Nearly 1.5 million teenage girls in some of the world's poorest countries will miss out on protection from cervical cancer as drugmaker Merck says it will not be able to supply millions of doses HPV vaccine as promised this year.
Merck has informed Gavi, the international organization that helps low- and middle-income countries deliver life-saving vaccines, and UNICEF, which purchases the vaccines, that it will supply only 18.8 million of the 29 .6 million doses it has contracted to supply by 2024, Gavi said.
That means more than 10 million girls won't get the expected HPV vaccine this year — and 1.5 million of those will most likely never get the vaccine because are too old to be eligible for vaccination in subsequent years.
Patrick Ryan, a Merck spokesman, said the company “experienced a production disruption” that forced it to hold and recheck many doses by hand. He declined to provide further details about the cause of the delay.
“We are taking urgent and rigorous action to deploy additional personnel and resources to resolve this issue as soon as possible,” he said.
Merck will deliver the delayed doses in 2025, Ryan said.
He also said the company will ship 30 million doses of the vaccine to Gavi-supported countries this year. However, around a third of these were doses expected to be sent in 2023, leaving Gavi with a shortfall of 10.7 million doses.
The delay is a major setback for countries that have waited years to start vaccinations against HPV, the human papillomavirus that causes about 90% of cervical cancers.
About 350,000 women die from cervical cancer according to the World Health Organization. 90% of them live in low-income countries, where routine screening for the disease is rare. This vaccine provides nearly complete protection against HPV infection, making it the only vaccine against cancer.
“HPV is the highest impact vaccine that Gavi has: If you vaccinate 1,000 girls, you will prevent 17.4 deaths in future”. “If there is one vaccine that you want to produce and do well, this is it.”
WHO recommends vaccination for girls up to 14 years of age. The delay means girls in countries including Sierra Leone, Burkina Faso and Mozambique who are currently 14 years old will no longer be eligible for vaccination when these campaigns begin.
The HPV vaccine is A complicated one to provide, because it involves sexual activity, a taboo subject for adolescents in many cultures affected by procrastination, and because it is routinely administered to children beyond the usual age range. Both girls and their parents have to comply with vaccination and that requires the creation of distinct messages, conveyed in different media to stimulate demand. The vaccine must be given before girls become sexually active to be effective.
Dr. Nguyen said the affected countries have the most under-resourced health systems in the world. They had invested in planning for the eliminated HPV campaign, she said, while also addressing other urgent vaccination needs such as measles or cholera, and could not afford the disruption. .
The delays will disrupt carefully laid plans to catch up on vaccinations — most of the delayed doses are going to so-called “multi-age groups,” as countries try to reaching all unvaccinated girls between the ages of 9 and 14, along with the standard nine-child vaccination program. -Children often run in school.
Most high-income countries routinely vaccinate both girls and boys against HPV, but global coverage of this vaccine is only 20%.
Gavi has been trying to expand HPV vaccination for more than a decade. Many low-income countries have designed programs to start in 2018, but Gavi cannot vaccinate either because Gavi and UNICEF are competing with the global market and suppliers are not increasing production to meet Gavi's anticipated demand.
The version of the Merck HPV vaccine used in the United States costs about $285. UNICEF, which often negotiates large discounts from pharmaceutical companies, pays between $3 and $5 per shot for the large quantities of vaccines it seeks to purchase.
“UNICEF and Gavi have struggled for years to get enough supplies and that is finally starting to change,” said Andrew Jones, UNICEF's deputy director for vaccine supplies.
UNICEF has contracts with other suppliers, but because Merck's products are in high demand from other countries, the Gavi program depends on the company's supply. That means the delay disrupts vaccination campaigns in half a dozen countries, many of which have had to postpone multiple times.
“It affected the confidence of countries because for many years they were told there wasn't enough supply, but when the supply finally opened up, they mobilized, got support,” Mr. Jones said. political support and now deliveries are delayed by six or eight months.” speak.
Merck's Mr. Ryan said the company is committed to supporting the HPV vaccination effort for millions of girls in developing countries and has invested more than $2 billion in that effort.
Although Mr. Ryan said the company will deliver the delayed doses next year, Merck has not yet told Gavi when countries can expect those deliveries, which means they have not yet You can start planning new campaigns.
Countries that will not receive vaccines this year include Mozambique, Sierra Leone, Ivory Coast and Burkina Faso. They will run multi-age blitz campaigns to attract as many girls as possible, in addition to routine vaccinations for 9-year-olds. The regular program will continue to use the doses that Merck has provided.
Additionally, Burundi and in Asia, Tajikistan, are expected to receive supplies later this year to begin both multi-age and routine vaccinations, while Cameroon and Liberia will receive injection so they can begin multi-vaccination. – Vaccination at the beginning of the new year. All those campaigns will be postponed.
Girls who did not receive the vaccine this year are among the few most likely to be vaccinated, said Dr. Cathy Ndiaye, director of the HPV vaccine program for the Dakar-based health-focused nonprofit. screening or treatment of cervical cancer in the world. PATH organization.
“In some countries, you can say, ‘Okay, you haven't been vaccinated but if you get something later in life, you can go for treatment,'” Dr. Ndiaye said. This girl doesn't.
The delays also complicate the challenge of maintaining political and public support for HPV vaccination, she said.
“When you have momentum, you want to take advantage of that: When you try to create demand from the community, you want to deliver, give them what they need,” she said. “Even at the national level, you have to convince them that this is important, that it has to be a top priority because they don't see cervical cancer, they don't see the disease now, they saying, 'No, let's tackle polio, let's tackle together' dealing with measles, that's the urgent thing right now.”
In Mozambique, the plan is to start a multi-age campaign in June. “There is a huge need, people are requesting”.
Merck also failed to deliver 7.7 million vaccine doses to Ethiopia that were expected to arrive late last year and now say they will arrive in June. The country had to cancel a planned school campaign planning for spring. Instead, that campaign will take place later this year and will remember girls who have grown old.
