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. 

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.