National human papillomavirus vaccination (GH_PV) programme: Ghana at a crossroads; is vaccine supply alone enough to ensure success?

Résumé fourni par la source

1.0 Introduction Ghana stands at a critical point to include human papillomavirus (HPV) vaccination in the Expanded Programme on Immunisation (EPI) to combat cervical cancer. Cervical cancer is the second most common female cancer in Ghana.1 The role of high-risk human papillomavirus (hr-HPV), particularly HPV 16 and 18, in cervical carcinogenesis is firmly established by both local and international studies.2,3 Annually, around 407 cervical cancer cases are managed at the two largest cancer treatment centres in the country, with a low overall 3-year survival rate of 39%.4,5 In straightforward terms, if 10 cases are diagnosed today, only about 4 will survive for 3 years post-diagnosis. The Ghana Health Service released a memorandum on June 2, 2025, to include the HPV vaccine in the routine immunisation schedules of all regions by September 2025. This commendable and timely project breaks new ground in the fight against cervical cancer; however, significant questions remain unanswered. 1.1 Health system readiness and capacity Ghana, with its elaborate and well-structured health care system spanning from the Community-Based Health Planning and Services (CHPS) compounds to the referral tertiary institutions, has achieved an overall high vaccine access and utilisation, from the inception of the EPI programme to date. The EPI implements a standardised series of preparatory activities for the introduction of each new vaccine. This process encompasses meetings of the National Immunisation Technical Advisory Group (NITAG), planning sessions, budget formulation, training for health workers, communicators, and journalists, as well as the establishment of a monitoring and reporting system for both the campaign and routine immunisation. However, challenges persist regarding regional disparity in coverage, as seen in the current malaria vaccine rollout, which should inform critical appraisal of operational gaps and institution of solutions.6,7 HPV vaccines must be stored and transported at temperatures ranging from 2-8 degrees Celsius across all 16 regions of Ghana. The existence of the three Walk-In Cold Rooms (WICRs), each with a capacity of 40 cubic metres, provides a net storage capacity of 28,571 litres for vaccine preservation, thereby optimising storage for the national HPV vaccination programme. It is commendable that the 10 new 20 cubic-metre WICRs, six for newly established regions and four for contingencies, can maintain the chain up to the regional level. The receipt and handling of the vaccine at the facility level is the delicate end of the cold chain, which is of much concern. Although the country has received 567 Cold Chain Equipment (CCE) units from the Cold Chain Equipment Optimisation Platform 2, this is insufficient to meet the needs of approximately 2,000 health facilities at the district and facility levels, which lack cold chain equipment. While further support for CCE is anticipated from Africa Centres for Disease Control and Prevention (CDC) and other collaborators to address existing gaps, it is of paramount importance that regional, district, and facility heads of deprived sites should actively plan and coordinate regularly with nearby endowed health facilities for vaccine storage and transport. In addition to the availability of the cold chain, it is essential to monitor the equipment for temperature incursions, which must be promptly identified and addressed to maintain vaccine efficacy. The cold chain temperature should be monitored at least twice a day, including weekends, alongside the continuous monitoring devices at the national level that offer 24-hour temperature visibility within the WICR. 1.2 Target population and coverage strategy The target age group aligns with World Health Organisation (WHO) recommendations, which focus on individuals aged 9 to 14 years.8 Per the compulsory basic education policy in Ghana, most of such girls will be in the upper primary and junior secondary school. The GH_PV programme roll-out is nationwide, ensuring coverage of out-of-school girls in the inner-city suburbs, including the "Kayayo herd porters" and daughters of pastoralist nomads, is paramount. To promote an all-inclusive strategy for the vulnerable population, eligible girls in schools or communities receive vaccinations without inquiring about their HIV status. Targeting established specialised ART clinics nationwide will ensure that no eligible girl is overlooked, while also maintaining privacy and confidentiality. The existing EPI programme has faced challenges in reaching hard-to-reach populations, particularly island communities in the northern and southeastern regions of the Volta Basin in Ghana. These sites necessitate focused attention through the standard program, along with supplementary vaccination via targeted outreach initiatives to improve access and coverage. 1.3 Vaccine hesitancy and cultural sensitivity Health provider communication (HPC) to parents and guardians is crucial in the uptake of the HPV vaccine (initiation, completion, and follow-through).9 Other key persons/groups include adolescent groups, opinion leaders, and religious groups. The communication must identify guardian-or parent-specific hesitations and concerns, and address them promptly to enhance parental knowledge of the vaccine.10 Such communication must extend beyond vaccine safety and the prevention of cervical, vulvar and vaginal cancers to encompass vaccine efficacy against benign hyperproliferative epithelial lesions, including genital warts and recurrent respiratory papillomatosis, as well as cancers of the oropharynx, skin, and penis.11–13 Adequate community education on the efficacy of the vaccine against these HPV-related diseases, presented in a clear and comprehensible manner, is essential for mitigating scepticism and addressing cultural sensitivities associated with the introduction of the vaccine. It is necessary to frame the HPV vaccine as a tool for protecting future mothers, not as linked to sexual behaviour. While the EPI communication arm, with its team of specialists, deserves applause for often crafting messages with appropriate content for previous exercises, similar attention is required for the GH_PV programme. Comprehensive sexual education of the adolescent and young individual has the potential to contribute significantly to the programme. The implementation of the programme can build on this critical phase in the Expanded Programme on Immunisation (EPI) by engaging teachers and educational sector leaders as strategic partners. Drawing on their pedagogical expertise and contextual understanding, these collaborations can facilitate the development and dissemination of culturally sensitive and socially acceptable messages aimed at increasing vaccine uptake among eligible school-aged girl. 1.4 Data recording and monitoring Ensuring the collection and use of high-quality data during the HPV vaccine roll-out is critical to achieving coverage of at least 90% among eligible girls. Robust data systems will not only support effective monitoring and evaluation but also safeguard Ghana's progress towards the elimination of cervical cancer as a public health concern. Both electronic and paper-based tools would be required to guarantee data completeness and accuracy. Past assessments of immunization data systems have identified challenges, including incomplete data and delays in reporting.14 In the context of the new campaign, it is advisable to hold onto vaccination registers, tally sheets, and summary reporting forms to collect case-based data. Furthermore, it is recommended that data aggregates be submitted to the national level through electronic platforms such as Google Sheets. To ensure data quality and accuracy, however, routine data recording and reporting tools may need to be revised and reformatted to integrate HPV vaccination indicators within the District Health Information System 2 (DHIS2) and Ghana's Health Management Inform

Ce résumé expose les affirmations des auteurs. BNTIC ne l’interprète pas comme une validation indépendante des résultats.