Grant: Project Grant

Human papillomavirus (HPV) was responsible for roughly 600,000 cervical cancers (CC) worldwide in 2018. Few diseases reflect global inequalities as much as CC, with roughly 85% of CC related deaths occurring in Low- and Middle-Income Countries (LMICs). In 2020, the World Health assembly set a target of 90% HPV vaccination coverage of girls in order to reach global CC elimination. The COVID-19 pandemic and vaccine shortages have slowed down the introduction of HPV vaccination in LMICs, and led to decreases in vaccination uptake in LMICs and High-Income Countries (HICs), mainly in populations with the highest CC burden. Currently, HPV vaccination coverage of girls in LMICs is 16% compared to 59% in HICs. Furthermore, in HICs, including Canada, there remains inequalities in vaccination coverage and CC burden between population subgroups (e.g. socioeconomic status) and regions. Failure to address these inequalities will imperil global CC elimination and accentuate health inequalities. Working with local decision-makers in 5 LMICs and Canada, and with the WHO, we aim to use a validated transmission-dynamic model (HPV-ADVISE) to identify optimal tailored country-specific HPV vaccination strategies that can accelerate reductions in CC and reduce inequalities between LMICs and HICs, and within Canada. We will examine a wide range of strategies adapted to the context of each country. For LMICs, we will examine the impact of different strategies (1 or 2 doses, new vaccines, campaigns or routine vaccination) and target populations (girls, boys, and/or older women) for different vaccination coverage. For Canada, we will project how inequalities in vaccination coverage can impact CC elimination, and the impact of increasing vaccination coverage in specific populations. By integrating knowledge users throughout the project, we will ensure that our work is responsive to real world needs and will be used to inform local and global HPV vaccination policy decisions.