National and International Human Papillomavirus Vaccination Programs with Special Reference to Low- and Middle-Income Countries: The Hurdles and the Success Stories

Abstract The stark disparity in human papillomavirus (HPV) vaccine availability, service delivery and the cost of vaccine between high income countries vs low and low and middle income countries (LMICs) demanded immediate attention and inclusion of HPV vaccination as one of the three pillars of World Health Organization’s (WHO) call for cervical cancer elimination strategy by 2030. HPV vaccination is currently the cornerstone of long-term cervical cancer control. Multiple studies have confirmed the safety, efficacy, and cost-effectiveness of these vaccines and if WHO s 90-70-90 strategy is implemented successfully, cervical cancer would not remain a public health problem. Although introduction of HPV vaccination is challenging, many LMICs have implemented HPV vaccination program with success and has shared their hurdles regarding implementation and sustainability of the program. Lessons learnt from these projects may strengthen adolescent health through implementation of HPV vaccination programs in other countries and also enhance reproductive health education, HIV prevention, and nutritional support programs. For successful implementation, multi sectoral cooperation between researchers, partner organizations, countries, and vaccine manufactures are essential to equally distribute HPV vaccines to the target populations in neglected areas. Recommendation of single dose HPV vaccination will prevent shortages of vaccines in the future and is more relevant to the LMICs offering countries the opportunity to increase the number of girls who can be vaccinated and alleviating the burden of the often complicated and costly follow-up required to complete the vaccination series.