Making HPV vaccination available to girls everywhere

Abstract

Cervical cancer is currently the fourth leading cause of cancer death among women worldwide, with most cases occurring in low- and middle-income countries. Safe, highly effective vaccines against HPV have been on the market since 2006, yet only 6% of girls worldwide have received this life-saving cancer prevention intervention. International organizations, including PATH, Gavi, and the pharmaceutical companies Merck and GlaxoSmithKline, have provided support to eligible low- and middle-income countries to implement national HPV vaccination programs. Still, glaring disparities in the availability of national HPV vaccination programs and the coverage of the primary target population between the global north and south persist. We illustrate worldwide HPV vaccine implementation and coverage using an online data visualization, which is publicly available and can be used to gain unique insights. We also present three emerging solutions to transform future HPV vaccine delivery in low- and middle-income countries: low-cost generics, single-dose vaccination, and co-administration with other adolescent vaccines. By rapidly expanding access to HPV vaccination to girls everywhere, vaccine-type HPV infections can be virtually eliminated. At high vaccination-coverage levels, more than 80%-or approximately 230 000-of the cervical cancer deaths that occur each year can be averted.

Keywords: Cervical cancer prevention; Co-administration; Coverage; Dosing schedule; Human papillomavirus; Impact; Low- and middle-income countries; Vaccination.

Figure 1

Proportion of cervical cancers attributable to vaccine-type human papillomavirus infections. Abbreviations: 2vHPV, bivalent vaccine; 4vHPV, quadrivalent vaccine; 9vHPV, nonavalent vaccine; HPV, human papillomavirus.

Figure 2

Worldwide distribution of human papillomavirus vaccination programs (2006–2017) (A). Proportion of countries with national human papillomavirus vaccination programs and demonstration projects by income group (2006–2017) (B). Green indicates countries with a national program, orange indicates a Gavi program, blue indicates a GAP program, violet indicates another demonstration program, red indicates eligibility for Gavi but no program, and gray indicates no program. Note: countries that have conducted multiple demonstration projects or have conducted demonstration projects prior to the introduction of a national program are labeled based on the program with the broadest reach. A national program is defined as any government policy or program that promotes broad access to human papillomavirus vaccines. The World Bank defines the income groups by gross national income per capita as: low income, US$1,005 or less; lower middle income, US$1,006–3,955; upper middle income, US$3,956–12 235; and high income, US$12 236 or more. An interactive version of this map is available (https://public.tableau.com/views/HPVVaccineReviewV3_0/NationalandDemoProgramsalltime2?:embed=y&:useGuest=true&:display_count=yes).

Figure 2

Worldwide distribution of human papillomavirus vaccination programs (2006–2017) (A). Proportion of countries with national human papillomavirus vaccination programs and demonstration projects by income group (2006–2017) (B). Green indicates countries with a national program, orange indicates a Gavi program, blue indicates a GAP program, violet indicates another demonstration program, red indicates eligibility for Gavi but no program, and gray indicates no program. Note: countries that have conducted multiple demonstration projects or have conducted demonstration projects prior to the introduction of a national program are labeled based on the program with the broadest reach. A national program is defined as any government policy or program that promotes broad access to human papillomavirus vaccines. The World Bank defines the income groups by gross national income per capita as: low income, US$1,005 or less; lower middle income, US$1,006–3,955; upper middle income, US$3,956–12 235; and high income, US$12 236 or more. An interactive version of this map is available (https://public.tableau.com/views/HPVVaccineReviewV3_0/NationalandDemoProgramsalltime2?:embed=y&:useGuest=true&:display_count=yes).

Figure 3

Worldwide distribution of human papillomavirus vaccination programs by year of implementation (A); darker shades of green indicate earlier implementation (from 2006), lighter shades of indicate more recent implementation (until 2017), and orange indicates 2018 and planned implementation. Proportion of countries with national human papillomavirus vaccination programs by income group (B); green indicates high income, blue indicates upper middle income, orange indicates lower middle income, and red indicates low income. Note: A national program is defined as any government policy or program that promotes broad access to human papillomavirus vaccines. The World Bank defines the income groups by gross national income per capita as: low income, US$1,005 or less; lower middle income, US$1,006–3,955; upper middle income, US$3,956–12 235; and high income, US$12 236 or more. An interactive version of this map is available (https://public.tableau.com/views/HPVVaccineReviewV3_0/NationalandDemoProgramsalltime2?:embed=y&:useGuest=true&:display_count=yes).

Figure 3

Worldwide distribution of human papillomavirus vaccination programs by year of implementation (A); darker shades of green indicate earlier implementation (from 2006), lighter shades of indicate more recent implementation (until 2017), and orange indicates 2018 and planned implementation. Proportion of countries with national human papillomavirus vaccination programs by income group (B); green indicates high income, blue indicates upper middle income, orange indicates lower middle income, and red indicates low income. Note: A national program is defined as any government policy or program that promotes broad access to human papillomavirus vaccines. The World Bank defines the income groups by gross national income per capita as: low income, US$1,005 or less; lower middle income, US$1,006–3,955; upper middle income, US$3,956–12 235; and high income, US$12 236 or more. An interactive version of this map is available (https://public.tableau.com/views/HPVVaccineReviewV3_0/NationalandDemoProgramsalltime2?:embed=y&:useGuest=true&:display_count=yes).

Figure 4

Full-course human papillomavirus vaccination coverage (2009–2017). Note: Coverage is defined as the proportion of the targeted population receiving full-course (two or three doses) human papillomavirus vaccination. Red/orange shades indicate coverage of approximately 0%–45% (darker indicating lower), lighter green shades indicate coverage of approximately 50%–70%, and darker green shades indicate coverage above approximately 70%, darkest shades indicating highest coverage). An interactive version of this map is available (https://public.tableau.com/views/HPVVaccineReviewV3_0/NationalandDemoProgramsalltime2?:embed=y&:useGuest=true&:display_count=yes).

Figure 5

Proportion of 10–20-year-old girls receiving human papillomavirus vaccination by country income group. The World Bank defines the income groups by gross national income per capita as: low income, US$1,005 or less; lower middle income, US$1,006–3,955; upper middle income, US$3,956–12 235; and high income, US$12 236 or more. Adapted from Bruni L et al. [16].

Figure 6

Vaccination schedule for adolescents aged 9–15 years as recommended by the WHO.