Worldwide, about 640,000 cancers are caused by human papillomavirus (HPV) each year, and persistent HPV infection can progress to precancerous and cancerous lesions. According to CDC and WHO data, HPV is the most prevalent viral infection of the reproductive tract and the most common sexually transmitted infection. Previous studies have shown that people with suboptimal access to healthcare and limited economic opportunities have a greater HPV burden and are less likely to receive preventive care from healthcare professionals (HCPs).

HPV vaccines have been shown to prevent up to 90% of cancers caused by HPV infections in clinical investigations. “These vaccines are effective when administered prior to infection with HPV, ideally before sexual activity initiation,” says Alvine M. Akumbom, MS, RN. Current guidelines recommend HPV vaccines for people aged 9-26 as a two- or three-dose series. However, delivery and programmatic costs can impede the distribution of HPV vaccines, especially in low-resource settings. In turn, this can influence the sustainability of HPV vaccination programs.

Costs & Cost-Effectiveness of Vaccination Strategies

Systematic reviews and metaanalyses have been conducted on the cost-effectiveness of HPV vaccines, but questions remain about the costs and cost-effectiveness of current HPV vaccination strategies. For a study published in Preventive Medicine Reports, Akumbom and colleagues reviewed the cost and cost-effectiveness of strategies that have been implemented to expand access to HPV vaccines.

For the study, the investigators created search queries for medical literature websites, with a focus on articles containing information on HPV vaccine uptake and reach, HPV vaccination costs, or cost-effectiveness of HPV vaccination programs. The authors retrieved 773 articles from several databases, assessed 251 full text articles, and included 15 articles in the final synthesis.

Improving Vaccination Availability & Increasing Recipient Numbers Are Key

Overall, the study found that improving the availability of HPV vaccines and increasing the number of people receiving these vaccinations were key strategies implemented to increase access to HPV vaccines (Figure). Novel interventions were used to increase uptake of HPV vaccines across study populations. Countries without national HPV vaccination programs aimed to identify and adopt sustainable strategies to make HPV vaccines available to adolescents using demonstration programs. Conversely, countries with existing national vaccination programs focused on identifying cost-effective interventions to increase vaccination rates and meet guideline-recommended standards.

These findings provide further evidence supporting the use of HPV vaccines in school-aged children in primary care settings and other accessible health facilities, according to the study group. “HCPs are vitally important in providing patient education on the importance of HPV vaccines in children,” says Akumbom. The researchers added that it is critical to empower HCPs to make decisions collaboratively with parents to increase vaccine initiation and completion.

Tailored Messages Must Be Clear, Consistent, and Culturally Sensitive

Of note, many HPV vaccination efforts were carried out in schools, according to the study findings. “Tailored messaging to promote HPV vaccination in school settings must be clear, consistent, and culturally sensitive,” says Akumbom. HPV vaccination programs in school settings may be enhanced by including HCPs and community representatives in the early stages of planning. Public health officials should consider offering incentives to mobilize communities and parents to respond to vaccination efforts.

Given the current public sentiment toward vaccines, the study authors note that it is important to consider cultural and historical contexts when developing and implementing HPV vaccine interventions. Studies are needed to further evaluate the cost-effectiveness of implemented HPV vaccination strategies and to test novel approaches. The primary objective of future research should be to engage healthcare systems, HCPs, communities, families, parents, and adolescents by creating culturally competent programs.