Abstract 79: The Impact of COVID-19 on HPV Immunization Programs in Countries With High Cervical Cancer Burdens: Global and National Perspectives
Authors: Guillaume Dominique , Waheed Due-e-Nayab , Schlieff Mieke , Muralidharan Kirthini , Vorsters Alex , Limaye Rupali 
Published: June 2023

Abstract
Purpose: The COVID-19 pandemic has had a considerable impact on HPV immunization efforts within low-and-middle-income countries (LMICs). This is a cause for concern as LMICs account for the global burden of deaths attributable to cervical cancer; yet the direct and indirect impacts of COVID-19 on HPV immunization programs have not been well described in the literature. Our study explored COVID-19 specific challenges in HPV vaccine introduction and scale-up in LMICs through interviewing stakeholders with context specific knowledge in cervical cancer prevention efforts within LMICs.
Methods: This qualitative study involved a stakeholder analysis coupled with semi-structured in-depth interviews with n=31 global stakeholders (i.e. academic institutions, global immunization partners) and national stakeholders (i.e. ministry of health officials, non-governmental organizations). Purposive sampling was used to select participants with content knowledge and experience in HPV vaccine programming. Data was analyzed using qualitative content analysis. Inductive codes were categorized into broader themes describing challenges HPV vaccination programs faced during the COVID-19 pandemic.
Results: Five broad themes emerged from the analysis: HPV vaccine prioritization, funding considerations, supply chain challenges, HPV vaccine delivery platforms and catch-up dosing, and vaccine hesitancy. The amplified focus of COVID-19 vaccines resulted in decreased prioritization and funding towards HPV vaccination efforts. In certain settings, HPV vaccines were found to be the least prioritized antigen. Decreased demand, coupled with global supply chain shortages due to COVID-19, resulted in sizeable challenges for HPV vaccine introduction and scale-up. Nearly all stakeholders described how anti-COVID-19 vaccine sentiments magnified hesitancy towards HPV vaccines. Particularly revealing, were delivery challenges as a consequence of school closures. This resulted in stakeholders’ acknowledgment of the need to establish alternative delivery platforms and strategies for catch-up dosing.
Conclusion: Understanding how emerging infectious disease outbreaks impact HPV vaccination efforts in countries with high cervical cancer burdens is critical. Increasing HPV vaccine prioritization within countries, developing strategies to overcome existing shortfalls, along with addressing vaccine hesitancy will be key in generating momentum towards HPV immunization programs.
Citation Format: Dominique Guillaume, Due-e-Nayab Waheed, Mieke Schlieff1, Kirthini Muralidharan, Alex Vorsters, Rupali Limaye. The Impact of COVID-19 on HPV Immunization Programs in Countries With High Cervical Cancer Burdens: Global and National Perspectives [abstract]. In: Proceedings of the 11th Annual Symposium on Global Cancer Research; Closing the Research-to-Implementation Gap; 2023 Apr 4-6. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(6_Suppl):Abstract nr 79.