Are the currently existing anti-human papillomavirus vaccines appropriate for the developing world

Cervical cancer prevention is expected to be achieved by vaccination of girls 2-3 years before sexual debut, and cervical smear cytology follow-up. The existing human papillomavirus (HPV) vaccines target the low-risk 6 and 11, and the high-risk 16 and 18 subtypes, the most common agents of ano-genital pre-invasive and invasive lesions. We conducted the review by searching PubMed using the terms "HPV," "HPV subtypes," "developing world," and "HPV-vaccine" to retrieve articles published between 2000 and 2011. We focused on studies that were relevant to the developing world. The proposed vaccination policy is currently unachievable in the developing world because of the cost of the vaccine, the lack of adequate cytology and follow-up infrastructures. Moreover, the subtypes of HPV involved in cervical pathology, their associations, and natural history (clearance and persistence rates) differ from the industrialized world. Therefore, the current bivalent and quadrivalent anti-HPV vaccines are unlikely to achieve their target in the developing world. It follows from published data that there is an obligation of the pharmaceutical industry and of the public-health policy makers not to embark on mass vaccination campaigns without thorough information and investigation of the local relevance.