Plan To Protect Millions Of Girls Against Cervical Cancer

Gavi, the Vaccine Alliance, and partners have committed to reaching 86 million adolescent girls with the human papillomavirus (HPV) vaccine by 2025, outlining an action plan following the Gavi Board’s approval of the revitalization of the HPV program.

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 revitalization push will be on three fronts:

• Introductions: providing new funding and assistance to introduce the HPV vaccine into routine immunization 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 immunization and primary health care.

In parallel, Gavi will also offer support to countries to optimize 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, Kenya, Nigeria, Togo, and Zambia. Gavi will also continue to work with countries that have already introduced the vaccine to help improve coverage and with 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 optimize 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 programs 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 program into routine immunization 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 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 the 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 the 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 immunization 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 programs, 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, present a unique opportunity to accelerate progress toward reaching vaccination targets.

Recognizing this, in December 2022 the Gavi Board approved the revitalization of the Alliance’s HPV vaccine program with an over US$ 600 million investment by the 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.