By Michael Gwarisa
Following the relaunch of the Human papillomavirus (HPV) programme by GAVI the Vaccine Alliance, in line with the new World Health Organisation (WHO) recommendations for a single-dose HPV vaccine, African states are embracing the administering of the one dosage in eligible populations.
The developments come amidst indications that GAVI has set an ambitious target to reach 86 million girls with the HPV vaccine by 2025, as immunisation partners outline an ambitious plan to protect millions of girls in lower- and middle-income countries against cervical cancer.
Speaking during a World Health Organisation (WHO) side event on HPV at the International Conference on Public Health in Africa (CPHIA2023) underway in Lusaka, Zambia, Dr Matsidiso Moeti the WHO-Afro Region Director said transitioning to the one dose for HPV was a game changer for Africa.
As Africa, we are progressing and indeed the transitioning to the one dose is a huge step towards accelerating reduced prevalence,” said Dr Moeti.
“I am very hopeful that the sensitisation of policymakers has been done, the sensitisation of immunisation in communities has been done and the vaccine will become more available and lessons have been learnt about how we combine delivery of these vaccines into communities.”
She emphasised that eliminating cervical cancer was a critical public health priority. She however noted that in Africa, HPV vaccination coverage for two doses was very low. She also noted that the Southern African region was doing well in terms of coverage for HPV vaccination compared to their Central African counterparts mainly due to some of the conditions such as Conflict which weaken the primary healthcare systems.
She added that while Cervical Cancer is the number one cancer killer for African women, the disease was preventable through HPV vaccination in the younger populations.
Dr. Washingwa Tambatamba, from Zambia’s Minsitry of Health said they have reviewed the age group eligible for HPV vaccination to 16. WHO now recommends a one or two-dose schedule for girls aged nine-14 years, a one or two-dose schedule for girls and women aged 15-20 years and two doses with a six-month interval for women older than 21 years.
“As a country, we did launch the two-dose HPV vaccine recently and the Ministry of Health was at the forefront of ensuring that the launch takes place. We have a strategy that we have earmarked for having young girls. In the last few years that is four or five years ago, we were giving girls between the age of nine and 10 years old in school but we now cover up to the age of 16,” said Dr Tambatamba.
HPV vaccines are often delivered in schools since the primary target group for the vaccine is 9 to 14-year-old girls. COVID-19 disruptions resulted in school and health facility closures and delayed vaccination rounds. Before the COVID-19 pandemic hit in 2020, momentum for HPV vaccination was building, however data shows that HPV vaccination coverage dropped by an alarming 15 per cent when the pandemic hit.
Nigeria recently introduced the human papillomavirus (HPV) vaccine into its routine immunisation system, aiming to reach 7.7 million girls, the largest number in a single round of HPV vaccination in the African region. Girls aged 9–14 years received a single dose of the vaccine, which is highly efficacious in preventing infection with HPV types 16 and 18 which are known to cause at least 70 percent of cervical cancers.
The Gavi board has since approved the revitalisation of its HPV vaccine programme with an investment of over US$ 600 million by the end of 2025.
David Marlow, the Interim Chief Executive Officer for GAVI said the successful rollout of the single-dose HPV as well as attaining the 86 million girls and young women, was premised on community buy-in and governments should engage communities prior to the roll-out of the vaccines.
“When we look at the data in 2022, we did not by any means reach where we intended to be with the HPV vaccination, so we went to work and we came up with a revitalised HPV relaunch plan and we are targeting 85 Million young women by 2025,” said Marlow.
“If we are successful in reaching 86 Million, we will prevent 1.4 Million deaths. That is sort of what we were doing with the relaunch plan obviously going from a two to one dose also helps from a cost perspective but obviously, we have got to be careful between the switch from two and the one dose.”
Marlow said the new plan also involves switching from the previous two doses to only one dose. This translates to 3.5 million more girls having missed out on HPV vaccination in 2021 compared to 2019.
Within four weeks of their relaunch, GAVI reached over 4 Million girls and young women in Nigeria. The HPV burden is highest on the African continent according to public health statistics.
According to UNICEF data, in 2020, there were over 600,000 new cervical cancer cases and 340,000 deaths. Ninety per cent of these cases and deaths occurred in low- and middle-income countries where access to prevention, screening and treatment services is more limited. Africa, Melanesia and South-East Asia have some of the highest burdens of cervical cancer deaths. Almost 60 per cent of cervical cancer cases occur in countries that have not yet introduced HPV vaccination.