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 HPV vaccine and ensuring sustainable prices.
Gavi supports HPV vaccines for national introduction, with immunisation of multi-age cohorts 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.
WHO recommends that countries use HPV delivery strategies that are compatible with their health systems infrastructure and cold-chain capacity; are affordable, cost-effective and sustainable; and achieve the highest possible coverage. The highest priority should be given to vaccination 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 interventions targeting adolescent girls should also be explored.
In 2016, the Gavi Board approved two main changes in the HPV programme, following a recommendation by the WHO Strategic Advisory Group of Experts (SAGE) on Immunization.
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.
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. Where feasible, they have also helped to push through comprehensive cervical cancer prevention plans which include vaccination of young girls and screening and treatment of women.