Written by Henry Neondo
More than 180,000 girls in eight developing countries are set to receive protection against the leading cause of cervical cancer thanks to human papillomavirus (HPV) vaccines funded by the GAVI Alliance.
In an announcement made on World Cancer Day, the Alliance confirmed that Ghana, Kenya, Lao PDR, Madagascar, Malawi, Niger, Sierra Leone and Tanzania will become the first countries to receive GAVI support to start HPV vaccine demonstration programmes.
The demonstration programmes will give each country the opportunity to test their ability to put in place the systems that would be needed to roll out the HPV vaccines nationally and to inform their decisions. Unlike most other vaccines, which are administered to children under the age of five, HPV vaccines are given to girls aged nine to 13.
“Introducing the HPV vaccine in developing countries is the start of a global effort to protect all girls against cervical cancer,” said Dr Seth Berkley, GAVI CEO. “Of the 275,000 women who die of cervical cancer annually, 85% live in the world’s poorest countries. Cervical cancer is one of the leading cancer killers of women in the developing world.”
By 2015, GAVI plans to support more than 20 countries to vaccinate approximately one million girls with HPV vaccines through pilot projects. By 2020, more than 30 million girls are expected to have been vaccinated in over 40 countries with GAVI support.
Seven of the eight selected countries will begin introducing HPV vaccines this year targeting girls aged 9 to 13, mainly through schools but also community health programmes to reach girls who do not go to school. Ghana, Kenya and Sierra Leone are likely to be the first to begin administering HPV vaccinations in early 2013 with Tanzania planning to start next year.
GAVI-eligible countries which already have systems in place for national rollouts targeting adolescent girls can apply for funding without undertaking demonstration projects.
Cervical cancer now kills more women worldwide than childbirth, claiming a life every two minutes. According to the Union for International Cancer Control (UICC) and the International Agency for Research on Cancer (IARC) currently, 7.6 million people die from one form of cancer or the other worldwide every year, out of which, 4 million people die prematurely (aged 30 to 69).
“The estimate of 1.5 million lives lost per year to cancer that could be prevented must serve to galvanise our efforts in implementing the World Health Organization’s (WHO) ‘25 by 25’ target,” said Dr Christopher Wild, Director of IARC. “There is now a need for a global commitment to help drive advancements in policy and encourage implementation of comprehensive National Cancer Control Plans. If we are to succeed in this, we have a collective responsibility to support low- and middle-income countries who are tackling a cancer epidemic with insufficient resources.”
On World Cancer Day, UICC and its members urged the public and governments alike to speak out with one voice to dispel damaging myths and misconceptions on cancer. Under the theme “Cancer – Did you know?” individuals and communities are encouraged to shed light on four key cancer ‘myths’ and the corresponding ‘truth’ via the UICC World Cancer Day App. Download the App and play your part in reducing the unacceptable burden of cancer.
GAVI has been working with vaccine manufacturers to secure the most affordable price for HPV vaccines. To date, one manufacturer has announced an indicative price of US$ 5 per dose, a 64% reduction on the current lowest public price. GAVI expects to secure a lower price for procurement of HPV vaccines, vital to the sustainability of current and future programmes.
One of the challenges to effectively delivering HPV vaccines is that many developing countries do not offer routine health services for girls in the 9 to 13 age group.
Other challenges include identifying the appropriate target group, engaging with those at highest risk who may not be easily reached, and preventing a sexually transmitted cancer-causing infection that is minimally symptomatic or asymptomatic.
Without changes in prevention and control, GAVI says cervical cancer deaths are expected to increase to 430,000 each year by 2030, virtually all in developing countries.
Immunising girls before sexual initiation – and before exposure to HPV infection – is a key strategy to preventing cervical cancer. Vaccination against HPV is only effective before the person is infected with the virus.
The eight countries approved for GAVI support will “learn by doing” in order to make an informed decision on whether to expand their programmes nationwide and potentially build capacity to do so.
Initial experience in offering HPV vaccinations through schools in Africa, Asia and Latin America has been encouraging.
This first round of HPV vaccines, which are administered in three doses, will require over half a million doses. UNICEF, a key GAVI partner, will procure the vaccines following a competitive tender process that is currently being completed. Merck and GlaxoSmithKline (GSK) are currently the only two manufacturers who have prequalified HPV vaccines.
The introduction of HPV vaccines in developing countries also provides a window of opportunity to strengthen other adolescent health services, exploiting synergies with nutrition, HIV, sexual and reproductive health.
Prof Ian Frazer, creator of the HPV vaccine, welcomed GAVI’s announcement. “I am very pleased that GAVI is standing firm in its commitment,” he said. “Today’s announcement of country approvals for HPV pilot projects is another big step forward to ensuring that girls living in developing countries enjoy the same access to HPV vaccines as girls elsewhere in the world.”