6th Global Meeting on Implementing New and Under-utilized Vaccines, 15-17 May 2012
Workgroup 5 - Delivery of Human Papillomavirus Vaccines
Cervical cancer is the 2nd most common cancer in women with an estimated 529,000 new cases and 274,000 deaths each year.
HPV vaccine offers a new tool for cervical cancer prevention. However, the vaccine needs to be administered to a population – 9 to 13 year old girls – that has not previously been routinely served by most immunization programmes, so new efforts to reach this population for routine vaccine delivery and communication will be necessary.
Since introducing HPV vaccine is very different from introducing other new vaccines into the routine immunization system, a number of issues need to be considered prior to introducing the vaccine, including:
- identifying the delivery strategy that will be acceptable, affordable, and sustainable and that can achieve high coverage;
- understanding the costs of HPV vaccine introduction, including vaccine delivery, transport, and social mobilization and communication activities; and
- considering how HPV vaccine introduction fits into the national health plan – how does it relate to the national cervical cancer prevention and control strategy? How does it fit into efforts to improve adolescent health services?
Main topics of discussion:
In reviewing the key considerations for decision-making and implementation of HPV vaccine into national immunization programmes, it is clear that a broad variety of tools are available, including the WHO Cervical Cancer Prevention and Control Costing (C4P) Tool. The question is, how best to share them? There are multiple strategies for disseminating lessons learned and tools, e.g. regional meetings, South-to-South sharing of information, partner websites, lists of key resources, etc. however, at policy level, it is essential to engage multiple stakeholders and have high-level coordination by the Ministry of Health.
Bhutan, Rwanda and Tanzania shared some of their experiences with preparing for and introducing HPV vaccine. From these, the key lessons learned included:
- A communication strategy is critical and needs careful planning:
- The audience need to include parents, not just the girls to be vaccinated
- The message selection is critical – especially cancer vs. STI (sexually transmitted illnesses)
- The need to have a communication strategy in place that can promptly respond to rumors and controversy which will inevitably occur
- Parental approval is vital for the success of the introduction, and unpredictably occurs on a continuum from formal consent to authorization to verbal approval to opt-out
- Adjustment of the vaccine delivery strategy is common after the first year once countries have experience in the various strategies that are more or less effective at service delivery level
- There is much interest in combining HPV vaccine delivery with other interventions such as deworming, measles campaign, Td booster, and the advantages and disadvantages of this approach need to be carefully considered
- Diversity of strategies at the local level may be needed but it will be important to evaluate for success before continuing or scaling up
The country presentations and discussions also highlighted the fact that programme evaluations generate different lessons learnt at different time points, for example, early evaluation will provide an indication of feasibility of delivery strategy and may suggest areas for refinement, a later evaluation will provide more of an indication of long-term sustainability and success. The group noted that it may take several years to optimize a strategy.
- Continue to monitor and evaluate programme implementation to build understanding
- Collect HPV vaccine coverage data with attention to the denominator in order to evaluate success of delivery
- Make use of Post-Introduction Evaluations (PIEs) both for improvement of target programme and for opportunity for PIE team members from other countries to learn
- Enhance dissemination of lessons learnt and tools
- Make use of the WHO C4P Tool in more countries
- to more widely enhance understanding of HPV vaccine introduction costs
- to build understanding of the required vaccine delivery components for planning (i.e., what it takes to successfully deliver the vaccine)