The opportunity of the single-dose HPV vaccine

Building on its longstanding commitment to reduce cervical cancer incidence and mortality, UICC worked closely with WHO as it developed the?'Global Strategy to Accelerate the Elimination of Cervical Cancer as a Public Health Problem', following Dr Tedros’ call to action in 2018. The Global Strategy was adopted by Member States in 2020.

UICC has since been supporting the implementation of the Strategy, for example, through the Unitaid-funded SUCCESS project, specifically working with its members to develop and drive national advocacy efforts, and raise awareness of the elimination agenda with its three targets: 90% of girls fully vaccinated against the human papillomavirus (HPV) by 15 years of age; 70% of women screened using a high-performance test by the age of 35 and again by 45; 90% of women identified with cervical disease receiving treatment and care.

In May 2023, UICC again reiterated its commitment and support to global efforts to eliminate cervical cancer by joining more than 1,400 organisations from 116 countries?in signing a new Global Declaration?to make elimination a reality.

Furthermore, UICC is currently conducting a?landscaping of civil society organisations, exploring their role in supporting the introduction and scale-up of HPV vaccination, and how further to support and facilitate their engagement as critical actors in achieving the 90% target.

The?latest progress report by WHO?indicates that since the call to action, 50 countries – mostly low- and middle-income countries have introduced the HPV vaccine into their routine immunisation programmes.

Vaccination against the human papillomavirus (HPV) is a key pillar in achieving elimination, as more than?95% of cervical cancers are due to the human papillomavirus, a communicable disease. Gavi and partners have recognised the urgent need to recover from a drop in vaccination rates due to COVID-19, improve coverage, and help build sustainable vaccination programmes. Their commitment to?reach 86 million adolescent girls?with the HPV vaccine by 2025 and?avert 1.4 million deaths?from cervical cancer underscores the global momentum that is gathering to achieve the objective of 90% coverage in every country.

Another recent development that should significantly improve countries’ ability to vaccinate more girls is WHO’s endorsement at the end of 2022 of a single-dose vaccine regimen. The Seattle-based non-profit organisation PATH has?outlined the evidence?supporting the conclusion by WHO’s Strategic Advisory Group of Experts (SAGE) on Immunization that a single dose of the HPV vaccine offers?protection comparable to a two-dose regimen.

On the occasion of the World Health Assembly in May 2023, PATH and partners, including UICC,?issued a statement?outlining the substantial benefits of this change in regimen.

“WHO’s recent one-dose guidance for HPV vaccination makes us hopeful that we can reach more girls. We’re thrilled to partner with countries, Gavi and many other partners, to improve access to HPV vaccines, overcome past supply challenges and pandemic-related disruptions, to protect more girls and women from cervical cancer.”

–?Violaine Mitchell, Director of Immunization,?Bill & Melinda Gates Foundation.

Most high-income countries have been moving ahead with widespread HPV vaccination programmes since the vaccine?was first introduced in 2006-2007. And while vaccine uptake?remains lower in low-resource settings?where the burden of cervical cancer is the highest, several lower-income countries, however, have demonstrated that the successful implementation of HPV vaccination programmes is possible in resource-constrained settings, through different strategies including school-based, community-based, and national programmes.

This is particularly important, as 90% of cervical cancer deaths occur in low- and middle-income countries due to low vaccination rates and late diagnosis of the disease. A notable challenge is the stigma, lack of awareness and even taboo that often surrounds sexual and reproductive health. HPV is a sexually transmitted disease, with vaccination in some communities being falsely perceived as promoting promiscuity.

“The people who influence decision-making within a family, within a community, should first be able to accept and take ownership of the need for the deployment of this vaccine so as to convince those around them to go and get vaccinated. A woman who is aware that she can develop cervical cancer at any time and who has the possibility of offering her nine-year-old daughter a vaccine so that she does not develop the disease later, is a huge asset."

–?Dr Samiratou Ouédraogo,?Deputy Coordinator, Research and Action Against Cancer (ReAAC); Chair and co-Founder, Women in Global Health, French-speaking West Africa,?in an interview with Gavi.

Bhutan, Rwanda, Brunei and Burkina Faso are among several low- and middle-income countries that have implemented wide-reaching vaccination programmes that have significantly enhanced vaccine coverage and disease prevention.

Bhutan was the first LMIC to introduce a national vaccination programme in 2010 and launched its cervical cancer elimination programme in 2019. The country has been vaccinating both boys and girls, with an overall coverage rate for both genders?of about 90%, including first and last doses (for the two or three-dose regimens). Rwanda implemented a national vaccination programme in 2011, and has since succeeded in achieving?a first-dose coverage rate of girls aged 9-15 above 90%. Both programmes have led to?significant reductions in HPV prevalence?and cervical cancer incidence.

Brunei implemented a school-based vaccination programme in 2012, which has also resulted in high coverage rates –?97% for first dose, 89% for last dose?– with associated reductions in HPV prevalence. The gap between first and second dose coverage rates highlights the advantage of a single-dose regimen, as in this case the target population would be almost fully vaccinated. A single-dose regimen may also facilitate community outreach by combining delivery with other vaccination programmes as well as the acceptability of the vaccine. It is also more feasible, due to the lack of need to follow-up with the second dose.

In April 2022, Burkina Faso introduced HPV vaccination as part of its national ‘Expanded Immunization Program’. Burkina Faso is also one of four countries that UICC is supporting as part of the SUCCESS project.

The paradigm shift and opportunity of single-dose HPV vaccination and the mobilisation of the global health community to tackle cervical cancer will be discussed at an upcoming side-event co-hosted by UICC, the Gates Foundation and other key organisations during the?Women Deliver Conference?in July.