One step closer to single dose

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. It’s exciting to see the WHO further support the transition to single-dose schedules for HPV vaccination.  

Gavi, the Vaccine Alliance, have confirmed that they will follow the SAGE recommendation on HPV vaccine regimens. Our partners, PATH, have also confirmed that they will be switching to single-dose schedules with their delivery partners who are providing HPV vaccinations. 

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. 

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 new WHO update, however, now advises that females with healthy immune systems aged 9-20 can receive a single dose of the HPV vaccine, based on evidence that a single dose will be sufficient to protect them against HPV.  

The WHO’s decision to update their guidance on HPV vaccination regimens – and advise 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. 

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. 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, and this could help alleviate these supply constraints restricting global access to the HPV vaccine. Requiring only one HPV vaccine for the majority of girls could also see HPV vaccination programmes becoming more affordable and feasible for lower-income countries.  

The fewer number of doses could also help advance HPV vaccination catch-up and outreach programmes. Hard-to-reach groups, such as girls out of school and those in remote areas, must be sufficiently supported through such programmes to access the vaccines. 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.

Collaborating for best practice: FIGO’s vaccination workshop 

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.