“Can a Pilot Succeed?”: Lessons Learned in Engaging Stakeholders for HPV Introduction
April 26th, 2016 | Viewpoint
April 26th, 2016 | Viewpoint
This World Immunization Week 2016, eyes are focused on countries’ progress towards achieving the global immunization goals laid out in the World Health Organization’s (WHO) Global Vaccine Action Plan 2011-2020 (GVAP). One GVAP goal that the world is on track to meet is: 86 of at least 90 low- and middle-income countries have introduced one or more new or underutilized vaccines. Moving forward, it is critical to leverage this country enthusiasm and commitment to vaccine introduction, including with one of the world’s newer vaccines, Human Papillomavirus (HPV) vaccine. The HPV vaccine protects women from the most dangerous strains of HPV that lead to approximately 70% of cases of cervical cancer in women worldwide.
In Madagascar, with funding from Gavi, the Vaccine Alliance and in partnership with the Malagasy government and its inter-agency partners, JSI provided technical support for the introduction of the HPV vaccine. Madagascar’s strategy with Gavi involved an initial 2-phase pilot, conducted from 2013 to 2015 in the urban district of Toamasina I and the rural district of Soavinandriana. In terms of meeting the goals and expectations, the pilot introduction was successful (i.e. exceeding the 50% pilot coverage objective). Based on the HPV pilot coverage survey (card and history for girls that received all 3 doses of HPV in the first year of the pilot), coverage was 61% and 69% for Toamasina I and Soavinandriana, respectively. As with most pilots, it was also not without its challenges, particularly related to planning – as well as information sharing and acceptance – with various stakeholders and communities. The country is learning from this experience to develop its strategy for continued roll-out of HPV vaccination in the future.
Introducing HPV vaccine has special considerations, given that Expanded Program on Immunization (EPI) departments, including in Madagascar, have not typically been structured to reach a target population such as adolescent girls as part of routine services. Additionally, some of the vital actors involved with HPV vaccination (e.g., schools; programs that work with adolescents) have not previously been closely engaged in immunization activities. With the Ministry of Health and Family Welfare (MoHFW), the Ministry of Education (MoE), and many new and traditional partners all involved in the effort, Madagascar’s experience demonstrated how effective collaboration between stakeholders is critical to success — for overall planning and implementation as well as to quickly and diplomatically address and resolve sensitivities (e.g. if there is confusion on why the vaccination is being conducted in schools and with this target population).
As soon as the decision to introduce the HPV vaccine is made, an HPV pilot committee should identify and engage with a comprehensive list of people and groups who have access to and influence over the target population to garner their support, explain the rationale, and assist with addressing questions and any concerns. In addition to health staff and community health workers, these stakeholders will likely include many actors within the MoE system (e.g., school district leaders, public and private school directors, and teachers), as well as parents’ associations, community leaders, religious leaders, groups that work with adolescents, and local civil society and non-governmental organizations.
Here are seven key lessons learned from Madagascar’s experience that HPV pilot committees need to consider when engaging stakeholders:
Madagascar’s experience during its initial introduction of the HPV vaccine can serve as an example for other countries that are planning similar introductions. These lessons learned can help to guide the vaccine introduction planning, including considerations to facilitate coordination with multiple stakeholders and most effectively and efficiently reach the target population.
This World Immunization Week and beyond, let’s continue to build on knowledge and successes in new vaccine introductions such as HPV vaccination so that more women across the globe can have the vital protection from cervical cancer that they need.
Written by Heather Casciato and Lora Shimp
 World Health Organization, “Human papillomavirus (HPV),” 20 March 2016. [Online]. Available: http://www.who.int/immunization/diseases/hpv/en/. [Accessed 23 April 2016].