IMMUNISATION PARTNERS OUTLINE AMBITIOUS PLAN TO PROTECT MILLIONS OF GIRLS IN LOWER- AND MIDDLE-INCOME COUNTRIES AGAINST CERVICAL CANCER
Over the next few years, Gavi, the Vaccine Alliance and partners will focus efforts to revitalise access to the human papillomavirus (HPV) vaccine to reach 86 million adolescent girls, rapidly recover and improve coverage, and help build sustainable vaccination programmes
Despite the availability of the HPV vaccine in the Gavi portfolio, the vaccine’s ability to prevent cervical cancer, and the number of introductions into routine immunisation programmes, global HPV vaccination coverage for final dose stands at 12% – with supply constraints, demand challenges and pandemic-related school closures hampering and setting back progress in recent years
Aurélia Nguyen, Chief Programme Strategy Officer at Gavi: “There are still millions of adolescent girls at risk of contracting cervical cancer – a life-threatening yet vaccine-preventable disease that disproportionately kills women in lower-income countries. Taking urgent action to ensure no girl is left behind is imperative from a gender and equity perspective.”
Geneva, 27 April 2023 – Gavi, the Vaccine Alliance and partners have committed to reach 86 million adolescent girls with the human papillomavirus (HPV) vaccine by 2025, outlining an action plan following the Gavi Board’s approval of the revitalisation of the HPV programme.
Over the course of the next three years, the Vaccine Alliance – which includes country governments, the World Health Organization, UNICEF, the Bill & Melinda Gates Foundation, civil society and other key partners– will work with low- and middle-income countries to help even more adolescent girls access this life-saving vaccine. This revitalisation push will be on three fronts:
Introductions: providing new funding and assistance to introduce the HPV vaccine into routine immunisation schedules;
Catch up and strengthen: implementing multi-age cohort (MAC) vaccination to rapidly catch up and improve coverage; and
Integration: promote sustainability through the integration of HPV vaccination into routine immunisation and primary health care.
In parallel, Gavi will also offer support to countries to optimise the 2022 WHO Strategic Advisory Group of Experts on Immunization (SAGE) one-dose recommendation, which now enables countries to opt for a single-dose schedule for the HPV vaccine. Country-led decision making to adopt and implement the new guidelines, as per country choice, will be critical.
Some of the countries that Gavi anticipates will receive support in the next 12 months include Bangladesh, Cambodia, Ethiopia, Indonesia[1], Kenya, Nigeria, Togo and Zambia. Gavi will also continue to work with countries that have already introduced the vaccine to help improve coverage and other countries to plan for future introductions.
In addition to its standard vaccine and health systems support activities, the December Board decision will allow Gavi to dedicate additional funding to help countries and partners reach more girls with this life-saving vaccine than ever. This includes approximately US$ 33 million for enhanced technical assistance for introductions, planning and implementation; US$ 40 million to optimise health systems strengthening investments focused on effective delivery of the HPV vaccine; and cash support of US$ 69 million for new introductions.
Given the unique challenges of HPV vaccination, such as service delivery, gender-related barriers, demand and trust – and the need to better understand how best to implement effective programmes that reach all girls (including those out of school and HIV+ populations) – Gavi will also dedicate US$ 15 million to establish a learning agenda to support the integration of the HPV vaccination programme into routine immunisation and primary health care in lower- and middle-income countries. Community engagement across diverse settings, communication and the collaborative efforts of partners – including civil society partners, WHO, UNICEF and other partners and governments – will be critical to the success of this agenda.
An extraordinarily impactful vaccine
“The HPV vaccine has amongst the highest impact of all Gavi-supported vaccines, saving millions of lives and helping to protect the future of adolescent girls across the world,” said Aurélia Nguyen, Chief Programme Strategy Officer at Gavi. “Yet that there are still millions of young girls who are at risk of contracting cervical cancer, a life-threatening yet vaccine-preventable disease that disproportionately kills women in lower- and middle-income countries. The COVID-19 pandemic and school closures have also hit hard and set back vital progress: taking urgent action to ensure no girl is left behind is imperative from a gender and equity perspective.”
HPV causes more than 95% of cervical cancer cases worldwide and is the most common cause of female cancer death in nearly half of sub-Saharan African countries. Despite efforts by countries and partners, global vaccination coverage rates for fully vaccinated girls remain low (12% in 2021), leaving millions of women and adolescent girls vulnerable to the virus, and at risk of developing the disease. While coverage in Gavi-supported countries is close to the global average (11% in 2021), it’s particularly low in the South-East Asia Region, and 90% of the estimated 342,000 people who died of cervical cancer in 2020 were in low- and middle-income countries.The HPV vaccine is highly effective: with 17.4 deaths averted per 1,000 adolescents vaccinated, it can prevent up to 90% of all cervical cancer cases, and it is the key intervention towards achieving elimination of cervical cancer. It also provides a unique opportunity to invest in the health of women and the future of girls.
