Building the case and capacities for successful HPV vaccine introduction
Before introducing a new vaccine into routine immunization programmes, each country has to weigh important factors such as:
- disease burden;
- vaccine efficacy and safety;
- strengths of the immunization programme and health system in general;
- financial aspects of introduction, including cost-effectiveness, affordability, and financial sustainability.
Countries eligible for support from Gavi, the Vaccine Alliance (Gavi), must also consider when and how to apply for support for introduction. To help strengthen this decision-making and planning process, WHO experts hosted a workshop on 16-17 March 2016 in Copenhagen, Denmark, for representatives of 6 middle-income countries currently considering introduction of the vaccine against human papillomavirus (HPV).
Workshop participants from Armenia, Azerbaijan, Belarus, Georgia, Republic of Moldova and Uzbekistan were eager to learn from the experiences of other countries and to gather information and technical expertise to help them evaluate the evidence and potentially prepare for successful introduction of the vaccine. They also shared their own best practices from previous vaccine introductions and concerns regarding introduction of HPV vaccine.
HPV vaccine is included in the national immunization schedules of 28 countries in the WHO European Region, with annual uptake ranging from 46% to 92% of the target group. Experience in these countries has shown that proper preparedness for introduction is key to achieving high coverage, with a focus on:
- a transparent and inclusive decision-making process;
- utilization of existing vaccine delivery and monitoring systems;
- effective communication and social mobilization strategy;
- preparedness for crisis communication.
"Over the last 10 years more than 200 million doses of HPV vaccine have been given to girls in 65 countries worldwide. Repeated, independent vaccine safety reviews by GACVS [Global Advisory Committee on Vaccine safety] and EMA [European Medicines Agency] concluded that the vaccine does not cause severe side effects, so we know the vaccine is both safe and very effective. Unfortunately safety concerns have affected the coverage in some countries. Most countries have reacted adequately and continue having robust HPV vaccination programmes" explained Paul Bloem of WHO headquarters.
Evidence and tools
WHO provided up-to-date information on:
- diseases caused by the HPV virus
- comprehensive approaches to prevent and control cervical cancer
- regional and global status of HPV vaccine introductions and
- the safety and efficacy of the vaccine.
Tools to help countries gather the necessary evidence at national level were also presented, including cost-effectiveness analyses and the Cervical Cancer Prevention and Control Costing (C4P) tool to collect local economic evidence to support decision-making on introduction of HPV vaccines.
Dr Liudmila Mosina, of WHO/Europe, noted the importance of having a solid communications system in place prior to introduction of HPV vaccine. "This includes collaboration with the education system, training of health care workers and engagement of decisions-makers." WHO offers communications support through publications, workshops, national communication reviews and technical advice.
Based on the expert presentations and group work, participants developed plans of activities to support decision-making on introduction of HPV vaccine and preparing for introductions, including development of proposals for Gavi support. The countries defined the technical and consultancy support they request from WHO and partners and developed preliminary timeline of activities. These plans will be shared with health authorities and ministries in the countries to initiate the implementation.