KUALA LUMPUR, Sept 17 — Malaysia aims to eliminate cervical cancer as a public health problem by 2030, but while progress has been made, challenges remain, advocates say.
According to the Ministry of Health’s (MOH) Action Plan Towards the Elimination of Cervical Cancer in Malaysia 2021-2030 – which aligns with the World Health Organization’s (WHO) global strategy – Malaysia’s 90-70-90 goals are to ensure, by 2030:
- 90 per cent HPV vaccination coverage among girls aged 13 years.
- HPV screening coverage of 70 per cent of women aged 30 to 65 years.
- 90 per cent treatment of precancerous lesions.
The MOH said in a statement last July 19, on the release of the new Malaysia National Cancer Registry (MNCR) Report 2017-2021, that cervical cancer incidence in Malaysia has consistently decreased from 7.6 per 100,000 women in 2007-2011 to 6.0 per 100,000 women in 2017-2021.
Cervical cancer elimination is defined as an incidence rate of less than 4 per 100,000.
HPV Vaccination Coverage Of Form One Female School Attendees Dropped To 14% In 2021
Prof Dr Woo Yin Ling, a consultant gynaecological oncologist at Universiti Malaya Medical Centre (UMMC), said HPV vaccination coverage of Form One girls attending school exceeded 90 per cent before the pandemic, but fell to 14.3 per cent in 2021.
“In May 2024, the National Immunisation Programme (NIP) resumed in full speed,” she told CodeBlue.
National Cancer Society of Malaysia (NCSM) managing director Dr M. Murallitharan observed that many girls and women who have yet to be vaccinated include school dropouts and undocumented people, citing the lack of education and awareness about the importance of the HPV vaccine and cervical cancer screening.
“According to research published, Malaysia has made notable progress in terms of HPV vaccination for current school cohorts with the achievement of high coverage rates. However, efforts to address lost cohorts who missed earlier vaccination rounds have been slower, with ongoing challenges in effectively reaching these groups,” Dr Murallitharan told CodeBlue.
“In an effort to curb this, the Leaving No One Behind programme carried out by the National Cancer Society of Malaysia in collaboration with various stakeholders aims to vaccinate underserved groups of girls and women all across Malaysia while equipping them with cervical cancer education.”
One hurdle against achieving Malaysia’s 2030 cervical cancer elimination goal is societal response to HPV vaccination programmes.
“Another issue we frequently face is the cultural and religious barriers that may sometimes create a resistance to vaccinations. It’s a dangerous misconception that we need to address strategically to ensure that no one is left behind,” Bukit Bendera MP Syerleena Abdul Rashid – who is also a member of the Parliamentary Special Select Committee (PSSC) on Women, Children, and Community Development – told CodeBlue.
“There are also logistical issues i.e. transportation, location, and storage, where administering vaccinations may prove to be challenging,” she added.
The DAP lawmaker also said most Malaysians are not aware or fully informed that there are vaccines that can prevent cervical cancer.
Crucial To Include Additional ‘At-Risk’ HPV Serotypes In HPV Vaccination Coverage
Three HPV vaccines that help prevent cervical cancer are currently available in Malaysia: bivalent, quadrivalent, and nonavalent that cover two, four, and nine HPV serotypes respectively.
The bivalent vaccine targets serotypes 16 and 18 to prevent cervical cancer.
The quadrivalent vaccine targets serotypes 6, 11, 16, and 18, offering protection against both cervical cancer and genital warts.
The nonavalent vaccine targets serotypes 6, 11, 16, 18, 31, 33, 45, 52, and 58, providing a broader range of protection against cancer-causing serotypes, according to Dr Murallitharan.
He said the previous NIP provided the bivalent and quadrivalent vaccines, but added that other serotypes should be covered for Malaysia to reduce cervical cancer incidence and eliminate the disease in six years’ time.
Dr Murallitharan, however, also said that although non-16 and non-18 HPV serotypes may lead to HPV-related diseases, serotypes 16 and 18 result in almost 70 per cent of all cervical cancers globally. Recent studies in Selangor and Sarawak indicate a significant proportion of HPV infection or abnormal cervical smears caused by HPV types 52/58.
“Therefore, the current vaccines available under the NIP are sufficient in terms of coverage and protection for the bulk of the serotypes causing cervical cancer. With additional resources in the future, an aspirational goal would be to move towards having vaccines that would be able to protect against the additional serotypes as well.”
Dr Woo said that theoretically, not covering non-16 and non-18 HPV serotypes would mean that women would have abnormal screening tests attributable to other high-risk HPV.
“In Malaysia we do have data to support that a significant proportion of women with changes in the cervix are caused by non-16 and 18 serotypes. Hence, women still need to have screening in the form of HPV testing followed by the appropriate treatment,” she said.
Screening And Treatment Critical Too, Ongoing HPV Vaccination Efforts In Schools
Dr Woo said HPV vaccination is one of three pillars of the cervical cancer elimination strategy, stressing on the other critical pillar of ensuring that 70 per cent of eligible women in Malaysia are screened with a HPV test at least twice in their lifetime.
“Most importantly, 90 per cent of those with abnormal screening need to have the appropriate treatment.”
According to the Action Plan Towards the Elimination of Cervical Cancer in Malaysia 2021-2030, previously, in the first two years of the implementation of NIP in schools, the programme achieved its target of vaccinating approximately 250,000 school girls against HPV each year.
However, earlier this year, a backlog in HPV vaccinations to Form One girls in the 2022 and 2023 cohorts was recorded due to limited vaccine supplies. Bukit Bendera MP Syerleena mentioned that the backlog could also be because of restrictions from the Movement Control Orders (MCO) during the Covid pandemic.
This year, according to Dr Woo, school health teams started vaccinating girls from Forms 1 to 4. For those who are non-school attenders, the outreach for those who are 13 to 19 years old will occur in 2025.
Recommendations For The Government
The Women, Children, and Community Development PSSC, in its 2023 report on the status of the HPV vaccination programme in Malaysia, recommended the following:
- For the MOH to consider the proposal to provide the 9-valent HPV vaccine instead of the 2-valent and 4-valent vaccines, subject to budgetary availability.
- To note that price of the vaccine is subject to the valency. The higher the valency, the higher the price of the HPV vaccine.
- That MOH uses any HPV vaccine that contains the strains 16 and 18.
In line with this, Dr Murallitharan opined that a comprehensive and cohesive elimination strategic plan that brings together all stakeholders is needed, more than what is being done currently.
“Using a stratified resource approach, we must move towards improving elimination strategies, making sure we are moving towards the 100 per cent elimination – a strategy that in time will include vaccination of boys as well as moving towards vaccines which protect against more serotypes as well,” he said.
“Underpinning all these targets will be the need to have a registry to monitor the progress of achieving the 2030 targets,” added Dr Woo.
Syerleena said educational campaigns with schools and communities can raise awareness about vaccinations, dispelling myths with trusted voices like health and religious leaders. Mobile clinics partnered with local providers can improve access in remote areas.
“Ultimately, it boils down to policies and effective implementation. This is where we need to draft clearer guidelines to maintain consistency and effectiveness. Again, the best way to create a more sustainable system is to get everyone involved and promote community engagement as well.”
