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Māori and the Human Papillomavirus (HPV) Immunisation Programme


tptBackground

In January 2014 two whānau contacted Te Puāwai Tapu after reading a Facebook ‘post’ that challenged the safety of the HPV immunisation programme in New Zealand. Te Puāwai Tapu produced this short article to provide sexual health promoters with basic information about the programme and links to credible HPV-related websites. The article was peer-reviewed by Jonathan Selu[ref]Community Health Worker, Education Unit, Auckland Sexual Health Service[/ref], Dr Andrew Sporle[ref]Ngāi Tahu, Senior Research Fellow, Department of Statistics, University of Auckland[/ref], and Dr Jeanie McDonald[ref]Dr Jeanie McDonald MBChB PhD FRANZCOG[/ref].

HPV and cervical cancer

Cervical cancer is the third most common cause of cancer in New Zealand women aged 25-44 and the fifth most common cause of cancer deaths (Immunisation Advisory Centre, 2013b). Māori have the highest rate of cervical cancer of any ethnic group, with Māori women almost twice as likely as non-Māori to get cervical cancer, and that cancer is almost three times as likely to be fatal. Certain types of human papillomaviruses (types 16 and 18) are known to be cancer-promoting, and are responsible for around 70% of cervical cancers. Types 6 and 11 are responsible for approximately 90% of genital warts (Immunisation Advisory Centre, 2013a).

Female risk reduction

HPVs are common viruses, with some transmitted through skin-to-skin contact, including but not limited to sexual contact. Two vaccines – Gardasil and Cervarix – have been developed to protect against infection from high risk HPVs (Chelimo & Wouldes, 2009; Rose, Lawton, Lanumata, Hibma, & Baker, 2012). Gardasil, the vaccine selected for the government-funded HPV Immunisation Programme in New Zealand, protects against HPV Types 16,18, 6 and 11 (Rose et al., 2012). Launched in 2008, the purpose of the programme is to reduce cervical cancer by protecting young women against high risk HPVs.

The programme is intended to address significant disparities between Māori and non-Māori in terms of the incidence of cervical cancer and cervical cancer-related deaths (Brownson, 2008). However, Māori have the lowest rate of immunisation of any ethnic group in New Zealand. While effort is being made to achieve equitable HPV immunisation rates (Blakely, Kvizhinadze, Karvonen, Pearson, Smith & Wilson, 2014; Ministry of Health, 2008; Brownson, 2008; Loring, 2008), awareness of HPV among Māori is low and requires increased promotion (Rose et al., 2012).

The HPV vaccine was free-of-charge to young women aged 17-18 years. Since 2009, the programme has been extended to include all 12-20 year old girls and women through the national school-based and community health organisation immunisation programme (Sopina & Ashton, 2011; Chelimo & Wouldes, 2009).

Male risk reduction

Gardasil is not government-funded for males in New Zealand. Recently published and current research investigates the link between HPV and rectal, penile and oropharyngeal cancers (Brownson, 2008; Blakely, Kvizhinadze, Karvonen, Pearson, Smith & Wilson, 2014), and contributes to ongoing international debate as to the advantage of including young males in school immunisation programmes (Harris, 2012; Blakely et al, 2014). In 2013, the Australian government extended its HPV school programme to include 12-13 year old boys (Cancer Council Australia, 2013). Of concern is that men who have sex with men have a significantly elevated risk of HPV-related anal cancers but are unlikely to receive any substantial immunity benefit from New Zealand’s current vaccination programme (Oliphant & Perkins, 2011).

Common questions

If you have any questions about the HPV immunisation programme, there are several free sources of expert advice available:

The Ministry of Health website:

  • Brochure and video about the HPV vaccine and how it works. [Link1]
  • Questions parents, young women and girls ask.[Link2]
  • Articles about HPV and the vaccine.[Link1]

Medsafe website:

  • Latest consumer information about Gardasil. [Link3]
  • Detailed information about the Gardasil vaccine.[Link4]

The New Zealand HPV Project provides free information and advice about HPV vaccination of girls and young women, boys, and women over 20 years, and information about genital warts, throat cancer, and men’s health. Contact the New Zealand HPV Project Helpline on FREEPHONE 0508 11 12 13.

The Immunisation Advisory Centre Helpline provides advice for parents with questions about the immunisation programme on FREEPHONE 0800 IMMUNE (0800 466 863). The National Cervical Screening Programme provides information about HPV on FREEPHONE 0800 729 792.

A downloadable copy of this article, with references, is available from Te Puāwai Tapu website.

Authors: Alison Green & Jillian Tipene