While few health services have emerged unscathed from the disruptions of COVID-19, the impact on global human papillomavirus (HPV) vaccination coverage, already low, has been especially stark: only 15 percent in 2021, compared with 20 percent in 2019.
Available since 2006, HPV vaccines are highly effective and can prevent most cases of cervical cancer, the most common cancer on the African continent and the fourth leading cancer in women worldwide. Increased use of HPV vaccines would save hundreds of thousands of lives each year, but that can only happen with widespread access.
From advancing new vaccine candidates to optimizing programmatic impact, PATH is uncovering ways to reach the World Health Organization’s (WHO’s) 90 percent coverage target as fast as possible.
One dose, greater reach
Over the last four years, the Single-Dose HPV Vaccine Evaluation Consortium, coordinated by PATH, has gathered and evaluated data from clinical trials, observational studies, and modeling analyses regarding the value of a single-dose HPV vaccination schedule. The Consortium collated, synthesized, and evaluated evidence that contributed to WHO’s decision in 2022 to endorse a single-dose HPV vaccine schedule for the primary target age group (9–14 years old).
A single-dose schedule can expand coverage, reaching more girls and preventing more cases of cervical cancer. While the Consortium continues to disseminate evidence and evaluate ongoing and additional clinical studies, the WHO endorsement provides reassurance that administration of a single dose will have a positive public health benefit while alleviating financial and logistical barriers.
Boosting HPV vaccine supply
Even before the COVID-19 pandemic, countries with low- and middle-income (LMIC) economies faced numerous financial and logistical barriers to HPV vaccine uptake. Entry of new, low-cost HPV vaccines into the global market could increase access, especially in the countries that face the most significant burdens.
To that end, PATH is supporting a Phase 3 clinical study of Cecolin®, a bivalent HPV vaccine manufactured by Xiamen Innovax Biotech Co., Ltd., which received WHO prequalification in 2021. (A bivalent vaccine protects against two different strains of the same disease.) The study will generate additional data on Cecolin’s performance outside of China, where it was initially licensed.
Already underway in Ghana and Bangladesh, the study will yield comparisons between Cecolin and the most widely used HPV vaccine, GARDASIL®; assess vaccine performance in countries with high HPV burden; and evaluate the use of flexible and extended dosing schedules. These additional data can strengthen vaccine confidence, support global recommendations, and improve individual country uptake.
Developing additional more affordable, multivalent HPV vaccines—which would protect against even more strains of HPV compared to bivalent vaccines—could also boost accessibility for LMIC countries. We are currently assessing potential HPV vaccine candidates from LMIC vaccine manufacturers to test in Phase 3 clinical trials by comparing the immunogenicity of the candidates to a licensed HPV vaccine with proven single-dose efficacy.
“Increasing the availability of affordable HPV vaccines and expanding options globally is crucial for reaching WHO coverage goals,” said Anne Schuind, MD, PATH Initiative Team Leader for HPV Vaccines. “HPV vaccination is highly effective, and all girls deserve access to this lifesaving tool—no matter where they live.”
“HPV vaccination is highly effective, and all girls deserve access to this lifesaving tool—no matter where they live.”— Anne Schuind, MD, PATH Initiative Team Leader for HPV Vaccines
The complexities of vaccine introduction
There are limited data on the cost of HPV vaccine delivery as national immunization programs mature. Previous research has focused largely on costs of introduction or demonstration projects. Improved understanding of recurrent costs would help inform future HPV vaccine introductions, as well as budgeting, planning, and program sustainability in LMICs.
To address this gap, we conducted a study in collaboration with local partners in Ethiopia, Guyana, Rwanda, Senegal, Sri Lanka, and Uganda to generate evidence on the ongoing annual costs (excluding the costs of vaccines and supplies) to deliver a two-dose HPV vaccination schedule. Full results will be available soon.
Likewise, understanding the cost-effectiveness of different HPV vaccine options is essential for countries considering introducing an HPV vaccine or switching to a different product. We’re conducting a series of country-specific cost-effectiveness analyses that can help local leaders estimate long-term health, economic, and financial impacts and make decisions about which vaccine products will be most appropriate and sustainable.
Results are currently available for the Philippines, with additional countries to follow.
We’re also conducting projects to assess health system barriers and opportunities for cervical cancer prevention in Zambia, evaluate the cost of cervical cancer and precancer screening and treatment in Senegal, and develop and maintain a user-friendly HPV vaccine product choice calculator for assessing and comparing costs of different HPV vaccination programs.
“These types of data and tools will be incredibly helpful for countries seeking to initiate HPV vaccine introductions or accelerate coverage in existing vaccination programs,” said Cathy Ndiaye, PhD, MPH, Director of HPV Vaccine Programs at PATH in Senegal. “This is one of the reasons that PATH is proud to be part of the new HPV Vaccine Acceleration Program Partners Initiative (HAPPI) Consortium.”
Led by JSI, Dr. Ndiaye explained, the HAPPI Consortium aims to increase and sustain equity and program quality and increase coverage of HPV vaccination in several low-resource countries, in support of WHO’s global goal of reaching 90 percent HPV vaccination coverage by 2030.
WHO’s goal is both worthy and attainable. Achieving it will mean saving hundreds of thousands of women’s lives from cervical cancer, but only if we vaccinate as many girls as possible today—and we at PATH are committed to doing our part.