HPV Vaccination Global policy perspectives Vacuna VPH Perspectivas de la política de vacunación mundial

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1 HPV Vaccination Global policy perspectives Vacuna VPH Perspectivas de la política de vacunación mundial 1 Paul Bloem EPI Team WHO IVB Geneva

2 Outline HPV disease burden, vaccines and WHO recommendations Global HPV vaccine introduction Early impact and safety Lessons learned on successful introduction 2

3 Source: Globocan, 2012

4 HPV- and Cervical cancer prevalence 4 Source: Forman et al., Vaccine 2012,

5 Cervical cancer in European countries Cervical cancer 5 Source: Globocan, 2012

6 Characteristics Vaccine Characteristics Bivalent 2vVPH Quadrivalent 4vVPH 9-valent 9vVPH Commercial Name producer Types of virus like particles (VLP) Cervarix, GSK Gardasil, Merck Gardasil 9, Merck /18 6/11/16/ Dose of L1 protein Adjuvant Licensed schedules 20/20 μg 20/40/40/20 μg ASO4 (500 μg aluminum hydroxide, 50 μg 3-O-deacylated-4 - monophosphoryl lipid A) 0, 1, 6 month 0, 6 month AAHS (225 μg amorphous aluminum hydroxyphosphate sulfate) 0, 2, 6 month 0, 6 month 30/40/60/40 μg 20/20/20/20/20 μg 500 μg AAHS 0, 2, 6 month 0, 6 month 6 Herrero et al., Lancet Oncol 2015, 16:e206 16

7 WHO Position paper on HPV vaccine: Source: (WER May, 2017) (

8 WHO Position paper on HPV vaccine (WER May, 2017) ( WHO recommandations (May,2017): Target: Girls, 9 to 14 years of age Doses: 2 doses Target: girls 9-13 years of age Interval : 6 months minimum ) No maximum interval (suggested If the interval until < 5 months, after give first an dose) extra dose 6 months after the introduction: one vaccinate multi- age cohort 9-14 years old (or up to 18yrs) Immuno depressed or 15 years of age: => 3 doses

9 INTEGRATION Comprehensive Approach to Cervical Cancer Prevention and Control INTEGRATION 9

10 Global Progress in HPV introduction Introduced* to date (74 countries or 38.1%) * Includes partial introduction Not Available, Not Introduced/No Plans Not applicable (120 countries or 61.9%) Data source: WHO/IVB Database, as of 09 August 2017 Map production Immunization Vaccines and Biologicals (IVB), World Health Organization The boundaries and names shown and the designations used on this map do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. WHO All rights reserved.

11 Early impact of HPV vaccines

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14 Safety of HPV vaccines 14 *Source GACVS June_2017/en/

15 WHO Global Advisory Committee on Vaccine Safety (GACVS) Statement on the continued safety of HPV vaccination (2017) "Since licensure of HPV vaccines, GACVS has found no new adverse events of concern based on many very large, high quality studies. The new data presented at this meeting have strengthened this position." 15

16 HPV 3 coverage in reporting 100% 80% 92% countries, % 87% 86% 84% 75% 73% 60% 61% 56% 54% 54% 46% 40% 20% 0% Source:

17 HPV vaccine coverage in years girls, United Kingdom Source: Public Health England

18 Lessons learned on successful introduction

19 Communication is key campaign in UNK Information packs for health professionals The HPV information leaflet for girls and their parents/guardians, a Q&A sheet and posters for schools PR and media activity Initially an advertising campaign, including TV advertising to publicise the start of the programme Second wave of advertising to remind girls and their parents/guardians of the need to complete the full immunisation course Dorian Kennedy Department of Health England 19

20 Elements of successful introduction: Education and training of medical workers Information packages sent to all GPs and school health services Scientific information provided through MoH web site, bulletins, GPs association Meetings with school doctors Trainings

21 Thank you 21