When the human papillomavirus (HPV) vaccine was commercially launched in 2006, the wellbeing of future generations of women was secured against the viruses that cause 70% of cervical cancer cases. However, cervical cancer continues to cause approximately 275,000 deaths every year, with 85% of those deaths occurring in developing countries. So how can we reach the young girls in low- and middle-income countries whose wellness could significantly benefit from a HPV vaccination?
Gavi, which funds vaccines for children in the world’s 73 poorest countries, has now set a target of supporting the vaccination of 30 million girls against HPV by 2020. Gavi-funded pilot projects are due to start in Ghana, Kenya, Laos, Madagascar, Malawi, Niger, and Sierra Leone this year, and in Tanzania in 2014. Countries that can demonstrate their ability to deliver the vaccine will have access to a full rollout of funding.
According to Seth Berkley, Gavi chief executive, ‘There is a triple whammy for women in the developing world: they have a higher incidence of HPV infection, there is usually no good screening programme in place, and if they do get cervical cancer they don’t have good treatment options.’ In Cambodia, for example, the age standardised cervical cancer mortality rate (which minimises the effect of age composition in different populations) is 16.2 per 100,000 and in Kenya it is even higher, at 17.3 per 100,000. By contrast, the rate in the UK is 2.0 per 100,000.
Dr Kimberley Fox of the Expanded Programme on Immunisation at WHO’s Western Pacific regional office in Manila, notes that the 70% level of protection offered by HPV vaccination ‘has lead to a lot of excitement, because countries can be confident of achieving a real impact from a fairly bounded intervention.’ However, she adds, ‘The cost and complexity of implementation is a barrier because it is being delivered through new systems, such as through schools. That seems a very convenient way to reach girls aged nine to 13 but this is not a system that the national immunisation programmes already have in place.’
There is also another big challenge at the local level; communications. ‘This vaccine has been a sensitive issue in many countries, because it relates to reproductive health,’ Fox explains. ‘Communications with communities, schools, teachers, parents and girls are really crucial to ensure acceptance of vaccine. They have to understand what the vaccine is, that it’s about preventing cancer.’
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