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Most high-income countries routinely vaccinate both girls and boys against HPV, but the global coverage rate for the vaccine is only 20 percent.<\/p>\n
Gavi has been trying to expand HPV vaccination for more than a decade. Many low-income countries had designed programs to begin in 2018, but Gavi could not get shots then either because it and UNICEF were competing with a global market and suppliers did not increase production to meet Gavi\u2019s predicted demand.<\/p>\n
The version of the Merck HPV vaccine used in the United States costs about $285. UNICEF, which typically negotiates big discounts from pharmaceutical companies, pays $3 to $5 per shot for the large volumes of vaccine it sought to procure.<\/p>\n
\u201cUNICEF and Gavi have struggled for years to get sufficient supply, and that was finally starting to change,\u201d said Andrew Jones, UNICEF\u2019s deputy director, immunization supplies.<\/p>\n
UNICEF has contracts with other suppliers, but because the Merck product is in high demand from countries, the Gavi program is dependent on the company\u2019s supply. That means this delay disrupts vaccination campaigns in a half-dozen countries, many of which have already had to postpone repeatedly.<\/p>\n<\/div>\n<\/div>\n
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\u201cIt affects countries\u2019 confidence because for years they were told there wasn\u2019t sufficient supply, but when finally supply opened up, they campaigned, got political buy-in, and now delivery is delayed by six or eight months,\u201d Mr. Jones said.<\/p>\n
Mr. Ryan of Merck said the company was committed to supporting the drive to vaccinate millions of girls in developing countries against HPV and had invested more than $2 billion in that effort.<\/p>\n
Though Mr. Ryan said the company will deliver the delayed doses next year, Merck has yet to notify Gavi when countries can expect those deliveries, which means they cannot yet begin to plan new campaigns.<\/p>\n
The countries that won\u2019t get doses this year include Mozambique, Sierra Leone, Ivory Coast and Burkina Faso . They were going to do the multi-age blitz campaigns aimed at catching as many girls as possible, in addition to the routine vaccination of 9-year-olds. The routine program will continue using doses Merck has delivered.<\/p>\n<\/div>\n<\/div>\n
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In addition, Burundi, and, in Asia, Tajikistan, were supposed to get supplies at the end of this year to start doing both multi-age and routine vaccinations, while Cameroon and Liberia were to take delivery of shots so they could start doing multi-age vaccination early in the new year. All of those campaigns will be postponed.<\/p>\n<\/div>\n<\/div>\n
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The girls who won\u2019t get vaccinated this year are some of the least likely in the world to be screened or treated for cervical cancer, said Dr. Cathy Ndiaye, the Dakar-based director of the HPV vaccine program for the health-focused nonprofit organization PATH.<\/p>\n
\u201cIn some countries you can say, \u2018OK, you weren\u2019t vaccinated but if you have anything later on in life you can go and get treated\u2019, but not for these girls,\u201d Dr. Ndiaye said.<\/p>\n
The delay also complicates the challenge of maintaining political and community support for the HPV shot, she said.<\/p>\n
\u201cWhen you have momentum you want to take advantage of that: When you manage to create demand from the community, you want to deliver, to give them what they need,\u201d she said. \u201cEven at the national level you have to convince them this is important, that it should be a priority because they don\u2019t see cervical cancer, they don\u2019t see the disease now, they say, \u2018No let\u2019s deal with polio, let\u2019s deal with measles, that is urgent now.\u2019\u201d<\/p>\n<\/div>\n<\/div>\n