HPV Vaccine
Access Program
From Africa to Asia and Latin America, the program helped establish the feasibility of HPV vaccination in LMICs.
2007-2015
Situation
Nearly 85 percent of cervical cancer cases occur in resource-poor countries. Despite the availability of an HPV vaccine since 2006, access to the vaccine remained limited in developing countries due to cost and logistical barriers. When vaccination is possible, achieving full protective efficacy can be difficult due to the need for multiple doses and the challenge of reaching an often difficult-to-reach patient population: adolescent females.
Merk & Co. sought the expertise of Akesis Health US to develop a strategy to build country capacity to increase access to the HPV vaccine in resource-limited settings.
Solution
Launched in 2007, Akesis Health US worked with Ministries of Health and non-governmental organizations to co-design and implement the Gardasil Access Program (GAP).
Akesis Health US coordinated a comprehensive application process that required potential participant organizations to think through the best approach for each key implementation area – target identification, delivery model selection, sensitization, supply chain management, and monitoring and evaluation. To support sustainability, program participants were responsible for implementing their own projects, with ongoing technical support from Akesis. This approach created strong ownership of the projects and better prepared participants for eventual national scale-up.
Prevalent issues found across the 25 projects included: importation barriers, lengthy customs clearance procedures that would affect vaccine usability, inadequate cold chain capacity, and limited resources and/or experience for transporting and distributing vaccines to various sites. To address these challenges, Akesis Health US provided technical assistance on vaccine handling procedures and worked with institutions to secure import permits, customs waivers, and exemptions well in advance of shipments, ensuring vaccination start dates were not affected by potential delays in obtaining permits.
Results
Through the GAP, 21 countries gained operational experience in designing and implementing HPV vaccination projects. GAP reached more than 445,000 girls, with a mean Vaccine Uptake Ratio (VUR) of 88.7% and a Vaccine Adherence (VA) of 90.8% between the first and third doses. Several countries went on to implement national programs on their own or received support from GAVI, including Ghana, Kenya, Tanzania, Lesotho, Uganda, and Bhutan.