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

Girls receiving the HPV vaccine.

April 2017: HPV vaccination in Kagasunzu primary school in Rwanda. Rwanda became the first low-income country to provide universal access to HPV vaccine and the first African country to begin an HPV national roll-out with Gavi support. Its nationwide HPV vaccination programme has successfully attained high coverage.
Credit: 2017/Rachel Wilkinson.

Since the first human papillomavirus (HPV) vaccine demonstration programme in Kenya in 2013, one million girls have been vaccinated with Gavi support.

By the end of 2016, Gavi had helped 23 countries to conduct HPV vaccine demonstration programmes – the first step towards national introductions. Three countries, Honduras, Rwanda and Uganda, have introduced HPV in their national immunisation programmes.

In addition, the Gavi Board has approved the acceleration of the human papillomavirus (HPV) vaccine programme that should allow Gavi-supported countries to protect around 40 million girls from cervical cancer by 2020, averting an estimated 900,000 deaths.

Lessons learnt

As it is taking longer than expected for countries to transition from demonstration projects to national introductions, Gavi is revising its HPV support. The new approach will draw heavily on the valuable lessons learnt from the demonstration projects. These important lessons include:

  • School-based delivery works: countries have achieved more than 80% coverage by administering the HPV vaccine through schools – well above the 50% minimum required to apply to Gavi for national support.
  • Integrate with routine immunisation: evidence from Rwanda, Uganda and the United Republic of Tanzania shows that delivery costs drop if the HPV vaccine is delivered through existing health clinics and outreach sessions, as well as schools.
  • Communication is essential: raising political and grassroots awareness of cervical cancer prevention is critical to the success of HPV vaccination programmes.
  • Deliver with other health programmes: countries have the opportunity to integrate HPV vaccine delivery with other adolescent health programmes such as deworming and health education.
  • Multi stake-holder engagement is critical: engaging key stakeholders and building political will at all levels are vital to the expansion of HPV programmes.

Record low price

A record low price for HPV vaccines has created an opportunity for developing countries to vaccinate millions of girls against a devastating women’s cancer.

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

In addition, WHO’s decision to switch from a recommended schedule of three doses to two doses helps to facilitate country roll-outs and reduce costs.

Gavi supports HPV vaccines for national introduction, with immunisation of multiple cohorts of girls in the age range 9–14 years

Immunisation coupled with screening and treatment is the best strategy to rapidly reduce the burden of cervical cancer. However, historically the high cost of the vaccine and challenges of reaching adolescent girls to deliver immunisation have been barriers to introduction in poorer countries.

Gavi is working to bridge the equity gap by providing the vaccine at affordable and sustainable prices, and to support countries with demonstration programmes to build capacity and test different approaches to deliver the vaccine to adolescent girls.

WHO recommends that countries use delivery strategies that are compatible with their health delivery infrastructure and cold-chain capacity; are affordable, cost-effective and sustainable; and achieve the highest possible coverage.

Priority should be given to strategies that include populations who are less likely to have access to screening for cervical cancer later in life. Opportunities to link vaccine delivery to other health programmes targeting adolescent girls should also be explored.

Gavi’s commitment to protecting women against cervical cancer supports the UN Secretary-General’s Global Strategy on Women’s and Children’s Health to address key global health priorities by increasing access to life-saving vaccines.

Support

In 2016, the Board approved two main changes in the HPV programme following a recommendation by WHO’s Strategic Advisory Group of Experts (SAGE).

First, countries can now apply directly for Gavi support to fund national introductions rather than starting with a demonstration programme. Countries also have the option of a phased introduction.

Second, countries can opt to vaccinate multiple age groups - between 9 and 14 years - in the first year of their programme.

Partnerships

Gavi works with cancer groups as well as reproductive health and women’s organisations to help countries deliver HPV vaccines cost-effectively. These partnerships also identify opportunities to integrate HPV vaccination with other health interventions for girls. These include adolescent reproductive health, HIV prevention, nutrition, family planning and safe motherhood.

WHO, the Alliance for Cervical Cancer Prevention, the Cervical Cancer Action coalition and the United Nations Population Fund have called for comprehensive cervical cancer prevention plans. These include vaccination of young girls and screening and treatment of women.

Partners

Many organisations are actively involved with clinical and operational research, policy analysis and advocacy related to HPV vaccine. Collaborating partners and their main roles include:

World Health Organization (WHO) offers technical information, standards and guidelines and in country planning and training; 

PATH supports operational research to inform decisions about how to introduce HPV vaccines;

UNICEF provides a market informational note for HPV vaccines, highlighting current and projected demand, as well as anticipated supply availability during 2014–2017, brings expertise in social mobilisation and demand generation;

United Nations Population Fund (UNFPA) brings expertise in reproductive health and identification of population estimates for adolescent girls;

International Agency for Research on Cancer (IARC) carries out epidemiological studies assessing HPV type-specific prevalence among various populations;

The Cervical Cancer Action coalition furthers advocacy and education;

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

Vaccine manufacturers and academia conduct clinical research.

Cervical cancer is the leading cause of cancer death among women in Gavi-supported 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

HPV infection is the main cause of cervical cancer, which claims the lives of 266,000 women each year, mainly in developing countries. Without changes in prevention and control, cervical cancer deaths are forecast to rise to 416,000 by 2035.

Most cervical cancer is caused by a sexually transmitted infection – human papillomavirus (HPV). HPV is highly transmissible and infection is very common.

Immunisation coupled with screening and treatment is the best strategy to rapidly reduce the burden of cervical cancer. In resource-poor countries where women often lack access to cancer screening and treatment services, immunising girls before exposure to HPV is critical.

HPV vaccines

Safe and effective HPV vaccines, which protect against the strains that cause up to 90% of cervical cancer cases, are available in the routine immunisation programmes of most high-income countries. 

WHO recommends HPV vaccination of girls aged 9–14 years through national immunisation programmes in countries under the following conditions:

  • cervical cancer is a public health priority;
  • vaccine introduction is feasible;
  • sustainable financing can be secured; and
  • vaccines are considered cost-effective.  

Countries are required to vaccinate girls on a two-dose schedule. However, girls with an impaired immune system will still require a three-dose schedule. 

High prices have been a major barrier to introducing these vaccines in developing countries, where the cervical cancer burden is highest. Thanks to the Vaccine Alliance and its partners, the poorest countries now have access to a sustainable supply of HPV vaccines for as little as US$ 4.50 per dose.

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