Achieving high uptake of human papillomavirus vaccination in Malaysia through school-based vaccination programme

Abstract

BackgroundIn 2006, 4 years of planning was started by the Ministry of Health, Malaysia (MOH), to implement the HPV (human papillomavirus) vaccination programme. An inter-agency and multi-sectoral collaborations were developed for Malaysia’s HPV school-based immunisation programme. It was approved for nationwide school base implementation for 13-year-old girls or first year secondary students in 2010. This paper examines how the various strategies used in the implementation over the last 7 years (2010–2016) that unique to Malaysia were successful in achieving optimal coverage of the target population.MethodsFree vaccination was offered to school girls in secondary school (year seven) in Malaysia, which is usually at the age of 13 in the index year. All recipients of the HPV vaccine were identified through school enrolments obtained from education departments from each district in Malaysia. A total of 242,638 girls aged between 12 to 13 years studying in year seven were approached during the launch of the program in 2010. Approximately 230,000 girls in secondary schools were offered HPV vaccine per year by 646 school health teams throughout the country from 2010 to 2016.ResultsParental consent for their daughters to receive HPV vaccination at school was very high at 96–98% per year of the programme. Of those who provided consent, over 99% received the first dose each year and 98–99% completed the course per year. Estimated population coverage for the full vaccine course, considering also those not in school, is estimated at 83 to 91% per year. Rates of adverse events reports following HPV vaccination were low at around 2 per 100,000 and the majority was injection site reactions.ConclusionA multisectoral and integrated collaborative structure and process ensured that the Malaysia school-based HPV immunisation programme was successful and sustained through the programme design, planning, implementation and monitoring and evaluation. This is a critical factor contributing to the success and sustainability of the school-based HPV immunisation programme with very high coverage.

Priority-setting to integrate sexual and reproductive health into universal health coverage: the case of Malaysia

“…For example, the high coverage and institutionalisation of the human papillomavirus vaccine in the school-based vaccination programme in Malaysia have demonstrated how inter-agency and multi-sectoral collaborations can contribute to sustained integration of SRH services. 64 Lastly, "reframing" was identified as an alternative strategy adopted for priority-setting for sensitive SRH services, such as GBV and abortion, as well as providing justification for addressing the SRH needs of marginalised populations. Framing ideas on the problem and its potential solution in a particular way and taking the values and contexts into consideration, helped to engage stakeholders, mobilise specific policy responses and shift the terrain of the debate.…”

“…For example, the high coverage and institutionalisation of the human papillomavirus vaccine in the school-based vaccination programme in Malaysia have demonstrated how inter-agency and multi-sectoral collaborations can contribute to sustained integration of SRH services. 64 …”

The prevalence of hrHPV among the isolated community in the Highland of Bario, Sarawak, East Malaysia

“…The non-target groups can obtain their HPV vaccination privately but both the cost and availability remain a challenge for those living in the low resource settings. It is still too early to speculate if HPV vaccination will reduce the cervical cancer incidence rate but the coverage is predicted to be excellent due to the high retention of females in the school system (7). Therefore, effective and penetrative screening strategies are still required to reach the unreachable.…”

The Prevalence of Human Papillomavirus Among the Indigenous Population in Serian, Sarawak, Malaysian Borneo

“…The bivalent (Cervarix, GSK; HPV16,18) and quadrivalent (Gardasil; Merck; HPV6,11,16,18) HPV vaccines were launched in Malaysia since 2006 and have been formally adopted into the National Immunisation Programme (NIP) in 2010 and administered to schooling female students aged-13, projecting to reduce the cervical cancer rate by 70% in the long run (7). However, there is a paucity of published epidemiological surveillance data in Malaysia when the decision was made with most epidemiological data came from large cities in Peninsular Malaysia and none from East Malaysia.…”