A Vaccine Against Cervical Cancer: Context for the Global Public Health Practitioner.

Abstract

Gavi, the Vaccine Alliance provides support for vaccine introduction and immunization programs in eligible countries; country eligibility for support from Gavi is chiefly determined by the gross national income (GNI) per capita, which determines the level of co-financing and nature of vaccine program support available.14 Between 2012 and 2016, both Gavi and vaccine manufacturers funded sub-national demonstration projects in countries around the world to better understand how to feasibly and sustainably deliver HPV vaccine to adolescents, a relatively new target age group that does not routinely access health services, especially in low- and middle-income countries. Gavi-eligible countries needed to demonstrate successful vaccination to this new target age group prior to requesting funds for national HPV vaccine introduction. Starting in 2017, Gavi shifted its focus from demonstration programs to national introductions, aiming to scale up early lessons learned and to accelerate progress toward the goal of protecting 40 million girls from cervical cancer by 2020 in Gavi-eligible countries.15 Following WHO recommendations, Gavi enacted policy to support vaccination of multiple age cohorts in the first year of program implementation for Gavi-eligible countries. However, due to current global vaccine shortage, some countries have been advised to target a single age group for the first year of introduction, with the potential to vaccinate multiple age cohorts in the future, as supply allows. Demonstrating experience in delivering the vaccine to adolescents is no longer a prerequisite for support of national implementation in these countries. Following WHO's change in HPV vaccine policy and Gavi's shift in program support, many Gavi-eligible countries are moving rapidly to introduce HPV vaccine into their national immunization programs.