National Primary Health Care Development Agency

Overview of HPV Vaccine

Introduction in Nigeria

26th March 2024

N A T I O N A L E M E R G E N C Y R O U T I N E I M M U N I Z A T I O N C O O R D I N A T I O N C E N T R E
( N E R I C C )
 Outline

1 Background

2 Rationale and Objective of HPV VI in nigeria

3 Phases of the HPVVI in Nigeria

4 Achievement

5 Routinization of HPV vaccine

6 Phase 2 projected timelines

 Background on Human Papillomavirus and HPV vaccines
(1/2)
 Human Papillomavirus (HPV) is the most common viral infection of the reproductive tract and
causes more than 95% of cases of cervical cancer as it accounts for the fourth most common
cancer in women worldwide and the second most common cancer affecting women in Nigeria
with an estimate of 12,075 reported new cases and 7,968 deaths recorded in 2020 alone
 This high burden of cervical cancer is attributed to several factors including, poor access to HPV
vaccination services, poor screening and treatment services, low awareness, and inadequate
access to healthcare especially in rural areas
 HPV is mainly transmitted through sexual contact and most people are infected with HPV shortly
after the onset of sexual activity
 It takes an average 20-30 years from infection to development of cervical cancer in women with
normal immune systems and can take as short as 5-10 years in women with weakened immune
systems such as those with untreated HIV infection, who are six times more likely to develop
cervical cancer

NPHCDA – National Primary Health Care Development Agency

 Background on Human Papillomavirus and HPV vaccines
(2/2)

• With the support of Partners , Nigeria introduced the HPV vaccine in a phased approach to sustain
the country’s focus on reducing morbidity and mortality due to the high burden of cervical cancer
and the weak secondary and tertiary platforms to manage and treat cases
▪ The HPV vaccine was officially into the Nigerian EPI schedule launch on the 24th October 2023 at
the Banquet Hall state house by Her Excellency the First lady of the Federal Republic of Nigeria
Senator Oluremi Tinubu, CON, OON

▪ As @ present, 16 phase 1 states including the FCT have introduced the HPV vaccine

▪ A total of 4,952,897 (80%) 9-14 years were vaccinated during the phase 1 MAC campaign across
the 16 phase 1 states

▪ This update is an overview of the progress on the HPV vaccine introduction in Nigeria

NPHCDA – National Primary Health Care Development Agency

 Rationale for HPV Vaccine Introduction in Nigeria
 The introduction of HPV vaccines into the routine immunization schedule in Nigeria is an additional
measure to complement the other strategies in line with the Global Strategy towards eliminating cervical
cancer as a public health problem, and it is one of the priority vaccines earmarked for introduction in line
with the NSIPSS
 In countries that have introduced the vaccine against HPV, cancer causing HPV prevalence was reduced by
83% among girls aged 13–19 after 5–8 years, and the prevalence of precancerous lesions decreased by 51%
among girls aged 15–19
 Following SAGE recommendations, Nigeria is introducing HPV vaccination using Gardasil 4vHPV which has
a longer duration of protection (>10 years) and provides cross protection for other types of Human
papilloma viruses beyond types 16 and 18 that cause cervical cancer
 The investment in HPV introduction in Nigeria will contribute to the achievement of the SDGs and targets,
specifically SDG 1 (End poverty in all its forms everywhere), SDG 3 (Good Health and Well-being), SDG 5
(Gender Equality), and SDG 10 (Reduce inequality within and among countries)
 It is therefore imperative to introduce the vaccine to improve women's health and well-being and reduce
the mortality due to cervical cancer

