HPV Vaccine Lessons Learnt

Only 7 countries in the review indicated that they had conducted formative research to inform communication activities. Most countries that reported data began mobilisation activities at least a month before vaccination; the success was greatest when activities were coordinated with health, education, and community leaders. Implementation activities included health worker and teacher training, as well as meetings with parents or students. These activities were conducted by nurses, school leaders, or teachers. A few demonstration projects used house-to-house visits, which were well received.

Countries employed multiple communication channels to deliver messages. Interactive methods included individual or group meetings at schools and health facilities with teachers and health workers. Non-interactive methods included leaflets, posters, community announcements, radio, and television. Communication was reported to be most effective when delivered by "credible influencers", such as health workers, teachers, and community or religious leaders. Most parents reported that they first learned about the vaccine from meetings and other communication with health workers or teachers. They also reported a preference for interactive information sources. A key lesson is that face-to-face interaction was the most effective way of mobilising parents and communities, especially with groups that were likely to refuse vaccination or that were exposed to anti-vaccination rumours (e.g., fear that HPV vaccination might reduce fertility or cause adverse events).

When developing messaging, most projects/programmes framed vaccination as preventing cancer rather than preventing a sexually transmitted infection (STI). One reason for this is that health decision-makers were concerned that associating HPV vaccination with STIs might increase stigma and decrease parental acceptance. Secondary messages focused on vaccine safety and efficacy, where and how it would be delivered, whether consent was necessary, and countering misinformation or specific rumours by tailoring messages to counter specific fears, seeking vaccine endorsements from high-level officials, and disseminating letters detailing World Health Organization (WHO) or government endorsement of the vaccine's safety.

In terms of acceptability, logistical challenges, such as lack of awareness of vaccination days and school absenteeism, were common reasons for non-vaccination and incomplete vaccination. Vaccine safety concerns, rumours, and attending a private school were associated with nonvaccination.

A package of resources synthesising findings from this review is available here, including a brief on key communication-related findings [PDF]. During a July 28 2016 webinar entitled "Mobilize, Deliver, Sustain: Lessons learnt and practical advice for effective HPV vaccine delivery in low- and middle-income countries", panelists presented findings from the HPV Vaccine Lessons Learned project. Their goal was to provide information for policymakers and programme planners on how best to prepare, deliver, and sustain HPV vaccinations. Available in English, French, and Spanish, the webinar recording is available online.

Immunisation and Vaccines, Girls

According to organisers, cervical cancer is a leading cause of morbidity and mortality among women in low- and middle-income countries, with nearly half a million new cases and 275,000 deaths annually. While screening programmes have helped reduce mortality rates in high-income countries, they are often unrealistic in low-income countries. In recent years, HPV vaccines, however, have emerged as an effective solution to prevent cervical cancer in low-resource settings, and the WHO recommends HPV vaccination for girls aged 9 to 13 years. In the past 10 years, dozens of countries have included HPV vaccine in their national immunisation schedule, and many low-and middle-income countries have gained experience in HPV vaccine delivery through demonstration projects and national programmes. More than 1,625,000 girls were reached (reports from 61 of 72 delivery experiences) as part of HPV Vaccine Lessons Learnt, and it is estimated that at least 837,800 girls were fully vaccinated. All 49 projects/programmes with reported data achieved at least 50% coverage; coverage for 41 of these was 70% or greater. Laos PDR achieved greater than 90% coverage in urban and peri-urban districts through school-based delivery, which was found to be an important aspect of the delivery strategy. For more on the research methodology, click here (see especially the "presentation slides").

"Based on country experience, decision-makers conducting communications for future HPV vaccine programmes should:

1. Develop a communication plan to inform social mobilisation activities. This should include strategies to prevent and manage rumours, measures to adequately mobilise private schools, training to sensitise health workers not involved in HPV vaccination, and a plan for delivering messages to out-of-school and hard-to-reach girls.
2. Engage early with community groups, including schools and churches. In-person meetings are the most effective method for increasing acceptance and confidence in vaccination.
3. Focus messages on cervical cancer prevention, vaccine safety and efficacy, government endorsement, and when and where to get vaccinated. Train teachers, community leaders and health workers to deliver messages, and adequately respond to questions and concerns from parents and the community.
4. Tackle emerging rumours as soon as possible. To do so, use respected institutions and high-level officials.
5. Begin social mobilisation at least one month before vaccination. In addition, ensure adequate and timely funding and preparation time to develop social mobilisation materials.
6. Ensure consistency with existing consent policy. Where possible, use opt-out processes and determine whether the consent process should be modified in private schools."