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Background
Human papillomavirus (HPV) is found in virtually all cases of cervical cancer, which kills 275,000 women every year. Eighty-eight percent of these deaths occur in developing countries. Two vaccines were recently approved to immunize against HPV. Historically, there is a 15-20 year time lag between the introduction of novel vaccines in high- and low-income countries.
Approach
Rwanda’s Ministry of Health partnered with Merck to offer universal access to the HPV vaccine Gardasil® for all girls of appropriate age. The MOH formed a “public-private-community partnership” to ensure effective and equitable delivery. Because 97% of Rwandan girls are enrolled in primary school, a school-based opt-out strategy was used. A nationwide sensitization campaign preceded delivery of the first of three doses, and teachers were trained to monitor and report adverse events following each round of vaccination. Rwanda’s 45,000 community health workers traced out-of-school girls to ensure universal coverage.
National Context
The proportion of infants receiving all basic WHO immunizations in Rwanda exceeds 90%. As a result of effective “diagonal” approaches focused on channeling vertical funding for HIV/AIDS towards health systems strengthening initiatives, health outcomes have improved dramatically in recent years.
Results
Rwanda’s program achieved 93.23% coverage among girls in primary grade six for the first course of three doses in 2011, made possible through a school-based vaccination strategy and community involvement in identifying out-of-school girls.
Discussion
Through a series of innovative partnerships, Rwanda reduced the historical gap in vaccine introduction between high- and low-income countries from nearly two decades to less than five years. High coverage rates were achieved due to a delivery strategy that harnessed the strength of Rwanda’s human resources for health. Rwanda’s example should motivate other countries to explore universal provision of the HPV vaccine, but implementation must be customized according to local context.
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Learning Objectives: 1) Learn about the Rwandan Ministry of Health’s human papillomavirus vaccine rollout program. 2) Describe Rwanda’s strategy in obtaining access to and delivering the HPV vaccination. 3) Evaluate necessary consideration for an effective vaccine delivery program in other contexts.