From SURE to Publication—Hannah Amber Segal Collaborates With Dr. Nazia Rashid on Research Paper Investigating the Cost-Effectiveness of the HPV Vaccine

In the summer of 2021, Hannah Amber Segal—a participant in Keck Graduate Institute (KGI)’s Summer Undergraduate Research Experience (SURE) program—collaborated with Dr. Nazia Rashid, Associate Professor of Administrative Sciences for KGI’s School of Pharmacy and Health Sciences, on a research paper investigating the cost-effectiveness of the human papillomavirus vaccine (HPV) from a global perspective. On March 27, 2023, that paper—A targeted literature review of health economic analyses of human papillomavirus vaccination from various countries—was published in the International Journal of STD & AIDS.

KGI’s SURE program has been offered since 2011 and has been supported by Norris Foundation since 2015. It introduces undergraduates to careers in the biotechnology industry. It allows them to perform cutting-edge, interdisciplinary research in applied molecular and cellular biology, drug discovery and development, pharmacogenomics, precision medicine, public health and virology, and next-generation sequencing. 

Dr. Anastasia LevitinMaster of Science in Applied Life Sciences (MS) Program Director and Professor of Practice in Translational Medicine, became the program director for SURE in 2015. 

“I enjoy leading the SURE program because it offers undergraduate students from schools with limited research the opportunity to gain such experience and build practical skills,” Levitin said.

“The program also strives to promote the success of women and underrepresented minorities in STEM. During summer, the participants also explore diverse, innovative healthcare and biopharmaceutical industry careers, identify their passions, and ultimately, become leaders in their chosen fields.”

SURE offers nine tracks (both in-person and virtual), each of which involves a team or individual research project. One of these tracks is in Health Economics and Outcomes Research (HEOR), led by Rashid.

When Segal—then an undergraduate at UC Irvine—participated in SURE, she had no prior research experience but was eager to acquire some experience. 

“Also, the fact that I am a female and an underrepresented minority in STEM affirmed my desire to participate in the program,” Segal said.

She had never heard of HEOR, but she thought it would be exciting to explore.

This interest quickly blossomed into a passion. As the program progressed, Segal became eager to dive deeper into HEOR and continue her research. She asked Rashid to mentor her. 

“I was impressed by her motivation and persistence,” Rashid said. “When students show persistence, I know it’s worth investing my time.”

Segal chose HPV as her research topic because she was passionate about the subject and already had some background knowledge of cervical cancer from working as a medical assistant.

“I had seen real-life applications of the vaccine and cervical cancer screening,” Segal said. 

Rashid helped Segal to hone in on a specific topic and to conduct her research from a pharmacoeconomics perspective, focusing on the cost-effectiveness of HPV vaccination programs across 175 countries. While Segal led most of the research, Rashid provided her knowledge, feedback, and guidance.

HPV is a viral infection that is primarily transmitted through sexual contact. Approximately 79 million people in the United States are currently infected with HPV as of 2022.

Currently, there are more than 200 HPV serotypes. Forty of these serotypes are transmitted through direct sexual contact and can be categorized into low-risk and high-risk serotypes (based on the risk of cancer development following infection). 

High-risk HPV serotypes are commonly associated with cervical, vulvar, vaginal, anal, oropharyngeal, and penile cancers. Cervical cancer is known to be primarily caused by HPV. 

While there is currently no cure for HPV, primary (vaccination) and secondary (screenings such as the HPV test and the pap smear), prevention programs have demonstrated benefits when it comes to preventing cervical cancer.

Over 300,000 women died from cervical cancer in 2018. Ninety percent of these preventable deaths were from low-income and middle-income countries. 

While the pap smear has been used as a preventative measure for cervical cancer since the 1950s, the development of the HPV vaccine—which was first licensed in 2006—has shown great promise in effectively reducing cervical cancer incidence rates.

After conducting a targeted literature review of published pharmacoeconomic literature, Segal found HPV vaccine cost-effectiveness to be most significant in low-income countries where screening programs and adolescent males and females were not yet in place. The majority of the economic evaluations viewed the implementation of the HPV vaccine as cost-effective and recommended national HPV vaccination.

“Generally, vaccination was found to be most effective for females around 11 or 12,” Segal said. “But sometimes the country doesn’t have the resources, or the patients are unaware that vaccination is available. They end up getting it later—for example, around age 20—and it is often too late by then, as they have already contracted the virus.”

Thus, early prevention and detection of HPV is critical.

The monovalent vaccine—where patients only have to get vaccinated once instead of returning for multiple shots—was also more cost-effective. Nevertheless, many countries did not offer this option.

Overall, Segal found completing the research paper a rewarding experience.

“Sometimes, students will pursue a topic because they believe it’s popular or cutting edge and it will look good on an application,” Segal said. “But for me, it was important to choose a topic that interests me and would enjoy researching.”

She also feels that Rashid’s assistance and mentorship were critical to her success.

“Dr. Rashid was supporting me every step of the way,” Segal said. “Completing this paper was a very long process, and sometimes I would text her at strange times, but she would always reply. She was not only a mentor but a friend. Having someone who advocates for you and the work you want to do.”

Segal graduated from UC Irvine in 2022 with a major in Human Biology and a minor in Medical Humanities. She is now applying to medical schools.

“Hannah took the initiative to write the whole paper, and I am very proud of her,” Rashid said. “I just know she’s going to thrive in medical school and her career.”