CHIC HPV Council Consensus Statement on One-Dose Recommendation

April 28, 2022

Just one dose of HPV vaccine will save lives—new single-dose options make it faster and easier to protect girls around the world against cervical cancer.

The HPV Council of the Coalition to Strengthen the HPV Immunization Community (CHIC) welcomes new global recommendations on single-dose options for human papilloma virus (HPV) vaccination. On April 11, 2022, the World Health Organization’s (WHO) Strategic Advisory Group of Experts on Immunization (SAGE) concluded that a single-dose HPV vaccine delivers solid protection against HPV, comparable to a two- or three-dose schedule, and recommended that countries update their dosing schedules to include a single-dose option. This permissive recommendation could be a game-changer, opening the door for national immunization programs to begin, or move to, a single-dose schedule for the vaccine.

The CHIC HPV Council welcomes the results of this comprehensive review of the evidence,[1] including new findings of special relevance to Africa.[2] We strongly support the recommendation for a single-dose option. Given its lower cost and greater flexibility in program delivery, this single-dose option will be particularly critical in resource-constrained settings that are currently struggling to vaccinate the WHO recommended target cohort of 9–14-year-old girls.

This single-dose option comes at a pivotal moment, when national leaders are facing the challenge of how to “catch up” from COVID-19 disruptions, as well as from past constraints on vaccine supply.

Global coverage of HPV vaccination fell to as low as 13% in 2020. Single-dose schedules make it more feasible for programs to offer vaccine to “multi-age cohorts” of girls who missed out in pandemic years and beyond. Restoring and strengthening vaccination programs to realize the bold goal of cervical cancer elimination, set by the World Health Assembly in 2020, requires countries to act now, with a fresh approach. The WHO Elimination Strategy calls for all countries to routinely vaccinate 90% of girls by age 15 by 2030 to set the world on the path to eliminate this cancer within 100 years. This single-dose option offers new hope that this can be achieved over the next eight years.

The CHIC HPV Council highlights these points in relation to the April 2022 SAGE statement:

  • For an individual girl and her family, a single-dose schedule offers comparably high levels of protection, compared to a two-dose or three-dose schedule.
  • For national immunization program leaders, a single-dose schedule offers greater efficiency, through simplified logistics for implementation and fewer vaccine doses per cancer prevented.
  • For countries that have been waiting to introduce HPV vaccines, a single-dose schedule offers an attainable promise of cervical cancer prevention for its girls and young women.
  • For global manufacturers, the council welcomes the entry into the market of more HPV vaccine products; and encourages and applauds existing and new manufacturers in their commitments to increase vaccine supply to meet forecasted demand.
  • For scientists, the council notes the unfinished agenda beyond this recommendation. The science is still being generated to confirm the duration of protection beyond 10 years, and more studies are needed to fully understand the efficacy of a single dose in immunocompromised populations. We note the need to pair a single-dose schedule with continued investment in strong, integrated systems for the registration and long-term retention of vaccine records. Durability of protection currently looks strong, and we note that the modelling considered by WHO SAGE shows that more lives could be saved by reaching more girls now, with one dose.
  • The reduction in logistic complexity needed to deliver a single-dose schedule, combined with global commitments to ensure that vaccine supply meets demand, increase the likelihood that national immunization programs can meet the challenge of cervical cancer elimination targets.

As such, the CHIC HPV Council urges all national immunization programs, policy advisory bodies, and implementation partners to take the following key steps to support the new single-dose option, and ensure that we catch up, keep up, and move forward to reach as many girls as possible with HPV vaccines over the next eight years:

  1. Move quickly to review the evidence supporting a single-dose schedule and assess the country-level use case for reducing costs, extending reach, and facilitating further catch-up and routine immunization initiatives
  2. Give special attention to how the single-dose option may reduce logistical barriers in delivery strategies to reach out-of-school girls and to broaden the target age groups to allow catch-up for girls who missed out on HPV vaccination in the past
  3. Ensure the dissemination of this new information and the associated science behind the single-dose option for consideration by program leaders including those in immunization and education, national immunization technical advisory groups, professional societies, and other relevant immunization partners and experts
  4. Identify and act upon opportunities for immunization programs and technical partners to strengthen partnerships and create shared goals with community-based organizations to increase uptake of HPV vaccination
  5. Continue to invest in stronger school-age and adolescent primary health care platforms for provision of essential care, including HPV vaccination, and health education
  6. Continue to take a broad strategic approach to cervical cancer elimination, in line with global and national commitments to scaling up vaccination, screening, and treatment

CHIC is funded by the Bill & Melinda Gates Foundation through the International Vaccine Access Center with the CHIC HPV Council secretariat managed by Jhpiego. Council members participate in their personal capacity; their views do not represent positions of the agencies for which they work.

[1] World Health Organization. Immunization Strategic Advisory Group of Experts (SAGE).

[2] Barnabas RV, et al. Efficacy of Single-Dose Human Papillomavirus Vaccination among Young African Women. NEJM Evidence (2022): EVIDoa2100056.