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Goal 4: Promote Global HPV Vaccine Uptake

Objective 4.1: The United States should continue its collaboration with and support of GAVI to facilitate HPV vaccine introduction and uptake in low-income countries.

Numerous countries and organizations, including the United States, support GAVI. In 2013, direct support for GAVI from the U.S. government totaled $145 million in donations and pledges.[1] This investment in global HPV-associated cancer control via funding of GAVI is appropriate. Additional support should be provided as necessary and appropriate to scale up implementation of HPV vaccination programs. Implementation science principles should be brought to bear in this process (e.g., paying close attention to processes of implementation to understand what works and what does not work). Best practices should be shared.

Some middle-income countries are not eligible for GAVI funding, yet have a great need for assistance to develop and implement national vaccine programs. Other mechanisms will be required to help these nations bring HPV-associated cancer prevention to their populations.

Objective 4.2: The United States should continue to support global efforts to develop comprehensive cancer control plans and cancer registries in low- and middle-income countries.

Limited public health and healthcare infrastructure creates challenges for implementing HPV vaccination programs in many LMICs. The World Health Organization (WHO) plays a central role in promoting public health in LMICs. The United States partners with WHO on many key initiatives and also independently supports capacity building in several LMICs.

U.S. government agencies have provided extensive support to WHO efforts to increase HPV vaccination around the world. CDC and NCI have provided technical expertise to support WHO in developing policies and recommendations related to HPV vaccination since 2006. CDC participated in creating WHO position papers and provided assistance and guidance to WHO and countries with vaccine introduction, communications, monitoring, and evaluation. In addition, the CDC HPV laboratory worked with the WHO HPV LabNet to improve standardization of laboratory procedures. CDC also has secondees* focused on new vaccine introduction, including HPV vaccines, at WHO headquarters and other WHO offices. Activities conducted by CDC staff and secondees include providing technical assistance to countries for vaccine introduction, vaccine impact monitoring, postintroduction evaluations, and coverage surveys to evaluate vaccine programs.

In 2013, WHO released a Global Action Plan for Prevention and Control of Noncommunicable Diseases (NCDs) aimed at reducing mortality from several NCDs, including cancers. The WHO global monitoring framework includes several targets and indicators related to prevention and control of cancers. These include decreasing premature mortality due to cancer by 25 percent by 2025, improving HPV vaccine coverage, monitoring cancer incidence, and increasing the proportion of women who are screened for cervical cancer.[2] Increased attention to cancer on the global stage will provide opportunities for the United States to contribute to cancer prevention and control efforts, including those that facilitate HPV vaccination in the short or long term.

In light of the emerging focus on NCDs, the International Agency for Research on Cancer (IARC) recently launched the Global Initiative for Cancer Registry Development in Low- and Middle-Income Countries (GICR) to improve the capacity of these countries to produce high-quality information on the burden of cancer so that effective cancer control policies can be developed, implemented, and evaluated.[3] Many LMICs do not have population-based cancer registries, making it impossible to accurately determine rates of cervical and other HPV-associated cancers. Panel workshop participants suggested that the absence of information about the burden of HPV-associated cancers and the prevalence of HPV infections within LMICs may make some governments hesitant to invest in HPV vaccination programs.[4] NCI and CDC have joined a number of other organizations from around the world as partners in the GICR initiative and are contributing funding and serving in an advisory capacity.[5]

The United States also engages in global public health activities. For example, CDC supports training in field epidemiology in several LMICs, and NCI and CDC are creating modules related to cancer prevention and control.[6] The NCI Center for Global Health develops and implements plans to inform cancer control efforts and provides technical assistance as countries work to implement cancer control programs.[7] The U.S. Agency for International Development Global Health Initiative helps countries strengthen their health systems, integrate service delivery, and create awareness to generate demand for available services.[8,9] In addition, the U.S. government has partnered with several other organizations to create Pink Ribbon Red Ribbon®, an initiative focused on improving prevention, screening, and treatment for cervical and breast cancers in sub-Saharan Africa and Latin America.[10] This initiative is leveraging the existing platform of the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) to accomplish its goals, including increasing access to HPV vaccination.[11]

The U.S. should continue to work with global partners to facilitate access to and uptake of HPV vaccines. These efforts should include research and capacity-building efforts by CDC and NCI, including the recently created NCI Center for Global Health. In particular, the U.S. should help increase the capacity of LMICs to conduct surveillance and enact robust cancer control programs.


* A person transferred temporarily to alternative employment.

Noncommunicable diseases are diseases that are not passed from person to person. Although cancer can be caused by HPV or some other infectious agents that are passed from person to person, cancer itself does not spread this way and is thus considered an NCD.


  1. GAVI Alliance. Funding and finance: donor profiles: United States of America—proceeds to GAVI from donor contributions and pledges (2011-2015) as of 30 June 2013 [Internet]. Geneva (CH): GAVI Alliance; [cited 2013 Nov 25]. Available from:
  2. World Health Organization. NCD global monitoring framework [Internet]. Geneva (CH): WHO; [cited 2013 Sep 9]. Available from:
  3. International Agency for Research on Cancer. Global Initiative for Cancer Registry Development (GICR) [Internet]. Lyon (FR): IARC; [cited 2013 Aug 19]. Available from:
  4. President's Cancer Panel. Meeting summary. Global HPV vaccination: opportunities and challenges; 2013 Apr 23-24; Miami, FL. Available from:
  5. National Cancer Institute. NCI joins international initiative to develop global cancer registries [News Release]. Bethesda (MD): NCI; 2013 Jul 3 [cited 2013 Aug 19]. Available from:
  6. Centers for Disease Control and Prevention. A new dimension in training: field epidemiology for noncommunicable diseases [Internet]. Atlanta (GA): CDC; [updated 2011 Sep 16; cited 2013 Aug 19]. Available from:
  7. National Cancer Institute. NCI Center for Global Health [Internet]. Bethesda (MD): NCI; [cited 2013 Dec 3]. Available from:
  8. U.S. Global Health Initiative. Home page [Internet]. Washington (DC): U.S. GHI; [cited 2013 Dec 2]. Available from:
  9. Kates J, Michaud J. The US Global Health Initiative: where does it stand? Lancet. 2012;379(9830):1925-6. Available from:
  10. Pink Ribbon Red Ribbon. Home page [Internet]. Washington (DC): PRRR; [cited 2013 Sep 27]. Available from:
  11. Pink Ribbon Red Ribbon. 2012 annual report. Partnering for progress and purpose. Washington (DC): PRRR; 2013. Available from: