The warts that would not clear

In Melbourne, in the early 1980s, a young physician was following a group of gay men into what turned out to be the beginning of the AIDS epidemic. Among everything else that was wrong with them, one thing kept catching his eye. They could not get rid of their warts.

That is where the cervical cancer vaccine starts. Not in a laboratory, and not with anybody thinking about cervical cancer.

Edinburgh, and the way in

Ian Frazer was born in Glasgow in 1953 and qualified in medicine at Edinburgh in 1977. He went into renal medicine deliberately, and for a reason he is candid about: he wanted to be an immunologist, there was no clinical immunology training in Scotland at the time, and renal medicine had transplantation in it, which meant it had immunology in it.

“I'd always wanted to be an immunologist, and the reason I chose renal medicine — apart from the physiology side of things — was that it had the immunology component, transplantation, built in.”

So: house jobs, then the Medical Renal Unit at the Royal Infirmary of Edinburgh as senior house officer and then registrar, looking after people on chronic dialysis. He left it, and the reason is not the one you would guess. He liked the work — “I really enjoyed the business of doctor-patient relationships, much more than I could have ever imagined that I would.” What he could not face was the arithmetic of the unit: twenty-five-year-olds who were not going to be transplantable, and were, in his word, sentenced.

Melbourne, and a question from a cytologist

He came to the Walter and Eliza Hall Institute around 1980, recruited by Ian Mackay, who with Macfarlane Burnet had written the book that began autoimmunity as a clinical science. What happened next was clinical, not laboratory.

The immunological disorder being described in Boston and San Francisco was turning up in Melbourne too — in about a third of the men in the cohort he was following. And alongside all of that, one thing stood out. In his own words: “these men were having a terrible problem getting rid of genital warts.”

Then somebody asked him a good question. Gabrielle Medley ran the Victorian Cytology Service, and had been reading Harald zur Hausen, who a couple of years earlier had linked papillomavirus to cervical cancer. She asked Frazer whether there was an equivalent disease in men.

So they looked, at the anal cytology of the men he was following, and found precancerous cells — concentrated in the ones who were immunosuppressed. It became a paper in The Lancet in 1986. The question that would take up the next twenty years of his working life had arrived, and it had arrived from a clinic and a cytologist.

Brisbane, and Cambridge

He moved to the University of Queensland in 1985 as Mackay approached retirement. From that year until 1999 he was Director of the Division of Clinical Immunology at Princess Alexandra Hospital, running a hospital clinical service and the state diagnostic immunopathology laboratory while building a research laboratory alongside them. The laboratory did not replace the clinic for another fourteen years.

On sabbatical in Cambridge in 1989, in Lionel Crawford's tumour virus laboratory, Frazer met a Chinese virologist named Jian Zhou. Zhou had qualified at Wenzhou Medical College in 1982 and taken a doctorate at Henan before coming to England. There was no thunderclap. Frazer's own description of it is an exchange of expertise across evenings and weekends — Zhou wanted to learn immunology, Frazer wanted to learn molecular biology, and each had what the other needed.

Zhou came to Brisbane in 1990. The problem was that human papillomavirus cannot be grown in culture. No virus, no vaccine: the ordinary route was simply closed.

The answer was to build an empty one. A viral shell with no genetic material inside it — the outside of the virus, which is all the immune system needs to see, and none of the inside, which is the part that causes cancer. Two things made it work. They started the gene expression downstream of where everyone else had been starting it, and Zhou suggested putting in a second capsid protein, L2, alongside the first.

In March 1991, Zhou's wife Xiao-Yi Sun, working in the same laboratory, assembled the proteins and the particle appeared under the electron microscope. She is the second author on the paper.

Seven years

Jian Zhou died in March 1999, in Hangzhou, aged forty-two. The university's notice at the time said only that it followed a brief illness, and no better source has ever said more, so neither will this.

Gardasil was approved in 2006. Zhou missed it by seven years. He did not see the vaccine licensed, did not see a national programme, did not see a girl in a school hall roll up her sleeve. He had thirty-eight papers and two first-author patents and a laboratory of his own, and he was forty-two.

Frazer was Australian of the Year in 2006, the year the vaccine was approved. The citation reads “Clinical Immunologist and Inventor of the Cervical Cancer Vaccine”. Inventor, singular. Frazer himself says co-invented, and what he did with the money says the same thing.

What it turned into

The University of Queensland licensed the patents to CSL in 1994; CSL sub-licensed to Merck in 1996. By the end of 2024, 147 of the World Health Organization's 194 member states had HPV vaccination in their national schedule for girls. China joined in October 2025.

What that has done is best measured where the programme started early and the data are good. In England, women offered the vaccine at twelve and thirteen have had 87% fewer cervical cancers than expected, and 97% fewer high-grade precancers — about 450 cancers and 17,200 precancers that did not happen, in one country, by the middle of 2019. The global figures you will see quoted, in the tens of millions, are century-scale model projections rather than counts. The English numbers are counts.

The part worth keeping

Frazer has said that when the royalties started arriving he realised he had a problem: he did not need the money and wanted it used well. He and his wife Caroline built a family foundation out of the proceeds, aimed at young people — in research, in medicine, or as he puts it, being a ballet dancer or an artist.

That foundation funds the Jian Zhou Medal, awarded by the Australian Academy of Health and Medical Sciences to an early-career translational researcher. The money the vaccine made pays, every year, for the name of the man who did not live to see it.

He stepped down from his university post in November 2022, after thirty-seven years, on the reasoning that “if I'm occupying a space, I'm keeping it from somebody else who might be able to do something useful with it”. He is Emeritus Professor at the institute that now carries his name, and still publishing — skin cancer immunology, immunotherapy for HPV, and new ways to immunise.

It is tempting to file all of this under laboratory science, and it is not. The vaccine exists because a physician in a Melbourne clinic noticed that a group of his patients could not clear their warts, and because a cytologist asked him what that might mean in women. Neither of those is a procedure. Neither is the sort of thing anybody writes up as a save. Frazer worked as a clinician for twenty years, and the most useful thing he did in all that time was to notice something that did not fit, and then not let go of it.

Most of us will not end up with a vaccine. But the noticing is available to everybody, on every ward round, and nobody can tell at the time which observation is the one that matters.