Gavi’s impact

To date, 3.9 million girls immunised against HPV with Gavi support. Four countries have introduced HPV vaccine into their national programmes in 2018. Record low price for HPV vaccines.

Since the inception of the human papillomavirus (HPV) vaccine programme in 2012, 3.9 million girls have been vaccinated with Gavi support.

In 2016, the Gavi Board approved an acceleration of the HPV vaccine programme, allowing countries to directly scale up nationally and vaccinate multi-age cohorts from 9–14 years in the first year of their programme. Through this new strategy, Gavi aimed to protect around 40 million girls from cervical cancer by 2020, averting an estimated 900,000 deaths.  However, due to surging global demand, this goal is at risk with an estimated 13 million girls that may be reached by 2020 and 300,000 deaths averted.

The uptake of the HPV programme since 2017 has been encouraging, 20 countries successfully approved with estimated 30 million girls to be vaccinated. Despite the supply challenges, Gavi has helped 13 countries to introduce the HPV vaccine into their national immunisation programme. In 2018 alone, four countries with the highest burden of cervical cancer: Ethiopia, Senegal, The United Republic of Tanzania, and Zimbabwe successfully launched an HPV programme.

To date, four countries introduced the vaccine into their routine programmes in 2018.

Record low price

A record low price for HPV vaccines has created an opportunity for low-income 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 perdose. 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.

A record low price for HPV vaccines has created an opportunity for low-income 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 perdose. 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’s response

Gavi supports HPV vaccines for national introduction, with immunisation of multiple age cohort of girls in the age range 9–14 years. However, due to ongoing supply constraints, countries have had to adapt their programmatic strategy by vaccinating a single cohort to introduce and the remaining multi-age cohort when supply is available.

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 low-income 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, depending on supply availability.

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

The Issue 

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.

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 311,000 women each year, mainly in low-income 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 low-income 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 

2018 saw significant supply shortages of the HPV vaccine, which is forecasted to continue in the short- to medium-term. This is because of the unprecedented uptake of HPV support in Gavi-eligible countries coupled with increased global demand for HPV vaccines from higher-income countries 

Alliance partners have been working with manufacturers in order to increase manufacturing capacity to meet worldwide demand, as well as working with countries to help them adapt programmatic strategies. 

External links

WHO SAGE Report for recommendation on HPV multi-age cohort vaccination, October 2016, PMNCH Knowledge Summary 15: Non-communicable diseases, World Cancer Report 2014 press release

Resources

Human papillomavirus and related cancers in GAVI countries

Human Papillomavirus (HPV) and Related Cancers in the Global Alliance for Vaccines and Immunization (GAVI) Countries. A WHO/ICO HPV Information Centre Report

Working Towards Affordable Pricing for HPV Vaccines for Developing Countries: The Role of GAVI

This publication is part of the Global Task Force on Expanded Access to Cancer Care and Control in Developing Countries (GTF.CCC) Working Paper and Background Note Series. It was produced in collaboration with the GAVI Alliance as a background…

How to apply for vaccine support

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