Optimal human papillomavirus vaccination strategies in the context of vaccine supply constraints in 100 countries.

IF 9.6 1区 医学 Q1 MEDICINE, GENERAL & INTERNAL
EClinicalMedicine Pub Date : 2024-07-18 eCollection Date: 2024-08-01 DOI:10.1016/j.eclinm.2024.102735
Kiesha Prem, Tania Cernuschi, Stefano Malvolti, Marc Brisson, Mark Jit
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引用次数: 0

Abstract

Background: Countries are recommended to immunise adolescent girls routinely with one or two doses of human papillomavirus (HPV) vaccines to eliminate cervical cancer as a public health problem. With most existing vaccine doses absorbed by countries (mostly high-income) with existing HPV vaccination programmes, limited supply has been left for new country introductions until 2022; many of those, low- and middle-income countries with higher mortality. Several vaccination strategies were considered by the Strategic Advisory Group of Experts on Immunization to allow more countries to introduce vaccination despite constrained supplies.

Methods: We examined the impact of nine strategies for allocating limited vaccine doses to 100 pre-introduction countries from 2020 to 2030. Two algorithms were used to optimise the total number of cancer deaths that can be averted worldwide by a limited number of doses (knapsack and decreasing order of country-specific mortality rates), and an unoptimised algorithm (decreasing order of Human Development Index) were used.

Findings: Routinely vaccinating 14-year-old girls with either one or two doses and switching to a routine 9-year-old programme when supply is no longer constrained could prevent the most cervical cancer deaths, regardless of allocation algorithm. The unoptimised allocation averts fewer deaths because it allocates first to higher-income countries, usually with lower cervical cancer mortality.

Interpretation: To optimise the deaths averted through vaccination when supply is limited, it is important to prioritise high-burden countries and vaccinating older girls first.

Funding: WHO, Bill & Melinda Gates Foundation.

100 个国家疫苗供应紧张情况下的最佳人类乳头瘤病毒疫苗接种策略。
背景:建议各国为青春期少女常规接种一至两剂人类乳头瘤病毒 (HPV) 疫苗,以消除宫颈癌这一公共卫生问题。由于大部分现有疫苗剂量已被实施 HPV 疫苗接种计划的国家(主要是高收入国家)吸收,因此在 2022 年之前,可供新国家接种的疫苗剂量有限;其中许多是死亡率较高的中低收入国家。免疫接种战略专家咨询小组考虑了几种疫苗接种策略,以便让更多国家在供应有限的情况下引入疫苗接种:我们研究了从 2020 年到 2030 年将有限的疫苗剂量分配到 100 个引入前国家的九种策略的影响。我们使用了两种算法来优化有限剂量可在全球范围内避免的癌症死亡总人数(knapsack 算法和特定国家死亡率降序算法),还使用了一种未优化算法(人类发展指数降序算法):无论采用哪种分配算法,为 14 岁女孩常规接种一剂或两剂疫苗,并在供应不再紧张时改用 9 岁女孩常规接种计划,都能避免最多的宫颈癌死亡。未优化的分配方案可避免的死亡人数较少,因为它首先分配给了高收入国家,而这些国家的宫颈癌死亡率通常较低:解释:在供应有限的情况下,要通过接种疫苗最大限度地避免死亡,必须优先考虑高负担国家,并首先为年龄较大的女孩接种疫苗:资助机构:世界卫生组织、比尔及梅林达-盖茨基金会。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
EClinicalMedicine
EClinicalMedicine Medicine-Medicine (all)
CiteScore
18.90
自引率
1.30%
发文量
506
审稿时长
22 days
期刊介绍: eClinicalMedicine is a gold open-access clinical journal designed to support frontline health professionals in addressing the complex and rapid health transitions affecting societies globally. The journal aims to assist practitioners in overcoming healthcare challenges across diverse communities, spanning diagnosis, treatment, prevention, and health promotion. Integrating disciplines from various specialties and life stages, it seeks to enhance health systems as fundamental institutions within societies. With a forward-thinking approach, eClinicalMedicine aims to redefine the future of healthcare.
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