Happy 20th birthday Gardasil. What a brilliant drug.

Adam Spencer
2 days ago
4 min read

Twenty years ago this week the world licensed a vaccine against a cancer. NerdNews highlights this glorious, almost accident, and the Aussie at its heart.

The belnded Northern Star Trail above Kitt Peak. — ('the enemy's twin' created via midjourney)

(First published on my Substack where you can get #NerdNews, marvellous maths and general geekery.)

20 years ago, we began to conquer a cancer.

On the 8 June 2006, America approved a medication that would change the world. A vaccine against a cancer.

As a father of two and a stepfather of one wonderful young women, I’m immensely proud that that they may grow up in a world where one of the great killers of women has quietly been shown the door.

Cancer's quiet accomplice.

Cervical cancer was never one of those great mysteries of nature. It has a culprit, and we caught it. Almost every case, around 99.7 per cent, traces back to the human papillomavirus, a common bug usually passed on through skin and sexual contact.

The German virologist Harald zur Hausen proved the link, and in 2008 the Swedes handed him a Nobel for it (hold that thought for later.)

Worldwide, cervical cancer still kills roughly 350,000 women a year, most of them in poorer countries. It is one of the very few cancers with a single, beatable trigger.

A shell game in a Brisbane lab.

Here is the part I love most. The two men who cracked it were not chasing a vaccine at all.

Ian Frazer, a Scottish-born immunologist who had landed at the University of Queensland, and Jian Zhou, a virologist he met by chance in a Cambridge lab in 1989, simply wanted to understand a maddening virus that caused cancer, dodged the immune system, and stubbornly refused to grow in a dish.

"We didn't set out to make a vaccine." — Ian Frazer, 2006 Australian of the Year.

What do you do when you can’t grow the real thing? Head back to the lab and bang out a fake.

In 1991, working alongside Zhou's wife Xiao-Yi Sun, they coaxed HPV's structural proteins into self-assembling into hollow particles that looked like the virus from the outside but carried none of its DNA inside.

A potential decoy. Show that empty shell to the immune system and it learns to fight a ghost, so the real virus never gets a foothold. That sleight of hand is the engine humming inside every dose of Gardasil.

Spare a thought for Jian Zhou.

The story has a hole at its heart. Jian Zhou never saw where his work led. In 1999, with the vaccine still years away from a single arm, he died of liver disease at just 42, after years of work that colleagues say took a heavy toll. Frazer has spent the decades since making sure his partner's name is spoken in the same breath as his own.

It also possibly makes a tidy Nobel Prize slightly awkward here. The prize is never given after death, and you cannot tell this story honestly without the virologist from Hangzhou who is no longer here to take a bow.

Zero is the new hero.

So does it actually work?

The real-world numbers are stunning.

In England, women offered the jab at age 12 or 13 have shown an 87 per cent drop in cervical cancer compared with the generations before them. In Scotland, among women given the vaccine at that same age, the tally of invasive cervical cancer cases so far sits at a flat zero.

"The vaccine works. Full stop." — Dr Linda Eckert, University of Washington.

And here at home is the stat that gives me goosebumps.

In 2021, for the first time since records began in 1982, not one Australian woman under 25 was diagnosed with cervical cancer.

Australia, which rolled out the world's first national program back in 2007, is now on course to become the first country to effectively eliminate the disease as a public-health problem, possibly by 2035.

Mind the gap.

But before we get too pleased with ourselves, the miracle is not yet evenly shared.

Modelling suggests vaccination alone could save more than 45 million lives this century, and tens of millions more with screening and treatment on top. The trouble is that most of those saveable lives are in sub-Saharan Africa and South Asia, exactly where the vaccine is hardest to come by.

Closer to home, Indigenous Australian women still face cervical cancer at three times the rate of other women, and our own vaccination rates have started to slip.

Just as the finish line swims into view, a fresh wave of anti-vaccine noise is rattling the very programs that carried us this far.

"Our national elimination strategy is centred on achieving cervical cancer elimination for all." — Dr Dorothy Machalek, epidemiologist.

So this anniversary is not a victory lap. It is a reminder that the win still has to be finished, and that it can be fumbled.

Bang a gong – get it on!

With the end of cervical cancer finally in sight, surely it is time they finished the job and honoured the people who built the shield.

A Nobel prize for Frazer, the National Cancer Institute's Doug Lowy and John Schiller, all honouring the memory of the quiet man from Hangzhou who never lived to see a single child protected by his idea.

The three young women in my life, will grow up standing behind that shield. Ian Frazer and Jian Zhou, thank you.