Delivery cost of HPV vaccination in LICs

Delivery cost of HPV vaccination in LICs

How to achieve high and sustainable coverage at an affordable cost? This is the conundrum facing many low income countries planning to introduce the HPV vaccine.


HPV vaccination protects against cervical cancer, a disease that disproportionately affects low and middle income countries (LMICs). Yet it is these same countries that often lack experience immunising adolescent girls - the target population for HPV vaccination - and there has been widespread concern that reaching a new age group could incur unrealistically high delivery costs.


Our study is the first analysis of HPV vaccine delivery costs in low income settings using a standardised costing tool. Data were collected using the WHO C4P tool, which has been designed to estimate the cost of cervical cancer programmes and to model the relative cost of different strategies for planning purposes. This study collates data from 12 countries and 23 districts, all of which used the C4P tool to retrospectively estimate the cost of district level HPV vaccine demonstration projects.


What were the key findings? First and foremost, our analysis emphasises the scale of heterogeneity between and within countries. There is no one-size fits all approach: decision-makers should take account of national and district level characteristics to arrive at the optimal delivery strategy. In countries with high fuel costs and per diems, school-based delivery may only be feasible in districts with high population density or by employing an annual vaccination schedule. Other countries have existing school health programmes or routine vaccine delivery outreach systems that can be utilised to reduce costs. The cost/coverage balance of various strategies is country and district dependent.


Secondly, there is greatest opportunity for cost saving by altering service delivery and social mobilisation strategies. In particular, our study found no link between coverage and higher spending on social mobilisation, both in relative and absolute terms. We suggest that stakeholders involved in social mobilisation planning at the national and local level incorporate evidence-based social mobilisation strategies that are effective in increasing coverage at an affordable cost.


Finally, although district level demonstration project costs have been high, we expect national HPV vaccination programmes to have significantly lower financial cost per girl. We encourage countries to continue to use the C4P and other costing tools after national introduction to continue to fine tune the balance between coverage and cost, such that they are able to build affordable, sustainable national HPV programmes.


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For more information on the article, contact:
Raymond Hutubessy,
Senior Health Economist, World Health Organization


Image credit: PAHO