Jhpiego, a Johns Hopkins University affiliate, Baltimore, MD, USA.
HPV Vaccine, Vaccine Implementation, Gavi, the Vaccine Alliance, Geneva, Switzerland.
Int J Gynaecol Obstet. 2021 Jan;152(1):32-39. doi: 10.1002/ijgo.13482.
Cervical cancer, caused by HPV infection, is responsible for more than 311 000 preventable deaths every year. A global call to accelerate efforts to eliminate this disease has generated a new global strategy proposing ambitious, but achievable, targets for HPV vaccination of girls, and screening and treatment of women. The present paper addresses the suboptimal access to HPV vaccination in low-income and lower-middle-income countries (LICs/LMICs), where the burden of disease weighs most heavily, in part through co-infection with HIV. A proposed framework for action was formulated by first reviewing the reasons underlying gaps in HPV vaccine coverage. Good practices from recent introductions of HPV vaccine at scale in LICs/LMICs were then assessed based on targeted literature reviews and the experience and views of the authors. Difficulties in uptake and coverage of the HPV vaccine relate to the costs of the vaccine and service delivery, lack of prioritization, the challenges of vaccinating adolescents, and shortage of vaccines as the supply failed to keep pace with the rapid expansion in global demand, including from LICs/LMICs. The framework for action calls for new strategic thinking to consolidate global learning and invigorate operationalization at a country level.
宫颈癌由 HPV 感染引起，每年导致超过 31.1 万人可预防死亡。全球呼吁加速努力消除这种疾病，制定了一项新的全球战略，为女孩接种 HPV 疫苗、为妇女筛查和治疗提出了雄心勃勃但可实现的目标。本文讨论了在疾病负担最重的低收入和中低收入国家（LICs/LMICs）中，HPV 疫苗接种的可及性不足的问题，部分原因是与 HIV 共同感染。首先通过审查 HPV 疫苗覆盖率差距的根本原因，制定了行动框架。然后，根据有针对性的文献综述以及作者的经验和观点，评估了 LICs/LMICs 中 HPV 疫苗大规模引入的良好做法。HPV 疫苗接种的吸收和覆盖困难与疫苗和服务提供的成本、缺乏优先事项、为青少年接种疫苗的挑战以及疫苗短缺有关，因为供应跟不上全球需求的快速增长，包括来自 LICs/LMICs 的需求。该行动框架呼吁进行新的战略思考，以巩固全球学习并激发国家层面的运作。
