South Africa's Health Department is transitioning from a two-dose to a single-dose HPV vaccination regimen, with girls in private schools set to receive government-funded jabs. The country's HPV vaccination campaign began in 2014, targeting girls and women aged 10 to 20. The vaccine has been given to Grade 5s who are 10 turning 11 since 2020, and before this, it was offered to Grade 4s. The South African government now aims to increase HPV vaccination coverage to 90% as part of global efforts spearheaded by the WHO to eliminate cervical cancer by 2030.
The HPV vaccine procured by the government and provided through the national HPV vaccination campaign is GlaxoSmithKline’s Cervarix. The vaccine, which contains two doses per vial, costs the government R394 per vial, or R197 per dose. When procured through the private sector, it costs R964 for a single-dose formulation, excluding dispensing fees.
From 2014 to 2023, the HPV vaccination campaign ran twice a year in public schools across the country. During the first campaign cycle, eligible girls were offered their first dose of the vaccine against HPV. During the second campaign cycle, typically between September and November, girls were offered the second dose. However, as of this year, girls who received their first dose during February or March will not be offered a second dose later in the year. Instead, the second round of the campaign, scheduled to run from 1 October to 15 November, will be used to offer catch-up doses to girls who were not vaccinated in previous campaigns and to provide HPV vaccination in private and independent schools.
This is the first year that government-procured HPV vaccines will be provided through private and independent schools. According to Bamford, reaching girls in private and independent schools is essential to eliminating cervical cancer in South Africa. The departments of Health and Basic Education are currently engaging with private-sector schools to prepare for this campaign.
There are concerns that vaccine hesitancy may be more widespread in private schools, which may pose a challenge to eliminating cervical cancer in the country. While the move from a two-dose to a single-dose vaccine regimen will save costs and simplify logistics for the government, it is also backed by strong scientific evidence.
The WHO Strategic Advisory Group of Experts on Immunization concluded in 2022 that a single-dose provides solid protection against HPV that is comparable to two- or three-dose regimens. A randomised controlled trial in Kenya demonstrated the effectiveness of single-dose regimens in preventing HPV infections in an 18-month study, while observational studies in India and Costa Rica have demonstrated that single-dose regimens work as well as multidose ones in preventing HPV infections 10 years after vaccination.
Professor Lynette Denny, a leading cervical cancer expert at the University of Cape Town, told Spotlight last month that while more evidence is needed on the effectiveness of single-dose HPV vaccination in preventing HPV infection in HIV-positive women, there is already evidence that girls with HIV generate protective antibodies against HPV following a single dose.
