International HPV Vaccination
Introduction and Equity

After the first phase of HPV vaccine introduction (pilot demonstration phase) in two health districts (2014-2016), Cameroon national EPI was approved to introduce the same vaccine nationwide in 2019. Ministry of Health requested technical support from JSI Research & Training Institute, Inc. along with other partners. Since March 2019, JSI contacted and signed a MOU with a local NGO, the partner Building Capacities for Better Health in Africa (BCH-Africa) to provide technical assistance (TA) in programmatic issues related to HPV introduction. Though the technical support focus of JSI remains, the communication and social mobilization activities, technical activities (planning, trainings, strategy delivery) and logistics cold chain activities (cold chain rapid assessment and logistics plan) remain, also key areas of support from JSI.

JSI has already started with its assistance during an initial scoping visit to Yaounde, identified through a rapid assessment, key needed activities to prepare, drafted checklist of key activities, discussed with key partners, developed with partners a communication plan and is planning to conduct rapid cold chain assessment and plan for logistics activities.

Following a successful HPV vaccine demonstration pilot from 2013-2015, the Kenya Ministry of Health through the National Vaccines and Immunization Program (NVIP) planned to introduce the HPV vaccine into the national routine immunization program in Fall 2019. In coordination with the NVIP and partners, JSI is supporting the development of training materials, technical guidelines and tools for national rollout—with a specific focus on integration into the routine immunization system—as well as job aids to assist health workers in linking service delivery and communications about the HPV vaccine with girls, their caregivers, and other stakeholders. JSI is currently supporting the capacity building of managers, health workers and other stakeholders, including teachers to engage in national rollout of the HPV vaccine JSI is also facilitating linkages with non-immunization stakeholders—like the Ministry of Education and civil society and community groups—who may have experience and expertise in delivering services to adolescent girls. JSI is also supporting microplanning to prepare for the launch and will track the implementation of these plans at subnational levels to ensure that planned activities are implemented according to the introduction plan and adjusted appropriately once the launch takes place. Other key areas of JSI technical support include assessing the cold chain readiness, designing the most efficient vaccine distribution model, and post-introduction support in strengthening service delivery capacity among health workers.

Beginning in 2013, with assistance from JSI, Gavi, and partners, the Government of Madagascar (GoM) began vaccinating adolescent girls with the HPV vaccine to combat the detrimental effects of HPV infection on a population of over 7 million Malagasy women at risk. The GoM, with technical assistance from JSI, conducted a series of pilot introductions of the HPV vaccine to identify the most effective strategy for reaching the target population given the financial, human resource, and health system constraints.

Learn more:
Introducing HPV Vaccine in Madagascar: Engaging Stakeholders
Lessons Learned: HPV Vaccine Introduction in Madagascar

In May 2017, JSI began support for the Ministry of Health and Population’s (MoHP) EPI with HPV vaccine introduction in Malawi. Since then, Malawi has made significant strides in the preparation and support for the introduction of the vaccine. JSI staff serves as part of the National Task Force (NTF), along with other in-county partners. Preparations for the first round introduction began in late 2018, including development of necessary tools and training materials, trainings for teachers and health workers, supporting mapping and microplanning in the districts, and more. In January 2019, JSI supported the NTF and MoHP with last minute pre-vaccination supervision and preparations before the National HPV introduction launch event on January 10th. Over the next few months, JSI supported supervision during the vaccination, data collection and analysis of performance, post introduction supervision, verification of mapping data and report writing, and integrated supportive supervision and zonal review meetings. JSI played a major role in the effort to verify the data reported from the first round and document the challenges and lessons learned from the first round. Since then, JSI has continuously worked with the EPI and other members of the NTF to apply the observed lessons for the next round in January 2020 and for HPV vaccinations in the future.

As countries prepare for the introduction of the HPV vaccine, there is a need for partner and stakeholder coordination to prepare an application to Gavi for a vaccine introduction grant. In Mozambique, JSI facilitated a stakeholder workshop to develop and then submit the HPV vaccine grant application to Gavi, building on best practices from other countries that have already introduced and lessons learned from the prior demonstration.

In 2014, JSI supported the Government of Niger and partners, to complete phase I of an HPV vaccine pilot introduction in three districts—two urban and one rural—and conduct a post-introduction evaluation, coverage survey, and cost study. Building on the lessons learned from the initial pilot, JSI also supported the completion of Phase II of the pilot introduction in 2018.

Learn more:
Lessons Learned: HPV Introduction in Niger

In Tanzania, JSI has worked closely with the MoHCDGEC Immunization and Vaccine Development (IVD) unit and partners to support comprehensive planning for the national rollout of the HPV vaccine as part of the routine immunization system. JSI’s in-country technical advisors provided technical assistance to the Ministry’s Advocacy and Communications Committee for the development of communication guidelines, IEC materials and television and radio spots for the introduction of HPV. JSI also provided technical input to the IVD in:

• Development of training manuals for regional and council health management teams (R/CHMTs) and an operational guide for health workers and teachers.
• Implementing the training strategy and plan for health workers and educators.
• Participation in the logistics sub-committee, which assessed the cold chain readiness for the rollout of HPV and introduction of IPV in the country.
• Monitoring and supervision in focus regions, districts and health facilities during microplanning to ensure preparations for HPV vaccination introduction.

JSI is currently supporting rollout of the second dose of HPV and providing technical support to the MoHCDGEC IVD to plan their long-term HPV vaccination strategy and financial support.

Learn more:
Tanzania Introduces HPV Vaccine to Prevent Cervical Cancer

In 2019, JSI and the Government of Zimbabwe (GoZ) introduced the national administration of the HPV vaccine to a multi-age cohort. Following last year’s introduction, JSI provided technical assistance in developing information, education, and communication (IEC) materials for the HPV vaccination program – in the three main local languages (English, Shona and Ndebele). Recently, JSI chaired and directed technical discussions on implementation strategies to vaccine delivery, leading to the reactivation of technical subcommittees. As the program moves forward, JSI will continue supporting coordination between the Ministry of Health and Child Care and Ministry of Primary and Secondary Education towards consensus for building a school-based health platform. Additionally, development and review of checklists, lesson learned reports, and data collection tools will continue as JSI identifies solutions to minimizing gaps in HPV immunization coverage. To this end, JSI had recently conducted rapid on-job-sensitization of HPV vaccination documentation upon learning that most districts in Zimbabwe had incomplete school registers.

Learn more:
Lessons Learned: HPV Vaccine Nationwide Introduction in Zimbabwe