5 Key Considerations for Improving HPV Vaccine Uptake

By far the single most common cancer caused by the Human Papillomavirus (HPV) is cervical cancer which results in 342,000 deaths each year, most of them in low- and middle-income countries. Despite a safe and effective vaccine to prevent HPV being available for the past 17 years, only one in eight girls globally is protected. To change the trajectory of these life-threatening trends, The Global HPV Consortium – a new Sabin-led movement to prevent HPV infection and eliminate cervical cancer as a public health concern – will drive action and catalyze momentum across the three pillars of vaccination, screening and treatment.

At Sabin’s Vaccination Acceptance Research Network (VARN) 2023 Conference in June, several stakeholders including HPV technical experts, healthcare workers, policymakers, journalists, and civil society leaders came together for a focus group discussion. From the rich and dynamic discussions, five key themes emerged as opportunities for increasing demand and acceptance of HPV vaccines.

1. Significant knowledge gaps remain for single-dose strategy recommendations.

Recent guidance from the World Health Organization’s Strategic Advisory Group of Experts on Immunization (SAGE) suggests that one-dose of the quadrivalent vaccine provides sufficient protection against HPV.  While there are clear health and financial benefits in a single- vs multi-dose regimen, single-dose vaccines are currently only recommended for women 20 years or younger. Also, immuno-compromised individuals, such as women living with HIV, will still need multiple doses. Depending on how the population demographics are skewed, countries may adopt different approaches. “There should be no influence mounted on countries from the global level to make a decision either way,” said Anuradha Gupta, Sabin’s President, Global Immunization.

2. As the HPV vaccine is ideally offered at ages 9-14, there are two different populations that must agree to the shot: parents and adolescents.

Unlike childhood and routine immunization, vaccinating adolescents against HPV requires not only acquiring consent of the guardian, but also participation from the adolescent themselves. Focus group participants widely agreed that school-based vaccination approaches are not a one-size fits all solution and present a unique set of challenges when gaining parental and adolescent consent. A participant in the group discussion highlighted one aspect of this conversation by sharing that, “school-based approaches are popular and efficient, but can include issues with parental consent and involvement, backlash, and problems with reaching out of school girls.”

3. Persistent differences between public vs private sector HPV vaccination have deepened inequity and impact acceptance.

While 130 countries so far have introduced the HPV vaccine into their national immunization schedule, discrepancies in vaccination between private and public sectors present persistent challenges. In several countries, the public sector must carefully distribute a limited number of vaccines to deliver the greatest benefits, resulting in HPV vaccination programs only for girls.. However, these barriers are not present in the private sector, where families that can afford to pay are not constrained by gender or age-specific requirements. Not only does this divide create inequities, but it also impacts communication strategy and HPV vaccine demand and acceptance.

4. HPV vaccination requires innovative communication strategies, including amplifying the voices of youth advocates.

A recurring topic during the session was the need for new communication strategies, particularly strategies that place adolescents at the center and actively engage youth in co-designing solutions.

One participant emphasized the many roles that youth can play in HPV vaccination by highlighting that: “Adolescents could be volunteers, they could be ambassadors, they could be change agents. They know how to leverage technology, they are smart, energetic.”

5. Successful elimination of cervical cancer requires integration of primary and secondary prevention.

Attendees discussed the numerous financial and political barriers to integrated vaccination, screening, and treatment programs, but both success stories and challenges shared by participants underscored the importance of sustained advocacy for integrated solutions for cervical cancer.

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