Estimate of global human papillomavirus vaccination coverage: analysis of country-level indicators

Abstract

BackgroundMortality rates from cervical cancer demonstrate deep inequality in health between richer and poorer populations. Over 310 000 women died of this preventable disease in 2018, mostly in low-income and middle-income countries (LMICs) where screening and treatment are beyond the capacity of health systems. Immunisation against human papillomavirus (HPV) offers a primary prevention strategy, but rates of vaccination uptake are unclear. Understanding coverage levels and factors affecting uptake can inform immunisation strategies.ObjectivesThe aim of this study is to evaluate the status of HPV vaccination coverage from nationally reported indicators and to estimate global coverage in a single year cohort of vaccine-eligible girls.DesignThis study provides quantitative population-level estimates of important global health indicators. Using data from the Global Cancer Observatory and WHO/UNICEF, incidence of and mortality from cervical cancer and HPV vaccination coverage are described for countries, categorised by income group. Characteristics of LMICs achieving high coverage are explored using selected development indicators from World Bank sources. Global HPV immunisation coverage is calculated and its impact on cervical cancer mortality estimated.ResultsIncidence and mortality for cervical cancer correlate with poverty. Whilst all WHO member states report high infant measles vaccination rates, fewer than half report on HPV vaccination. Even amongst high-income countries, coverage varies widely. In upper-middle-income countries, there is a trend for higher coverage with increased health spending per capita. Four LMICs report good coverage levels, all associated with external funding. Global HPV immunisation coverage for 2018 is estimated at 12.2%. Of the global cohort of 61 million 15-year-old girls in 2018, 7000 are likely to die from cervical cancer, almost all in LMICs.ConclusionsCountries in all income groups must devise strategies to achieve and maintain higher levels of HPV immunisation. For all but the richest, affordability remains a barrier.

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“…In a relatively low number of countries (76/195, 39%), the HPV vaccine has been introduced as mandatory and in most cases for young females, with a gradient of application ranging from 10% for low-income countries to 69% for high-income countries, thus clearly indicating the negative influence of poverty on the possibility of introducing this relatively expensive vaccine. The global HPV vaccination coverage is estimated to be as low as 12.2% [ 290 ]. Australia was the first country to organize, in 2007, an eradication program of the cancer of the cervix [ 291 ].…”

“…Australia was the first country to organize, in 2007, an eradication program of the cancer of the cervix [ 291 ]. Despite that the fight against cervical cancer is a priority considering the high number of annual cases and deaths, especially in low-income countries [ 290 ], and for this reason, the vaccination campaign has mainly been addressed to young girls before starting sexual activity, the vaccination of the males should also be considered to prevent male cancers [ 292 ].…”

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“…22,26,29 This will limit applicability to the global stage, especially to LMICs. 35 There was a range of methodological concerns in the included systematic reviews including small sample sizes, poor and/or incorrect reporting of statistical analyses in the primary studies and inappropriate combining of studies in meta-analyses. Importantly, the primary outcome across most studies was self-reported vaccination behaviour as opposed to actual vaccination behaviour and vaccination intent was often used as a proxy for vaccination receipt.…”

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“…Bathalapalli has been conducting population-based screening programs, but it is not reaching all the population, as it is done opportunistically. In 2015, 59 million women worldwide received at least one vaccine, but only 1.4 million were from low income, and lower or middle income countries 4. If we want to change the history of cervical cancer, a true commitment is needed from all the national health programs, whatever the country, to extend the use of vaccines.…”