A moment of opportunity
The Vaccine Alliance began supporting countries with HPV vaccines in 2012; to date, 29 countries, including 20 in Africa, have introduced the vaccine, and 14.7 million girls[2] have been fully vaccinated with Gavi support through routine immunisation and MACs. However, severe global supply constraints, combined with the unique challenge of reaching adolescent girls with the HPV vaccine due to cultural sensitivities and gender-related barriers, have hampered the ability to improve coverage. The COVID-19 pandemic also severely impacted HPV vaccination programmes, many of which are school-based, resulting in girls missing out on life-saving vaccines.
Gavi and partners have been working with manufacturers for several years to support the development of a healthier HPV vaccine market. Consequently, supply challenges are now easing, thanks to increased production capacity and new vaccines receiving pre-qualification from WHO. These developments, combined with confirmation from WHO last year that a one-dose schedule also provides a high degree of protection, presents a unique opportunity to accelerate progress toward reaching vaccination targets.
Recognising this, in December 2022 the Gavi Board approved the revitalisation of the Alliance’s HPV vaccine programme with an over US$ 600 million investment by end of 2025. With the additional funding in place, the Alliance has set an ambitious goal to reach over 86 million girls by 2025, aiming to avert over 1.4 million future deaths from cervical cancer. In order to achieve this goal, all partners must work together.
QUOTES FROM ALLIANCE AND IMMUNISATION PARTNERS:
“It’s time for African Union member states and international partners to come together to ensure generations of adolescent girls and young women receive the human papillomavirus (HPV) vaccine to secure their protection against cervical cancer,” said H.E. Ambassador Minata Samaté Cessouma, African Union Commissioner for Health, Humanitarian Affairs, and Social Development.
“WHO’s recent one-dose guidance for HPV vaccination makes us hopeful that we can reach more girls,” said Violaine Mitchell, Director of Immunization at the Bill & Melinda Gates Foundation. “We’re thrilled to partner with countries, Gavi and many other partners to improve access to HPV vaccines, overcome past supply challenges and pandemic-related disruptions to protect more girls and women from cervical cancer.”
“Young people of all backgrounds deserve access to accurate, comprehensive and age-appropriate sexual health education and care. Through the ‘Form ni HPV’ project, we aim to make cervical cancer prevention an essential part of comprehensive sexual and reproductive health services for young girls, and welcome this joint effort to ensure millions of girls get access to the HPV vaccine,” said Kristine Yakhama, Coordinator and Co-founder of Good Health Community Programmes.
“Girls and young women must have access to vaccines that protect them from preventable diseases like HPV. It is integral that governments urgently introduce the HPV vaccine if they haven’t done so. For those that have, they must rapidly scale up vaccination efforts, especially to catch up the girls missed during the pandemic due to school closures. We can protect the women of tomorrow, and help them realise their full rights, by ensuring we reach every girl with vaccines today,” said Ephrem Tekle Lemango, Director of Global Immunization, UNICEF.
“Achieving HPV vaccination rates is key to reducing the burden of cervical cancer. WHO is working with countries and partners to promote a multisectoral approach to addressing barriers to vaccination and increasing HPV vaccination coverage rates,” said Dr Matshidiso Moeti, WHO Regional Director for Africa.
“Girls are our future scientists, writers, sports champions, and innovators. We want to see every girl and woman protected from cervical cancer throughout her lifetime. With new evidence available on vaccine performance, WHO updated its recommendations in 2022 to give countries the option of a one-dose schedule of the HPV vaccine. This has been an important step towards vaccinating and protecting more women and girls. WHO will continue to work with countries and international partners to accelerate the global roll-out of HPV vaccines, through our regulatory support, policy advice, training, data monitoring and programme support,” said Dr Kate O’Brien, Director, Department of Immunization, Vaccines and Biologicals, World Health Organization.
[1] Support to Indonesia is offered under Gavi’s Middle-Income Countries Approach.
[2] The number of girls fully immunised with Gavi support through 2021 were undercounted in Gavi’s 2021 Annual Progress Report (APR) 2021 as 9.8 million; an updated figure will be included in the 2022 APR
