8th December 2022

In a previous blog, we discussed the announcement from the World Health Organization (WHO’s) Strategic Advisory Group of Experts on Immunization (SAGE) that a single dose of human papillomavirus (HPV) vaccine delivers a comparable level of protection against HPV infection as two doses of HPV vaccine. 

It is anticipated that the WHO will share an official endorsement of SAGE’s advice, and a subsequent change to HPV vaccination guidelines. In light of this, CCAE conducted a ‘temperature check’ survey, to understand how network organizations were engaging with the shift to single dose and if they would value any support from CCAE on the matter. 

The survey was completed by 14 network organizations, and there was consensus in many of the responses. For example, there were shared opinions particularly around gaps in guidelines and implementation strategies at the country level, which were both considered barriers to the successful implementation of single-dose vaccination programs. Similarly, concerns around the effectiveness of single-dose schedules have been heard by numerous organisations, reflecting the need for clear and coordinated messaging on the shift.  

These survey responses, and our analysis of them, can be found here. They will be used to inform CCAE’s strategy for 2023, and the details of this will be shared in the first quarter of 2023. 

In the meantime, there are several network organizations doing fantastic work to provide insight on the shift to single-dose, including PATH. 

Their suite of resources on current evidence for single-dose HPV vaccination is considered the standard on the topic; providing both high-level and in-depth information on HPV and cervical cancer, HPV vaccines, and the potential impact of a single-dose regimen. 

Links to the resources in both French and English are listed below. 

English 

• Single-Dose HPV Vaccination: High-Level Brief on Current Evidence  

• Single-Dose HPV Vaccination: In-Depth Overview of Current Evidence 

French 

• Vaccination contre le HPV à dose unique: note d’information de haut niveau sur les données probantes actuelles 

• Vaccination à dose unique contre le HPV: aperçu approfondi des données probantes actuelles 

Since the start of the pandemic and the launch of the Global Strategy, opportunities for collaborative in-person discussion have been limited in global health communities, and the cervical cancer community has been no exception. With international travel now permitted for many of our network, the CCAE co-chairs were delighted to host a working meeting, with support from UICC, at the 2022 World Cancer Congress in Geneva, thereby providing that opportunity for partners and advocates to unite.

“We must seize this opportunity. The WHO strategy was agreed upon, in no small part, due to the collective efforts of civil society. We will need a similar concerted and collective effort to turn the strategy into reality.”

Meeting Participant

The meeting was focused on identifying the key advocacy priorities for attaining global equitable access to HPV vaccination. The CCAE co-chairs came away from the discussion with a wealth of

 ideas and insight on unified approaches to HPV vaccination advocacy, and this has been worked up into the World Cancer Congress Special Working Meeting on HPV Vaccination Report. 

There was another clear takeaway from bringing civil society organizations and advocates together in this way; in order to achieve equitable access to the HPV vaccine for all adolescent girls, we must continue to collaborate on collective action. By unifying the voices of the community, we can work with policymakers and influential populations more efficiently and effectively, to ensure that girls everywhere are protected against cervical cancer.   

CCAE will be moving forward using insights gained from the report to build out a collaboration-focused strategy for 2023/24.

In April, the World Health Organization’s (WHO’s) Strategic Advisory Group of Experts on Immunization (SAGE) came to the agreement that a single dose of human papillomavirus (HPV) vaccine delivers a comparable level of protection against HPV infection – the prerequisite to cervical cancer – as two doses of HPV vaccine. 

In June, the WHO’s Weekly Epidemiological Record (WER) reported on SAGE’s recommendation that a single- or two-dose HPV vaccination schedule is suitable for the majority of girls and women aged 9-20 years. The WER stated that the single-dose option is ‘recommended from a public health perspective’ for routine and multi-cohort catch-up vaccinations. 

Previous guidance stipulated that two doses of the HPV vaccine should be given to females with healthy immune systems younger than 15 years of age, and three doses should be given to females who are either 15 years of age or older or without healthy immune systems. 

The WHO’s decision to update their guidance on HPV vaccination regimens – and endorse a reduction in the number of vaccine doses required – was informed by the findings of research studies published over the last three years. These studies collectively demonstrate the immune response of a single dose of HPV vaccine and its efficacy in preventing HPV infection. 

This new guidance is a huge step towards our shared vision of ensuring that cervical cancer is eliminated within the lifetime of today’s girls, and has been welcomed by many in the community.

Our partners, PATH, have also confirmed that they will be switching to single-dose schedules with their delivery partners who are providing HPV vaccinations. Gavi, meanwhile, have confirmed that they will support countries hoping to transition to single-dose strategies.

Current global levels of HPV vaccine coverage are vastly inequitable. Whilst 85% of high-income countries had integrated HPV vaccines into national immunisation programmes by 2020, fewer than 25% of low-income countries had done the same.  

This has been, in part, attributed to insufficient supplies of HPV vaccines to meet the global demand and the comparatively high cost of the vaccine. If countries across the world switch to a single dose of the vaccine for girls with healthy immune systems, the number of vaccine doses required globally could be reduced; alleviating supply constraints. Similarly, requiring only one HPV vaccine for the majority of girls could see HPV vaccination programmes becoming more affordable and feasible for lower-income countries.

Fewer numbers of doses could also help advance HPV vaccination catch-up and outreach programmes. However, hard-to-reach groups, such as girls out of school and those in remote areas, must be given additional opportunities through such programmes to access the vaccines and avoid missing out on immunisation. Without this, it will not be possible to universally improve uptake within nations and reduce disparities for vulnerable girls.  

The HPV vaccine is safe and highly effective in preventing cervical cancer. In addition to cervical screening, it is a crucial measure to prevent the development of cervical cancer. With this new guidance, we hope that all adolescent girls globally will be able to access this HPV vaccination, in order to equitably reduce the risk of developing cervical cancer around the world.  

PATH resources 

Our partners, PATH, are developing a number of informative resources on the shift to single-dose regimens for HPV vaccines. These will be live on PATH’s website shortly, and we will share links to the resources when they become publicly available.

Earlier this month, CCAE’s co-chair, Cancer Research UK, attended a workshop hosted by the International Federation of Gynecology and Obstetrics (FIGO). The event served to bring together medical, policy and technical implementation professionals from across the world to discuss means of sustainably implementing vaccination programmes for women. Through these conversations, delegates contributed to the discussions of best practice strategies on HPV vaccination programme implementation. FIGO will flesh out these initial suggestions in collaboration with members throughout their global community, before publishing official recommendations for all HPV programme developers and deliverers around the world. 

It was a privilege to learn of the diverse experiences of researchers, advocates, and implementers across the globe, all committed to eliminating cervical cancer. By listening to the stories and studies of fellow delegates, and sharing our own insights, CCAE hopes to support the creation and implementation of strategies that will see every girl vaccinated against HPV before she turns 15. 

The timing of developing HPV vaccination programmes, and delivering them well, has never been more crucial. With new HPV vaccines making their way through approval, and the WHO’s endorsement of single dose regimens, we are at an opportune moment to make the HPV vaccine accessible to more girls than ever before.  

Click here to find out more about FIGO’s global approach to HPV vaccination and cervical cancer.