The Ministry of Health of Ethiopia in its effort to prevent cervical cancer and ensure a healthier population conducted the human papillomavirus (HPV) vaccination campaign nationwide with support from Gavi the Vaccine Alliance (Gavi) reaching over 6.8 million Multi-Age Cohort (MAC) 9-14 years girls. The nationwide HPV (MAC) single-dose vaccination was launched on 18 November 2024 by H.E. Dr Mekdes Daba, Health Minister to Ethiopia, and graced by representatives from Gavi, WHO, UNICEF, and other immunization partners. The HPV MAC vaccination doubled the total number of vaccinated girls in the country to over 13 million along with the 6.3 million girls reached in the past five years.
“Cervical cancer remains the 4th most common cancer globally, affecting over 8,168 women in Ethiopia, and the Ministry of Health has continued its commitment to ending this preventable disease and launched this HPV vaccination to multi-age cohort (MAC) to reach close to 7 million 9-14 years of age girls.” H.E. Mekdes Daba, Health Minister to Ethiopia.
“This HPV MAC vaccination is a big milestone to the country in contributing to the reduction of morbidity and mortality as it expands its coverage from only 14 years to multi-age-cohort vaccination among 9- to 14-year-old girls that helped to double the total number of girls vaccinated in Ethiopia” says Dr. Owen Kaluwa, WHO Representative in Ethiopia.
The government of Ethiopia embarked on different prevention modalities including the introduction of the HPV vaccine in 2018. Over the past five years, the vaccine was given in two-dose schedule. However, in the last campaign conducted in early March 2024, the two-dose schedule was switched to a single-dose schedule for the primary target of 14-year-old girls in line with the WHO’s independent Strategic Advisory Group of Experts on Immunization (SAGE) recommendation in April 2022.
The optimization of the HPV schedule is expected to improve access to the vaccine, offering countries the opportunity to expand the number of girls who can be vaccinated. However, the recommendation underscores the importance of vaccinating immunocompromised people, or those living with HIV as a priority with a minimum of two doses and where possible three doses. Ethiopia not only revised and endorsed the recommendation for a single-dose schedule, but the country has also expanded the target to reach MAC of 9-14 years of age targeting over 7 million girls from all regions and city administration.
The HPV vaccine was administered using a campaign mode for four consecutive days in schools where most of the target age group, 9-14-year girls, are easily found. The out-of-school targets were reached through outreach and fixed post vaccination. School teachers and directors have supported the social mobilization activities, and the TV and Radio spots were broadcasted at all national and regional levels. Other key messages on HPV were disseminated to the community using fliers and fact sheets. The HPV MAC campaign is a one-time activity for the current year and will subsequently be integrated into the routine immunization schedule and be administered to girls at 9 years.
WHO’s Contribution
WHO deployed technical officers to support the preparation and implementation of the campaign at all levels. WHO also recruited additional five Technical Assistants (TAs) to support the HPV MAC campaign through Gavi the vaccine alliance support.
As part of the preparation, WHO supported the pre-campaign readiness assessment, reviewed the woreda and team Open data Kit (ODK) based supervisory checklist, and generated a Power BI for daily monitoring and review. WHO also provided training virtually for Expanded Program on Immunization (EPI) focal points, partners agencies, and Ministry of Health (MOH) on the supervisory checklist and the use of ODK to ensure the campaign quality through real-time data monitoring. Over 10,560 supervisory visits were conducted to teams by ministry of health, WHO and other partners.
Lessons learned
Strong collaboration with education bureau in engaging the schools and using the school media platforms facilitated smooth implementation of vaccination campaign
Engagement of schools’ communities, parent committee and teachers helped to build trust and awareness, making the campaign more accepted and effective.
Immediate observation and care for AEFI cases are essential to ensure the safety and well-being of vaccinated individuals, and maintain vaccine confidence
The daily campaign review meeting, field support debriefing and recommendations helped to improve the campaign’s effectiveness
Active Engagement of higher officials including the regional president office and other key stakeholders during launching ceremony facilitated the smooth implementation of the campaign and enhanced social mobilization
Implementing real-time monitoring systems helped in identifying and addressing challenges promptly, ensuring the continuity of the campaign
Strong advocacy on vaccine effectiveness and safety of the HPV vaccine was integral to minimize the effect of misconception
The involvement of community, religious, and local leaders played a pivotal role in overcoming resistance at both community and school levels
Tailored communication strategies such as using the Ministry of Health social media, and education of healthcare workers, teachers, and community members helped to combat misinformation and addressed rumors to maintain high coverage
Cervical cancer and its prevalence
Cervical cancer is caused by persistent infection with the human papillomavirus (HPV). It is the fourth most common cancer in women globally with around 660 000 new cases and around 350 000 deaths in 2022. The cervical cancer statistics on World Cancer Research Fund shows that cervical cancer is the second most common and deadly cancer in Ethiopia. It has been estimated that around 8,168 new cervical cancer cases occur every year and about 5,975 people will consequently die.1
Targets for the elimination of cervical cancer
Countries around the world are working to accelerate the elimination of cervical cancer in the coming decades, with an agreed set of three targets (90-70-90 targets) that must be met by 2030. The 90-70-90 targets that would qualify countries to be on the path towards cervical cancer elimination requires 90% of girls to be fully vaccinated with HPV vaccine by age 15 years, 70% of women to be screened with a high-performance test by 35 years of age and again by 45 years of age, and 90% of women identified with cervical disease receive treatment (90% of women with precancer treated, and 90% of women with invasive cancer managed).
