Millions of girls in Africa will miss HPV vaccines

Nearly 1.5 million teenage girls in some of the world’s poorest countries will miss the chance to be protected from cervical cancer because drugmaker Merck has said it will not be able to deliver millions of promised doses of the HPV vaccine this year.

Merck has notified Gavi, the international organization that helps low- and middle- income countries deliver lifesaving immunizations, and UNICEF, which procures the vaccines, that it will deliver only 18.8 million of the 29.6 million doses it was contracted to deliver in 2024, Gavi said.

That means that more than 10 million girls will not receive their expected Hpvshots this year— and 1.5 million of them most likely will never get them because they will be too old to qualify for the vaccine in subsequent years.

Patrick Ryan, a spokesperson for Merck, said the company “experienced a manufacturing disruption” that required it to hold and reinspect many doses by hand.

He declined to give further details about the cause of the delay.

“We are acting with urgency and rigor to deploy additional personnel and resources to resolve this matter as soon as possible,” he said.

Ryan said that Merck would deliver the delayed doses in 2025.

He also said the company would ship 30 million doses of the vaccine to Gavi- supported countries this year. However, about one- third of these are doses that were supposed to have been sent in 2023, leaving Gavi with the 10.7million- dose shortfall.

The delay is a big setback for countries that had waited years to begin vaccinating girls against HPV, the human papillomavirus, which causes an estimated 90% of cervical cancers.

About 350,000 women die from cervical cancer annually, according to the World Health Organization. Ninety percent of them are in low- income countries, where routine screening for the disease is rare.

The vaccine offers neartotal protection against HPV infection, making it the lone vaccine against cancer.

“HPV is the highest impact vaccine Gavi has: If you vaccinate 1,000 girls, you prevent 17.4 future deaths,” said Dr. Aurélia Nguyen, Gavi’s chief program officer. “If there is one vaccine that you want to get out and do well on, this is it.”

The WHO recommends the vaccine for girls up to age 14. The delay means that girls in countries including Sierra Leone, Burkina Faso and Mozambique who are now 14 will no longer be eligible for vaccination when these campaigns finally start.

The HPV vaccine is a complex one to deliver, because it is associated with sexual activity, a taboo topic for teenagers in many of the cultures affected by the delay, and because it is given to children who are outside the usual age for routine immunization.

Girls and their parents must be amenable to vaccination, and that requires crafting distinctmessages, delivered on different media, to drum up demand. The vaccine has to be given before girls are sexually active to be effective.

The countries affected have some of the lowestresource health systems in the world, Nguyen said. They have invested in planning for the scrapped HPV campaign, while juggling other urgent vaccination needs such as measles or cholera, and can illafford the disruption, she said.

The delay will disrupt carefully laid plans to catch up on vaccinations — most of the delayed doses were bound for what’s called “multiage cohorts,” when countries try to reach all unvaccinated girls between 9 and 14, alongside a standard immunization program for 9- year- olds, usually run in schools.

Most high- income countries routinely vaccinate girls and boys against HPV, but the global coverage rate for the vaccine is only 20%.

Gavi has been trying to expand HPV vaccination for more than a decade. Many low- income countries had designed programs to begin in 2018, but Gavi could not get shots then either because it and UNICEF were competing with a global market and suppliers did not increase production to meet Gavi’s predicted demand.