Policy Development for Human Papillomavirus Vaccine Introduction in Low- Resource Settings

Abstract

The objectives of this analysis are: (1) to describe the policy environment related to human papillomavirus (HPV) vaccine introduction; (2) to identify the policy processes and key stakeholders in HPV vaccine introduction; (3) to summarize specific characteristics about HPV vaccines and their introduction that may be barriers to introduction; and (4) to recommend advocacy strategies to achieve a positive environment for cervical cancer prevention. This descriptive qualitative study of HPV vaccine policy development used an iterative, inductive, theme-based approach to data analysis. The study was conducted in four developing countries—India, Peru, Uganda, and Vietnam. Study participants were comprised of a total of 237 national policymakers, legislators, officials, and senior managers from ministries of health, finance, and planning; leaders of medical and health professional associations; cancer institutes; heads of nongovernmental organizations; and women's health advocates. While differences existed among low-income countries in specific cervical cancer, women's health, adolescent health, or immunization policy environments, we found the policymaking process itself, specific concerns related to HPV vaccines, and the information needs of policymakers for HPV vaccine introduction to be strikingly similar. Data on burden of cervi- cal cancer, HPV vaccine safety and efficacy, and cost-effectiveness and vaccine affordability were top issues reported by policymakers. Advocacy strategies need to address these issues in order for HPV vaccine policy formulation and approval to be successful.