Human papillomavirus vaccine support

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1.5 million girls immunised against HPV with Gavi support

Six countries have introduced HPV vaccine into their national programmes

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, 1.5 million girls have been vaccinated with Gavi support.

By the end of 2017, Gavi had helped 30 countries to conduct HPV vaccine demonstration programmes – the first step towards national introductions. Six countries, Bolivia, Guyana, Honduras, Rwanda, Sri Lanka and Uganda, had introduced the HPV vaccine into their national immunisation programmes.

In 2016, the Gavi Board approved an acceleration of the HPV vaccine programme. This should allow Gavi-supported countries to protect around 40 million girls from cervical cancer by 2020, averting an estimated 900,000 deaths.

Record low price

A record low price for HPV vaccines has created an opportunity for developing countries to vaccinate millions of girls against cervical cancer.

Thanks to the Vaccine Alliance, the lowest-income countries now have access to 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 developing countries. Gavi is working to bridge the equity gap by providing support for the HPV vaccine and ensuring sustainable prices.

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.

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.

Globally, one woman dies of cervical cancer every two minutes

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

The growing burden of cervical cancer

Infection with human papillomavirus (HPV) 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.

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 is highly transmissible and infection is very common. Safe and effective HPV vaccines can prevent up to 90% of all cervical cancer cases.

Surging demand

2017 saw significant supply shortages of the HPV vaccine, a result of a spate in country applications. Although this had been forecasted and shared in advance with the primary supplier, the increase in demand could not be met.

Addressing the supply shortages will require investment in additional manufacturing capacity, as well as time.

Meanwhile, Alliance partners are working with countries to help them adapt to the supply situation by adjusting the timing of their introductions. Also, a new tender will be issued to ensure supply for 2020 and beyond.

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