eprintid: 10136002 rev_number: 16 eprint_status: archive userid: 608 dir: disk0/10/13/60/02 datestamp: 2021-10-08 12:17:05 lastmod: 2021-12-03 23:16:15 status_changed: 2021-10-08 12:17:05 type: article metadata_visibility: show creators_name: Spayne, J creators_name: Hesketh, T title: Estimate of global human papillomavirus vaccination coverage: analysis of country-level indicators ispublished: pub divisions: UCL divisions: B02 divisions: D01 note: This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/. abstract: BACKGROUND: Mortality rates from cervical cancer demonstrate deep inequality in health between richer and poorer populations. Over 310 000 women died of this preventable disease in 2018, mostly in low-income and middle-income countries (LMICs) where screening and treatment are beyond the capacity of health systems. Immunisation against human papillomavirus (HPV) offers a primary prevention strategy, but rates of vaccination uptake are unclear. Understanding coverage levels and factors affecting uptake can inform immunisation strategies. OBJECTIVES: The aim of this study is to evaluate the status of HPV vaccination coverage from nationally reported indicators and to estimate global coverage in a single year cohort of vaccine-eligible girls. DESIGN: This study provides quantitative population-level estimates of important global health indicators. Using data from the Global Cancer Observatory and WHO/UNICEF, incidence of and mortality from cervical cancer and HPV vaccination coverage are described for countries, categorised by income group. Characteristics of LMICs achieving high coverage are explored using selected development indicators from World Bank sources. Global HPV immunisation coverage is calculated and its impact on cervical cancer mortality estimated. RESULTS: Incidence and mortality for cervical cancer correlate with poverty. Whilst all WHO member states report high infant measles vaccination rates, fewer than half report on HPV vaccination. Even amongst high-income countries, coverage varies widely. In upper-middle-income countries, there is a trend for higher coverage with increased health spending per capita. Four LMICs report good coverage levels, all associated with external funding. Global HPV immunisation coverage for 2018 is estimated at 12.2%. Of the global cohort of 61 million 15-year-old girls in 2018, 7000 are likely to die from cervical cancer, almost all in LMICs. CONCLUSIONS: Countries in all income groups must devise strategies to achieve and maintain higher levels of HPV immunisation. For all but the richest, affordability remains a barrier. date: 2021-09 date_type: published official_url: https://bmjopen.bmj.com/content/11/9/e052016 oa_status: green full_text_type: pub pmcid: PMC8413939 language: eng primo: open primo_central: open_green verified: verified_manual elements_id: 1889310 doi: 10.1136/bmjopen-2021-052016 pii: bmjopen-2021-052016 lyricists_name: Hesketh, Therese lyricists_id: THESK91 actors_name: Flynn, Bernadette actors_id: BFFLY94 actors_role: owner full_text_status: public publication: BMJ Open volume: 11 number: 9 article_number: e052016 event_location: England citation: Spayne, J; Hesketh, T; (2021) Estimate of global human papillomavirus vaccination coverage: analysis of country-level indicators. BMJ Open , 11 (9) , Article e052016. 10.1136/bmjopen-2021-052016 <https://doi.org/10.1136/bmjopen-2021-052016>. Green open access document_url: https://discovery.ucl.ac.uk/id/eprint/10136002/1/e052016.full.pdf