Human papillomavirus vaccine support

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1 million girls immunised against HPV with Gavi support

Coverage reported from demonstration programmes encouragingly high

Record low price for HPV vaccines

October 2013, Lao PDR : first Asian country to begin a HPV demonstration project with Gavi support.

In October 2013, Lao PDR became the first Asian country to begin a HPV demonstration programme with GAVI support. The country also launched pneumococcal vaccine nationwide at the same time. Credit: Gavi/2013/Bart Verweij.

Kenya was the first country to carry out a human papillomavirus (HPV) vaccine demonstration programme with our support in 2013. Since then, Gavi-supported countries have vaccinated one million girls against HPV.

By the end of 2015, we had supported HPV vaccine demonstration programmes in 19 countries. These programmes are the first step towards national introductions. Two countries, Rwanda and Uganda, had added the vaccine to their national programmes by the end of the year.

We have also approved catalytic funding for 15 transitioning countries to introduce HPV vaccine. These countries were no longer eligible when we first started offering this support.

New approach

It has taken longer than expected for countries to switch from demonstration projects to national introductions. As a result, we have revised our HPV support. The new approach draws on the valuable lessons learnt from the demonstration projects. These include:

  • School-based delivery works. Countries have achieved more than 80% coverage by providing HPV vaccine through schools. This is well above the 50% required to apply to Gavi for support for a national introduction.
  • Integrate with routine immunisation. Delivery costs are lower when countries deliver the vaccine through clinics and outreach sessions as well as schools.
  • Communication is essential. Raising awareness of how to prevent cervical cancer is critical to the success of HPV vaccination programmes.
  • Deliver with other health programmes. Countries can integrate HPV vaccine delivery with other health interventions for adolescent girls.
  • Multi stake-holder engagement is critical. Building political will at all levels is vital to the expansion of HPV programmes.

Record-low price

Thanks to a record-low price for HPV vaccines countries can vaccinate millions of girls against cervical cancer.

Gavi can now access a sustainable supply of HPV vaccine for the poorest countries for as little as US$ 4.50 per dose. The same vaccines can cost more than US$ 100 in high-income countries. The previous lowest public sector price was US$ 13 per dose.

WHO’s decision to change its recommendation from three doses to two makes it easier for countries to roll out the vaccine. It also helps to reduce costs.

Gavi supports HPV vaccines for national introduction and demonstration programmes

Immunisation combined with screening and treatment is the best strategy to reduce the burden of cervical cancer. In the past, the high cost prevented countries from introducing the vaccine. Also, it was difficult for some countries to put systems in place to reach adolescent girls.

Gavi is addressing this by providing the vaccine at affordable and sustainable prices. Further, countries can run demonstration programmes with our support. These help countries test different approaches to deliver the vaccine to adolescent girls.

WHO has several recommendations for how countries should deliver HPV vaccine. For instance, strategies should be compatible with countries' existing health delivery infrastructure. They should be affordable, cost-effective and sustainable, and achieve the highest possible coverage.

Countries should prioritise populations who may not have access to cervical cancer screening. They should also link vaccine delivery to other programmes targeting young girls.

Two types of support

We support both HPV demonstration programmes and national introductions of HPV vaccines.

Countries that can show they can deliver the vaccine can apply for a national introduction.1 

Those that lack this experience can get support for smaller-scale demonstration programmes. This will give them the experience necessary to apply for national roll-out.

Partnerships

We work with partners to help countries deliver HPV vaccine in a cost-effective way. We also aim to combine vaccine delivery with other interventions for girls. These include adolescent reproductive health, HIV prevention, nutrition, family planning and safe motherhood.

Initial experience in offering HPV vaccination in Africa and Asia has been encouraging. Lessons learnt documents are available through the Reproductive Health Outlook Cervical Cancer library.

Partners

Collaborating partners and their main roles include:

World Health Organization (WHO) offers standards, guidelines and in-country planning and training.

PATH supports research to inform decisions about how to introduce HPV vaccines.

UNICEF provides an informational note for the HPV vaccine market. This includes current and expected demand and supply availability. UNICEF also brings expertise in social mobilisation and demand generation.

United Nations Population Fund (UNFPA) brings expertise in reproductive health. It also provides population estimates for adolescent girls.

International Agency for Research on Cancer (IARC) carries out studies assessing HPV prevalence.

The Cervical Cancer Action coalition works with advocacy and education.

Alliance for Cervical Cancer Prevention provides news, resources, advocacy and information.

Vaccine manufacturers and academia conduct clinical research.

Gavi funds HPV introductions in eligible countries.


1 Prior experience in delivering vaccines with a multi-dose schedule to at least 50% of a one-year cohort. The cohort should be part of the population of 9–13-year-old girls in at least one district of the Expanded Programme on Immunization.

Cervical cancer is the leading cause of cancer death among women in developing countries

HPV vaccines aren’t routinely available in countries with the highest burden

HPV vaccines aren’t routinely available in countries with the highest burden. | View full size image.

THE GROWING BURDEN OF CERVICAL CANCER

Human papillomavirus (HPV) is the main cause of cervical cancer. HPV is very infectious and almost all men and women get it at some point in their lives.

Cervical cancer kills 266,000 women each year, most of whom live in developing countries. If the current trend continues, cervical cancer deaths are forecast to rise to 416,000 by 2035.

In many developing countries women lack access to cancer screening and treatment. In these countries, immunising girls before exposure to HPV is especially critical.

HPV VACCINES

HPV vaccines can prevent up to 90% of cervical cancer cases. These vaccines are already available to adolescent girls in most high-income countries.

WHO recommends HPV vaccination of girls aged 9–13 years in countries where:

  • cervical cancer is a public health priority;
  • vaccine introduction is viable;
  • sustainable financing is available; and
  • vaccines are cost-effective.

Countries should vaccinate girls on a two-dose schedule. Girls with an impaired immune system need three doses of the vaccine.

In the past, high prices prevented developing countries from introducing HPV vaccine. Thanks to the Vaccine Alliance and its partners, the vaccine is now available for as little as US$ 4.50 per dose.

Feedback

Ian Frazer

Professor Ian Frazer
creator of the HPV vaccine


“Today’s announcement by GAVI of country approvals for HPV demonstration projects is another big step forward to ensuring that girls living in developing countries enjoy the same access to HPV vaccines as girls elsewhere in the world. ” 

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