Breakthrough Findings from Wits-Led Research
The latest research from the University of the Witwatersrand (Wits) has delivered compelling evidence on the real-world effectiveness of South Africa's national HPV vaccination programme. Published in The Lancet Global Health in April 2026, the study marks the first population-level demonstration that a school-based HPV (Human Papillomavirus) vaccination initiative can significantly curb vaccine-targeted HPV infections, even in a high HIV-prevalence environment. This achievement underscores the pivotal role of South African universities in advancing public health research and informing national policy.
Human papillomavirus is a common virus transmitted primarily through skin-to-skin contact during sexual activity, with over 200 types identified. High-risk types like HPV-16 and HPV-18 are responsible for approximately 70% of cervical cancers worldwide. In South Africa, where cervical cancer is the second most common cancer among women, the dual burden of HIV—prevalent in about 19% of adults—exacerbates risks, as HIV-positive women face up to six times higher chances of persistent HPV infections leading to precancerous lesions and cancer.
Historical Context of South Africa's HPV Vaccination Effort
South Africa's journey with HPV vaccination began with pilot programmes in 2008-2009 in two districts, achieving high coverage and paving the way for national rollout. In 2014, the Department of Health launched a free, school-based programme targeting Grade 4 girls (aged 9 and older), switching from a three-dose quadrivalent vaccine (Gardasil, covering HPV-6/11/16/18) to a two-dose bivalent vaccine (Cervarix, targeting HPV-16/18). This shift was based on evidence showing comparable efficacy with fewer doses, improving feasibility in resource-limited settings.
By design, the programme boasts impressive coverage: around 87% of eligible learners received at least one dose, with sustained uptake over the years despite challenges like the COVID-19 pandemic. Universities such as Wits have been instrumental, not only in evaluation but also in advocacy and capacity-building for implementation. The Wits Reproductive Health and HIV Institute (Wits RHI) has long championed vaccine research, contributing to global knowledge on HPV dynamics in HIV-endemic areas.
Unpacking the Study's Rigorous Methodology
The HOPE (HPV in Oncology - Population Evaluation) study employed a repeat cross-sectional design, a robust epidemiological approach comparing HPV prevalence before and after vaccine introduction without relying on individual follow-up, which is logistically challenging in large populations. Researchers recruited adolescent girls aged 17-18 years—precisely the cohort eligible for vaccination—from 15 primary health-care clinics across four provinces: Free State, Gauteng, Mpumalanga, and North West.
- Pre-vaccine cohort (born before 2001): Surveyed June-December 2019, n=819 (248 HIV-positive).
- Post-vaccine cohort (born 2001+): Surveyed February-December 2023, n=1,538 (295 HIV-positive).
Participants provided self-collected vaginal samples tested via AnyPlex II HPV28 assay, detecting 28 HPV types. HIV status was confirmed through clinic records and rapid testing. Vaccination history came from district registers and self-reports. Statistical analysis used generalised linear regression to compute adjusted prevalence ratios (aPR), accounting for confounders like age, province, and HIV status.
This method allowed direct measurement of programme impact, distinguishing direct vaccine effects from natural trends.
Striking Reductions in Vaccine-Targeted HPV Types
The study's headline result: an 83% decline in HPV-16/18 prevalence among post-vaccine girls (3.2% vs. 21.6% pre-vaccine; aPR 0.17, 95% CI 0.12-0.24). Remarkably, efficacy held across HIV strata:
- HIV-negative girls: 82% reduction (3.0% vs. 17.8%; aPR 0.18).
- HIV-positive girls: 82% reduction (4.4% vs. 29.4%; aPR 0.18).
Individual type breakdowns showed HPV-16 down 83% and HPV-18 down 86% overall. Cross-protection against related types HPV-31/45 was evident (59% reduction), affirming Cervarix's broader shield. No uptick in non-vaccine oncogenic types, quelling replacement fears.
Professor Sinead Delany-Moretlwe, Wits RHI Research Director and study lead, noted: “This is a major public health success for South Africa... investing in early, school-based HPV vaccination can dramatically reduce future cervical cancer risk.”
Photo by Karl Solano on Unsplash
Evidence of Herd Immunity in Action
Beyond direct protection, the study detected herd effects: unvaccinated post-vaccine girls showed 74% lower HPV-16/18 prevalence than pre-vaccine peers (aPR 0.26, 95% CI 0.15-0.45). This indirect benefit arises as vaccinated girls reduce community transmission, safeguarding others. In high-HIV settings, where sexual networks amplify spread, such population-level dynamics are crucial for equity.
These findings mirror high-income country experiences but are groundbreaking for Africa, validating two-dose strategies amid single-dose shifts (adopted 2024 in SA).
Wits University's Pivotal Role in HPV Research
The University of the Witwatersrand, through Wits RHI, spearheaded this landmark work alongside international partners like Australia's Kirby Institute. Key contributors included Zizipho Mbulawa and Ishana Naidoo from Wits, leveraging the institute's expertise in HIV-HPV co-infection studies. Wits RHI's infrastructure—clinics, labs, and longitudinal cohorts—enabled precise sampling and analysis.
This positions Wits as a leader in translational research, bridging academia and policy. Collaborations with the National Department of Health highlight university-government synergy, fostering careers in epidemiology and vaccinology.
Policy Implications and Public Health Wins
South Africa's programme exemplifies scalable prevention in low-resource, high-burden contexts. With cervical cancer causing ~5,000 deaths yearly, these reductions portend fewer precancers and cancers long-term. For HIV-positive girls—over 300,000 adolescent cases nationally—the equal protection is transformative, aligning with WHO's 90-70-90 cervical cancer elimination targets (90% vaccination, 70% screening, 90% treatment by 2030).Read the full Lancet study here.
Experts urge electronic registries for lifelong tracking, integrating HPV, HIV, and cancer data to monitor equity and single-dose efficacy.
Challenges Ahead: Sustaining Momentum
Despite successes, gaps persist: private-sector vaccinations (~5%) lack tracking; parasitic infections like schistosomiasis may blunt responses; non-vaccine HPV monitoring is needed. Universities must innovate surveillance tools, perhaps AI-driven modelling for prevalence forecasts.
Coverage dips in out-of-school girls highlight equity issues, demanding community outreach.
Photo by Karl Solano on Unsplash
Global Lessons from South African Innovation
In sub-Saharan Africa, where HIV drives 5-10% of cervical cancers, SA's model—high-coverage, two-dose, school-based—offers a blueprint. Wits' evidence bolsters calls for Gavi support, potentially averting millions of cases. For higher education, it spotlights interdisciplinary research: virology, epidemiology, health economics.
Wits press release.Future Directions for University-Led Research
South African universities like Wits, UCT, and UP are poised to lead next-phase studies: long-term cancer incidence, single-dose trials, male vaccination (piloted 2023). Funding via NRF, MRC will create jobs in clinical trials, data science. Aspiring researchers: pursue MSc/PhD in infectious diseases—demand surges.
Integrated platforms linking vaccination to screening could eliminate cervical cancer by 2040, with unis driving evidence.