young university students in north, south and central Vietnam to get a national perspective. We will also study two important high risk groups, sex workers and men who have sex with men in both the north and south. We will use the records of the cancer hospitals in Vietnam to estimate the proportion of the population who were affected by HPV associated cancer, and to understand better the ages affected and the outcome and treatment costs of cases. This will enable us to predict the effect of HPV vaccine introduction on the community and calculate the money that will be saved by the health system if those cancers are prevented. Finally we will develop, within Vietnam, the laboratory skills that are needed to study HPV disease, and especially to undertake a trial of HPV vaccines in Vietnam. The trial is not covered by this proposal, but we hope in future to do a trial that will help us to decide which is the simplest and therefore least expensive, way to introduce HPV vaccine into a developing country like Vietnam. The project will be undertaken jointly by five institutions. The three Vietnamese institutions (two in the north and one in the south) will be able to share their expertise in this area and also develop new skills with help from expert groups in London (London School of Hygiene and Tropical Medicine) and Australia (Murdoch Childrens Research Institute).

This project will study the rate of HPV infection among young university students in north, south and central Vietnam to get a national perspective. We will also study two important high risk groups, sex workers and men who have sex with men in both the north and south. We will use the records of the cancer hospitals in Vietnam to estimate the proportion of the population who were affected by HPV associated cancer, and to understand better the ages affected and the outcome and treatment costs of cases. This will enable us to predict the effect of HPV vaccine introduction on the community and calculate the money that will be saved by the health system if those cancers are prevented. Finally we will develop, within Vietnam, the laboratory skills that are needed to study HPV disease, and especially to undertake a trial of HPV vaccines in Vietnam. The trial is not covered by this proposal, but we hope in future to do a trial that will help us to decide the simplest, and therefore least expensive, way to introduce HPV vaccine into a developing country like Vietnam. The project will be undertaken jointly by five institutions. The three Vietnamese institutions (two in the north and one in the south) will be able to share their expertise in this area and also develop new skills with help from expert groups in London (London School of Hygiene and Tropical Medicine) and Australia (Murdoch Childrens Research Institute).

The proposed research will have benefits for the general Vietnamese community, the Vietnamese scientific and medical community, and the global health community.
For the Vietnamese community, we expect that the research will accelerate the introduction of effective HPV vaccination. At present the lack of clear epidemiological evidence for HPV and HPV-related cancers represents a major obstacle to the introduction of HPV vaccine in Vietnam. Prevalence of and types of HPV among young female adults and sex workers will help guide policy with regard to vaccine choice and schedule for the vaccination of girls. In particular the young, educated university students represent an important group whose level of sexual activity and HPV infection rate may prove decisive as the government considers the need for HPV vaccine introduction. MSM represent an important subgroup of young males, whose risk of HPV infection and HPV associated cancers is higher than the general population. As vaccination must take place before sexual orientation is clear, consideration of this group should help to guide the need for HPV vaccination of boys. Rates of cancer, ages of those affected, treatment costs and outcomes are all needed along with data on risk factors in order to make evidence based decisions regarding HPV vaccine introduction. A Japanese research group working with the Hai Phong University is in the process of collecting tumour specimens for HPV detection and genotyping, so we will not duplicate this work. Finally, our proposed new vaccine trial (not covered by this application) will guide the government of Vietnam to help them find a low cost but effect way of introducing HPV vaccine. Overall the information collected should accelerate the introduction of HPV vaccination.
This project will facilitate the introduction of a well-organized, national HPV research program, including both northern and southern institutions. While both NIHE and PIHCM have established HIV and sexual transmitted diseases (STD) programs that have collaborated in the past, this project provides the opportunity to strengthen their HPV epidemiology and diagnostics with a national collaborative project. While NIHE have made considerable progress in HPV virology, PIHCM have advantages in other areas, such as econometric modelling, while IBT brings strong skills in cellular immunology and molecular genetics. LSHTM brings health economics skill and vaccine trial design experience, and MCRI Melbourne bring strength in HPV immunology and vaccine evaluation. As the project is designed to enable the groups to work towards an HPV vaccine trial, this is envisioned as a collaborative north-south project.
Information gathered during this project will add to the global understanding of HPV epidemiology. Regionally it can be expected that data from Vietnam will influence HPV introduction in surrounding south-east Asian countries such as Cambodia and Thailand.