Gender-neutral HPV vaccination in Africa – Authors' reply
Authors: Onyema Greg Chido-Amajuoyi, Joël Fokom Domgue, Chisom Obi-Jeff, Kathleen Schmeler, Sanjay Shete
Journal: The Lancet Global Health (2019)

We thank Ruo-Yu Zhuang and colleagues for their interest in our recent Comment.1Chido-Amajuoyi OG Domgue JF Obi-Jeff C Schmeler K Shete S A call for the introduction of gender-neutral HPV vaccination to national immunisation programmes in Africa.Lancet Glob Health. 2019; 7: e20-e21Summary Full Text Full Text PDF PubMed Scopus (18) Google Scholar We acknowledge their points in support of an initial introduction of human papillomavirus (HPV) vaccination for females, later followed by the inclusion of males. Zhuang and colleagues state that the priority should be increasing vaccination coverage in females because herd effects start to be observed at coverage rates as low as 20%. However, the paper2Brisson M Bénard É Drolet M et al.Population-level impact, herd immunity, and elimination after human papillomavirus vaccination: a systematic review and meta-analysis of predictions from transmission-dynamic models.Lancet Public Health. 2016; 1: e8-e17Summary Full Text Full Text PDF PubMed Scopus (169) Google Scholar referenced in support of their statement also calls for caution in extrapolating predicted herd effects to low-income and middle-income countries. This is largely because of the significant differences that exist between high-income countries and low-income and middle-income countries with regard to sexual behaviour, vaccination coverage, and potential cofactors of HPV (eg, high HIV prevalence).2Brisson M Bénard É Drolet M et al.Population-level impact, herd immunity, and elimination after human papillomavirus vaccination: a systematic review and meta-analysis of predictions from transmission-dynamic models.Lancet Public Health. 2016; 1: e8-e17Summary Full Text Full Text PDF PubMed Scopus (169) Google Scholar Furthermore, even in high-income countries, herd effects were not observed when female vaccination coverage was lower than 50%.3Drolet M Bénard É Boily M et al.Population-level impact and herd effects following human papillomavirus vaccination programmes: a systematic review and meta-analysis.Lancet Infect Dis. 2015; 15: 565-580Summary Full Text Full Text PDF PubMed Scopus (506) Google Scholar Regarding support from Gavi, countries that have transitioned out of Gavi support because of economic growth remain eligible for HPV vaccine subsidies, because vaccine manufacturers have made price-freeze commitments and will offer the HPV vaccine to countries that have transitioned out of Gavi support at the same rates obtainable to Gavi-supported countries.4World Health OrganizationVaccine pricing: Gavi transitioning countries.https://www.who.int/immunization/programmes_systems/procurement/v3p/platform/module2/Factsheet_vacc_pricing_Gavi_transitioning_2017.pdfDate accessed: February 8, 2019Google Scholar We acknowledge the important challenges that lie ahead. Our call keys into contingencies such as the prospect of new developments in the rapidly changing HPV vaccination landscape—eg, promising results from pilot studies on the efficacy of single-dose HPV vaccination that might have implications for the overall cost of vaccination programmes. Although the problem of global HPV vaccine shortage is of genuine concern, the prospects of production of large quantities of HPV vaccines in countries such as China and India will potentially help to remedy existing vaccine shortages and allow for more affordable prices. Furthermore, the need for broader conversations on issues of intellectual property and technology transfer surrounding the manufacture of low-cost HPV vaccines5Padmanabhan S Amin T Sampat B Cook-Deegan R Chandrasekharan S Intellectual property, technology transfer and manufacture of low-cost HPV vaccines in India.Nat Biotechnol. 2010; 28: 671Crossref PubMed Scopus (35) Google Scholar, 6Crager SE Improving global access to new vaccines: intellectual property, technology transfer, and regulatory pathways.Am J Public Health. 2018; 108: S414-S420Crossref Google Scholar must be advanced by pharmaceutical companies, governments, and leading global health institutions in order to further promote equitable access to the HPV vaccine globally. With several African countries yet to initiate any form of HPV vaccination, gender-neutral vaccination will be needed to accelerate the elimination of HPV-associated cancers and bridge the already widening global disparities that exist in the prevalence of HPV-associated cancers.7The LancetCervical cancer: unequal progress.Lancet. 2019; 393: 104Scopus (8) Google Scholar We declare no competing interests. A call for the introduction of gender-neutral HPV vaccination to national immunisation programmes in AfricaHuman papillomavirus (HPV) causes more than 90% of cervical and anal cancers, more than 70% of oropharyngeal cancers, and a substantial proportion of vaginal, vulvar, and penile cancers. About 85% of women and 91% of men with a sexual partner will be infected with HPV in their lifetime.1 However, if countries can attain 80% HPV vaccination coverage in both men and women, HPV-associated cancers could be eliminated.2 The theme of the upcoming European Research Organization on Genital Infection and Neoplasia conference, due to be held in December 2018—“From control to elimination of HPV induced cancers: time to match visions with actions”—could not be more pertinent to the African continent. Full-Text PDF Open AccessGender-neutral HPV vaccination in AfricaOnyema Chido-Amajuoyi and colleagues (January, 2019)1 appeal for the introduction of gender-neutral human papillomavirus (HPV) vaccination to national immunisation programmes in Africa, as has been done in many developed countries such as the USA and Australia. Gender-neutral HPV vaccination seems to have become a trend worldwide, but its introduction might not be a simple task to achieve in Africa. 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