The HPV Vaccine Abroad: The Good and the Bad

Globalization: Medical Technology

This week I’d like to highlight some of the organizations working on HPV vaccination campaigns internationally.

As I wrote last week, the Global Call to Stop Cervical Cancer movement began during the World YWCA International Women’s Summit in 2007 and has brought to light the tremendous importance of cervical cancer prevention and HPV vaccination worldwide. There are currently a number of organizations working to stop this preventable cancer.

PATH: Work in India, Peru, Vietnam, and Uganda

First, there is PATH, a Seattle-based nonprofit health advocacy organization, which received a $27.8 million grant from the Bill and Melinda Gates Foundation research in 2006 for research in HPV vaccination. PATH has launched pilot HPV vaccination programs in Uganda, Peru, and Vietnam, and India. All four countries have strong existing vaccination programs, and are thus likely to be able to sustain immunization efforts.

In the next 5 years, PATH plans to collaborate international agencies and government officials in the four countries, as well as with industry partners Merck & Co., Inc., and GlaxoSmithKline Biologicals, the manufacturers of the two HPV vaccines currently available on the market.

Since it’s start in 2008, the PATH program in Uganda has been quite successful. Uganda currently has very little screening in place for cervical cancer, and according to the Ugandan Ministry of Health, 85 percent of the Ugandan women who develop cervical cancer are diagnosed at an advanced stage. Furthermore, there are only 140 obstetricians and gynecologists and 3,4000 midwives for the country’s 30 million people.  Uganda only has one radiotherapy machine to treat cancer patients.

In the past few years, public health officials have intensified efforts to attract women to urban health clinics for cervical cancer screening with some success. Now experts are looking to immunization with the HPV vaccine as another major strategy to reduce the incidence of cervical cancer and improve the reproductive health of Ugandan women. GlaxoSmithKline, the manufacturer of Cervarix, donated the immunizations for the project.

In cooperation with PATH, the Uganda Health Ministry began to inoculate 9- and 10-year-old girls against HPV in two Ugandan districts. The programs in the two districts represent different strategies for vaccine administration, and serve as preliminary research to inform national and international efforts at HPV immunization.

In the first district, Nakasongola, health workers who normally deliver vaccinations and de-worming medicines are responsible for distributing the vaccine, which means few additional costs for the government. However, these workers have reported that identifying all eligible girls in the district has been difficult, as has follow up.

In the second district, Ibanda, the immunization program has followed a school-based approach. In this area, all girls in “primary 5” or fifth grade were vaccinated.  This simplified the problem of follow up, since the HPV vaccine is administered in three doses over a six month span.

In addition to the actual distribution of the vaccines, PATH also launched an extensive awareness campaign, which included television and radio talk shows programs, education materials, and community meetings, to educate parents about the safety of the vaccine.

Panama’s HPV Vaccine Initiative

Another international HPV immunization campaign has taken place in Panama. Health officials in Panama announced in the fall of 2008 that they would provide the HPV vaccine to young adolescent girls at no cost. The Panamanian Ministry of Health cooperated with UNICEF in this effort to vaccinate all girls aged 10 and 11. Panama is the first Latin American country to announce such a campaign, and has the potential to play a critical role in promoting HPV vaccination in other countries with similar demographics.

As is the case in Uganda, most Panamanian women do not get frequent pap smears, so that vaccinating girls is the most effective way to prevent cervical cancer.

In the first few months of the program, Panama reportedly vaccinated 19,000 girls, both from urban centers and rural communities. Furthermore, parents have been largely supportive of the vaccine, which has been the subject of enormous controversies in the United States.

The lack of resistance to the HPV vaccine in Panama may largely be attributed to manner in which it’s been marketed. Panamanian officials have presented the vaccine as a means of cervical cancer prevention, failing to mention that it’s primary action is to prevent infection with an STD. Panama has no national sexual education program and the government may be missing a crucial opportunity to educate its citizens. Thus, although girls are receiving this vaccine, they may not know about the importance of other forms of contraceptives in preventing STDs and unwanted pregnancies. Although the Panamanian government has taken an important step in improving women’s reproductive health, they still have enormous amounts of work to do in educating both men and women about safe sex practices.


Author: Leslie Carol Botha

Author, publisher, radio talk show host and internationally recognized expert on women's hormone cycles. Social/political activist on Gardasil the HPV vaccine for adolescent girls. Co-author of "Understanding Your Mood, Mind and Hormone Cycle." Honorary advisory board member for the Foundation for the Study of Cycles and member of the Society for Menstrual Cycle Research.