Closing the gap: UNICEF bolsters country efforts to increase HPV vaccination

Globally, just one in eight girls are vaccinated against human papillomavirus (HPV) – the leading cause of cervical cancer. Although momentum was building before the global pandemic, HPV vaccination programmes were severely affected by COVID-19.

HPV vaccines are often delivered in schools because the primary target group for this vaccine is 9 to 14-year-old girls. COVID-19 disruptions resulted in school and health facility closures and delayed vaccination rounds. Since 2019, HPV vaccination coverage dropped by an alarming 15 per cent. This represents one of the largest backslides of any vaccine during the pandemic.

Oluwaseun Ayanniyi is a Contracts Specialist in the Vaccine Centre of UNICEF’s Supply Division in Copenhagen. She is optimistic that significant ground can be regained to prevent cervical cancer. In 2023 alone, UNICEF will supply one in four countries worldwide with this life-saving vaccine, with seven countries (Bangladesh, Cambodia, Eswatini, Kiribati, Mongolia, Nigeria, and Togo) introducing these vaccines to their routine immunization programmes. We spoke with Oluwaseun, to learn how this will significantly benefit girls in these countries and protect them from cervical cancer.

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. The good news is that 20 of the countries with the highest burden will introduce the HPV vaccine in the next two to three years. UNICEF and Gavi, the Vaccine Alliance are supporting these efforts in 5 of these countries including India, Nigeria, Bangladesh, Angola and Mali.

The priority is to close immunization gaps and plan catch-up strategies for HPV vaccination. Vaccines are one of the most cost-effective medical interventions we can make. For HPV vaccination, the results speak for themselves. Studies have shown an almost 90 per cent reduction in cervical cancer in girls who received the vaccine.

Around 125 countries have introduced HPV vaccines, offering access to one in three girls aged 9-14 worldwide. As more supplies become available, we need to encourage the remaining countries to introduce HPV vaccines into their routine immunization programmes and offer these countries the necessary technical and financial support to do so.

At the same time, we need to ensure accurate demand forecasts, and indicate timelines for vaccine introduction so we can signal to manufacturers to scale up production to meet countries’ demand.

WHO recommends that the primary targets for HPV vaccination are girls aged 9–14 years. This is the age group where vaccination can have the biggest impact. WHO recommends the following dose schedule for primary, secondary and tertiary target groups:

If vaccine supplies are not constrained, additional age groups and boys can be vaccinated. Currently, 47 countries offer male vaccination.

UNICEF began supplying the HPV vaccine in 2013. Demand through UNICEF was initially limited. Following Gavi’s new strategy to accelerate HPV vaccination, there was considerable increase in demand from 2017. In addition, global demand for HPV vaccines surged as interest in preventing cervical cancer through vaccination increased. Due to this spike in demand, global supply constraints were observed. UNICEF’s close engagement and partnership with vaccine manufacturers in the last five years has resulted in increased supply availability for countries procuring through UNICEF.

This year, UNICEF expects to procure almost 36 million doses of HPV vaccines on behalf of 52 countries. That’s almost a seven-fold increase over the last five years, so, we’ve witnessed a huge jump in both demand and supply availability.

UNICEF will procure HPV vaccines for 28 countries receiving Gavi support, 8 Gavi transitioned countries* and 16 self-financing middle-income countries in 2023.

The market dynamics are evolving quickly. There are currently five WHO prequalified HPV vaccines. UNICEF currently procures three out of the five vaccines to meet current demand from countries. However, we can’t say that we have a healthy vaccine market yet because supply does not meet demand.

But the market is constantly evolving, and many exciting developments and innovations are taking place. All HPV vaccines target two HPV strains (16 and 18) that cause at least 70 per cent of cervical cancers. While some HPV vaccines can target four or even nine strains of cancer-causing viruses. So, the health benefits and impact of these vaccines are extremely consequential.

By 2024, UNICEF anticipates that the HPV vaccine market will evolve towards a moderate state of health with the entry of new suppliers and additional capacity from existing suppliers. UNICEF is closely engaging with suppliers and partners to make this a reality. New WHO prequalified vaccines will help to diversify the supplier base and improve vaccine security and pricing.

Current pricing levels remain a concern for countries for their long-term sustainable financing of HPV programmes. As UNICEF is the largest buyer of vaccines in the world, we can pool demand for countries, drive down prices and really help shape the market. UNICEF is collaborating with different partners including Gavi, the Vaccine Alliance; WHO; and the Bill and Melinda Gates Foundation, to develop strategies that will improve the market health for HPV vaccines. Ultimately, a healthy market facilitates more equitable access and wider uptake of the vaccine.

HPV vaccines are proven to be very safe and highly effective. The potential benefits are enormous – hundreds of thousands of lives could be saved each year. Countries that wish to procure through UNICEF are advised to forecast, plan their demand and consider long-term commitments to achieve more affordable prices. The HPV vaccine must be introduced as part of broader cervical cancer programmes – together with screening and treatment. All three pillars are essential if we are to eliminate cervical cancer as a public health problem.

This is why UNICEF has recently developed the Cervical Cancer Toolkit, so we can offer all of these critical components to governments and donors. We have everything we need to make huge progress against this disease. We need to scale up the roll out of these vaccines as soon as possible to protect the health of girls and women around the world.

* A Gavi transitioned country previously received funding support from Gavi but is now fully self-financed.