Introducing Vaccines Against Cervical Cancer

Published in the Program in Appropriate Technologies for Health (PATH)'s Directions in Global Health, this 2-page report explores strategies for introducing vaccines against the human papillomavirus (HPV) within developing countries, where women rarely receive routine screenings for early cancer detection. PATH is collaborating with women's rights advocates, adolescent and reproductive health experts, and the vaccine community to find effective ways to reach adolescent girls with the vaccine, assess vaccine demand, and communicate the results of research and lessons learned to decision-makers and global health colleagues around the world.

As explained here, HPV vaccines pose unique introduction challenges. The vaccines are effective if given before girls are infected with HPV. Because infection usually results within a year or two of sexual debut, it is important to protect girls between the ages of 9 and 16 years. But young girls in economically poor countries rarely access health services. Furthermore, some communities oppose vaccinating young girls against a sexually transmitted infection (STI); others may be suspicious of a vaccine offered only to girls.

So, working with the World Health Organization (WHO), ministries of health, vaccine manufacturers, and in-country partners, PATH began planning demonstration projects to introduce the HPV vaccine in India, Peru, Uganda, and Vietnam. To prepare, PATH supported formative research to answer the following questions:

• What societal attitudes will influence the acceptability of HPV vaccine?
• How can HPV vaccines be integrated into existing health systems?
• What are the costs of HPV vaccine programmes?
• What combination of programme activities, including cervical cancer screening and treatment services for older women who may already have been infected, could have the greatest impact on cervical cancer rates?

Building on formative research and conversations with governments and donors, PATH worked to develop a global demand estimate for the HPV vaccine to guide manufacturers' supply and pricing decisions. This information was expected to help the Global Alliance for Vaccines and Immunization (GAVI), the United Nations Children's Fund (UNICEF), and manufacturing partners negotiate the best possible price for public health programmes in low-resource countries.

Throughout this process of research and advocacy, PATH is synthesising and disseminating findings in an effort to inform HPV vaccine policy, programming, and funding decisions. In doing so, PATH's strategy has involved carefully tailoring its communications to various audiences, sharing results in peer-reviewed journals and producing: interactive online tools for decision-makers and programme managers, resources for health workers and nurses, and media support materials to help raise global public awareness of the need for HPV vaccine. The May 2007 issue of PATH's Outlook newsletter provides evidence-based information about cervical cancer. It summarises key issues related to HPV transmission, new HPV vaccines, and strategies for introduction in low-resource countries. The issue also identifies new methods for early detection and treatment of cervical cancer. (Click here for access). PATH's Reproductive Health Outlook (RHO) is an online clearinghouse for cervical cancer resources, offering research, films, and many publications.

Through these and other vehicles, PATH shares information and lessons learned from its formative research, demonstration projects, awareness-raising on cervical cancer prevention, and work on the demand–supply equation. The goal is to help decisionmakers in resource-poor countries make informed decisions regarding introducing the vaccine, improving screening services, and so on. Their experience will, in turn, guide strategies for introducing future vaccines for STIs.