NPHCDA – National Primary Health Care Development Agency

Objectives of HPV Vaccine Introduction in Nigeria

Vaccinate at least 80% of adolescent girls aged 9-14 by December

2024

Achieve routine HPVV coverage of at least 69% for girls aged 9

years by December 2025

Achieve a minimum of 4% annual increase in routine HPVV

coverage from December 2026

Disseminate information on primary, secondary and tertiary

preventive measures across the 774 LGAs

NPHCDA – National Primary Health Care Development Agency

 Phases of HPVV Introduction in Nigeria
HPVV Phase 1 and 2 states in Nigeria  Based on global guidance on single dose and vaccine
availability of 8mil doses Gardasil4, Nigeria will be
Sokoto
introducing the HPV vaccine in a phased approach
Katsina Jigawa
 Key criteria for distribution of states in phases include:
– Level of risk to cervical cancer disease. The indicators
Yobe
Zamfara Borno
Kebbi Kano
are;
• Mean age at sexual contact
Kaduna
Bauchi Gombe • % teenage pregnancy
Niger • Mean number of sexual partners in a lifetime
Plateau
Adamawa
• STI prevalence in the last 12 months
Kwara
FCT • % male circumcision and HIV prevalence
Nasarawa
Oyo
Taraba – Cold chain capacity sufficiency
Osun
Ekiti
Kogi
Benue
– Penta3 coverage using admin and survey (NDHS 2018)
Ogun
Ondo  The introduction will be based on lessons learnt from
Lagos
Edo
Ebonyi other countries and previous new vaccines introduced in
Cross
Nigeria
Delta Imo
River

Bayelsa
Rivers
Akwa
Ibom
2023 MAC (15 states + FCT)  15 states and the FCT introduced the HPV vaccine in Q4 of
2024 MAC (21 states)
2023, this is followed by the remaining 21 states in Q2 of
2024
NPHCDA – National Primary Health Care Development Agency
 Achievement

NPHCDA – National Primary Health Care Development Agency

 Phase 1 achievement for MAC Campaign coverage across the 16 states

Cumulative Coverage By States

100% 98% 97% 94% 93% 93% 92%
90% 87% 87%
84% 84% 83% 82% 80% 80%
80% 75%
70%
70%
60%
50%
40% 36%
30%
20%
10%
0%
Taraba Akwa Kano Nasarawa Abia Bayelsa Bauchi Jigawa FCT Osun Adamawa Benue Kebbi Enugu Ogun Lagos National
Ibom

4.9 million adolescent girls were vaccinated during the MAC Campaign across 15 phase 1 states
and the FCT
Source: Daily Call-In Data
NPHCDA – National Primary Health Care Development Agency 9
 Current issues with HPV vaccine routinization for
phase 1 states and mitigation plan
Issues Mitigation plan
Slow pace of commencement of • NTWG engaged via zoom with all phase 1 states
routinization of HPV vaccines in some • The issue was robustly discussed
phase 1 states • The National routinization Strategy was shared with the states,
to be adapted to state specific strategy
HPV Vaccine stock out for routinization • HPV vaccines were redistributed by the NLWG to cover
reported in some states reported gaps

Sub-optimal data reporting for reporting • Engagement meeting held via zoom with phase 1 state teams
on the DHIS 2 platform • Hands on orientation conducted for all M&Es in phase 1 states
on proper reporting for HPV vaccine data on the DHIS 2
platform
Sub-optimal implementation of the • Continues tracking of HPV vaccine data on the DHIS and
routinization strategy by states engagement with phase 1 states

NPHCDA – National Primary

Sample Footer Text
Health Care Development Agency 10
 National HPV vaccine Routinization strategy

1 2 3 4
Utilize routine government funded
Integrating HPV During other
outreach and mobile services
Immunization Campaigns – Nigeria
being provided by RI providing
will leverage Polio and NPSIAs for
health facilities for the provision of
Leveraging bi-annual Maternal and measles, MenA, Yellow Fever, CSM
HPV vaccination.
Leveraging Fixed post vaccination Child Week (MNCH-Week) to and Cholera to provide HPV
Facilities should conduct school
where RI is provided to provide provide HPV vaccination. Most of vaccination.
outreach at least once every
HPV vaccination to both in-school the states have taken the Following the HPV vaccination
quarter.
girls and out of schoolgirls. ownership of MNCH week by the rollout in Nigeria, all scheduled
Most of the states to provide
wives of the Governors campaigns will include
regular support for outreach and
administration of HPV vaccines to
mobile sessions as part of
eligible girls to increase HPV
government policy.
vaccination coverage

NPHCDA – National Primary Health Care Development Agency

 Country HPVV Phase 2 Introduction Projected Timeline and Activities
Deal Breaker

Pre implementation phase Implementation phase

Shipment State/LGA Launch

(Vaccines will not be adequate for MAC
introduction)
Funds released
Implementation training

Jan. Feb. Apr. Apr. May Jun. Jul.

Micro planning TOT
Readiness dashboard
Review CC readiness

Establish linkages with schools

Engagement of non-EPI stakeholders

Ops room set up
This timeline is based on the following
Dissemination of formative research results assumptions:
(1) Funds are received by Feb. 2024
(2) Vaccines are received by April 2024
(3) HPVV is launched by May 6th 2024

NPHCDA – National Primary Health Care Development Agency

NPHCDA – National Primary Health Care Development Agency