A disease of the past: Twenty years on from Gardasil cancer vaccine

By Janelle Miles

Topic:Vaccines and Immunity

Professor Ian Frazer prepares to immunise 13-year-old Emma McMillan against cervical cancer on August 28, 2006. (Supplied: The University of Queensland)

In short:

Twenty years ago, Australia launched the Gardasil vaccine, the world's first vaccine against cervical cancer.

Griffith University professor of infectious diseases Nigel McMillan said Australia was on track to eliminate cervical cancer in the next 10 years.

Despite that, Australian Immunisation Register data shows HPV vaccine coverage for girls and boys is dropping.

Twenty years on from the launch of the world-first vaccine against cervical cancer in Australia, more than 800 million doses have been administered worldwide in a breakthrough expected to save tens of millions of lives by early next century.

The vaccine, co-developed at the University of Queensland by Ian Frazer and his late colleague Jian Zhou, protects against strains of the sexually transmitted human papilloma virus (HPV), which cause most cases of cervical cancer and genital warts.

It also safeguards against many cases of throat, genital, and anal cancer.

Professor Frazer, the 2006 Australian of the Year, was dubbed by a magazine as "God's Gift to Women" because of the revolutionary vaccine's impact on cervical cancer, but HPV also causes cancers that affect men.

Professor Ian Frazer co-developed the Gardisil vaccine with his colleague Jian Zhou. (AAP: Mick Tsikas)

Dr Zhou died aged 42 in 1999, seven years before the vaccine was approved for use.

The Gavi Vaccine Alliance — a public‑private partnership that assists in vaccinating children in high‑risk countries — estimates the vaccine would have prevented 1.4 million future deaths across low and middle‑income countries during a three‑year immunisation program beginning in 2023.

In 2020, the World Health Organization released its global strategy to accelerate the elimination of cervical cancer as a public health problem, which seeks to save 62 million lives by 2120, underpinned by the HPV vaccine.

'A disease of the past'

Griffith University professor of infectious diseases Nigel McMillan, whose daughters Rachel and Emma were among the first Australian teenagers to be vaccinated on August 28, 2006, said Australia was on track to eliminate cervical cancer in the next 10 years.

Professor Ian Frazer gives 15‑year‑old Rachel McMillan a cervical cancer vaccine in August 2006. (Supplied: The University of Queensland archives)

"We'll have a few sporadic cases, but generally, it will be a disease of the past," Professor McMillan said on the eve of today's 20th anniversary.

"This will really be the first cancer vaccine in the world that will have achieved that sort of result.

"European countries are now reporting that they also see that this is incredibly effective."

While a hepatitis B vaccine, approved in the 1980s, was the world's first anti‑cancer jab because it helps prevent liver cancer, Australia still sees about 3,000 new diagnoses of the cancer annually, with causes extending beyond hepatitis B.

Professor McMillan said its "spectacular" results were helped by the fact that almost all cases were caused by HPV.

Public health expert Julia Brotherton, a professor of cancer prevention policy at the University of Melbourne, has spent most of her career studying the HPV vaccine.

She was part of the working party that recommended to the Australian Government that the vaccine should be included in the national immunisation program.

Julia Brotherton, a professor of cancer prevention policy at the University of Melbourne. (Supplied)

Australia was the first country to fully fund a HPV immunisation program, but only after the nation's Pharmaceutical Benefits Advisory Committee (PBAC) in early November 2006 controversially knocked back funding for Gardasil, a cervical cancer vaccine made by Merck and marketed in Australia by CSL.

But after a public backlash, political pressure by then Prime Minister John Howard, whose wife Janette had survived cervical cancer, and CSL made a price compromise, the PBAC reversed its decision and recommended funding at an extraordinary meeting later the same month.

The vaccine has been provided free to Australian girls and young women up to age 26 as part of the national immunisation program since 2007 and boys and young men were added in 2013.

Professor Brotherton said the cervical cancer vaccine was now included in the immunisation programs of 165 countries.

"It's really difficult to overstate the significance of this vaccine," she said.

"It's an incredibly effective vaccine. It's the backbone of what is now a global cervical cancer elimination strategy where we're going to make this a rare disease around the world.

The cervical cancer vaccine was now included in the immunisation programs of 165 countries. (Pan American health Organisation/flickr.com/CC BY‑ND 2.0)

"Cervical cancer is an absolutely devastating disease if it's not caught early. The suffering is absolutely immense. It strikes down women who are in their peak age of having kids and their career. It's an absolutely avoidable tragedy."

Vaccination numbers down

Professor Brotherton joined Professor McMillan in describing the vaccine as extremely safe.

Professor McMillan said he had "no hesitation" to allow his own daughters to be vaccinated after he had followed the HPV vaccine trial results as it went through testing worldwide.

"I'd looked at the safety profile. This was actually one of the safest vaccines we'd ever made," he said.

Despite that, Australian Immunisation Register data shows HPV vaccine coverage for girls by their 15th birthday fell from 86.6 per cent in 2020 to 78.7 per cent in 2025.

And coverage for boys by age 15 plunged from 84.9 per cent in 2020 to 75.6 per cent last year.

Professor Brotherton said the drop below 80 per cent was "really concerning".

"I go around the world and see countries struggling to try and afford this vaccine. We're so lucky we can prevent cancer in our kids with a single dose of a very safe vaccine," she said.

"There seems to be a lot more concerns and hesitancy. But the evidence for this vaccine is incredibly robust.

"It's been very carefully studied for 20 years. I absolutely am confident in recommending this vaccine as an incredible thing you can do for your kids. It's a single dose, it's free, it's easy, it prevents cancer, go get it."

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