PATH's Cervical Cancer Prevention Action Planner

HPV vaccination logistics

As they do for routine immunizations in an EPI program, managers must be sure that an adequate supply of vaccine and vaccination materials are on hand, storage facilities are adequate, sufficient numbers of health workers are available, and supplies and personnel can be transported to vaccination sites. While adding HPV vaccinations to a country program can increase workloads, it also provides the opportunity to assess and improve the overall vaccine delivery system, including the cold chain, the transport and supply system, and health center staffing. Such assessments should be used to ensure that health systems are strengthened and essential services are not disrupted during HPV vaccination sessions. The WHO Vaccine Introduction Guidelines and country EPI manuals are good sources of information on these topics.

Supply, storage, transport, and cold chain management

USAID’s Immunization Essentials has a chapter on calculating how much vaccine to order to meet demand and avoid wastage. PATH project countries found that single-dose vials resulted in low wastage, on the order of less than 1 percent. Because it is important to avoid running out of vaccine, managers can start with a projected wastage of 5 percent and then adjust subsequent requests based on their experience. Managers must also ensure adequate storage space for the vials. To assist with this, a Vaccine Volume Calculator is available from WHO.

Adequate space must be available for ancillary supplies such as syringes, waste collection materials, and ice packs for vaccine carriers for transport to vaccination sites. In order to avoid overloading the cold chain storage space at health facilities, health workers should request their vaccine supply close to the dates of vaccination so the vials will be stored for only a short period of time.

A good strategy for conserving resources is to arrange delivery of HPV vaccine to coincide with scheduled delivery of other vaccines from the national to the district level as well as from district to local health posts, provided that storage space is available. Funds must be available to transport supplies and health workers to immunization sites, since this may require hiring motorbikes, bicycles, or other vehicles and making sure that adequate staff are available.

HPV vaccines must be stored at +2 to +8 degrees Celsius and are very sensitive to temperatures below +2 degrees Celsius; once HPV vaccine freezes, it loses potency and should not be used. To determine whether vaccine has been frozen, see the WHO guide Immunization in Practice Module 3: The Cold Chain. This manual also illustrates how to store vaccine in refrigerators to avoid freezing.

The vaccination session

Because HPV vaccination programs may be held at schools rather than health centers, some aspects of logistics on and before vaccination days may differ from standard procedures. For example, managers may need to contact teachers or administrators for lists of eligible girls, schools will need to provide rooms for vaccinations, and the schedule must be confirmed with the school administration. The Uganda publication, Bridging Phase for the Delivery of Human Papillomavirus (HPV) Vaccine to Prevent Cervical Cancer: A Field Guide for Health Managers and Service Providers includes details on the roles and responsibilities of staff on immunization days. It also includes instructions on how to administer an HPV injection and on monitoring AEFIs.

The WHO publication Immunization in Practice Module 6: Holding an Immunization Session is a manual for administering routine immunizations that is also useful for HPV vaccinations, with information such as how to prepare a vaccine carrier and how to set up a room for immunizations.

Sample vaccination cards and registers are available from HPV vaccination programs in India, Uganda, and Vietnam. This resource also includes an example of an integrated register (i.e., a register with space for several types of vaccinations). A monitoring tool used in the four PATH country projects, HPV Vaccination Monitoring Tool, contains a comprehensive checklist for HPV vaccination activities.

In some cases, HPV vaccination may become part of an existing outreach program to schools or communities. While this can be an efficient mode of intervention, staff responsibilities will increase, so managers need to make sure that the workload remains reasonable. As mentioned earlier, existing programs may be underfunded, so additional funds may be needed for personnel and transport costs and should be included as part of the total cost of delivering HPV vaccine. The timing of the three HPV doses may not coincide exactly with existing outreach program visits to schools, so additional planning may be needed.

HPV vaccinations can impact routine activities at health centers, whether staff leave clinics to vaccinate at schools or girls travel to clinics for vaccination. During vaccination sessions in the PATH projects, staff were not always able to attend to their other activities but were usually able to continue emergency services. To address these challenges, on immunization days, centers can mobilize additional staff from district or provincial offices or from civil society organizations. According to staff, the impact was minor, since HPV vaccination sessions were typically held just three times during the year.

When managers are planning the schedule for the three doses of vaccine, they will need to check current vaccine manufacturer recommendations, as requirements for the time between doses may change in the future.

Immunization safety

A safe injection is one that does not harm the recipient, does not expose the provider to any avoidable risks, and does not result in waste that is dangerous to the community. Unsafe injection practices can lead to transmission of bloodborne pathogens, with their associated burden of disease. For detailed information on all aspects of immunization safety, see the WHO manuals Best Practices for Injections and Related Procedures Toolkit and Immunization in Practice Module 4: Ensuring Safe Injections.

HPV vaccines can be administered with autodisable syringes, a practice recommended for immunizations in general by WHO, the United Nations Children’s Fund (UNICEF), and UNFPA.

Waste management

Sharps waste can cause serious health and environmental problems, and leaving used syringes and needles in the open or on the ground puts the community at risk. Safe management of waste requires that injection equipment be discarded immediately after one use, so all used injection equipment should be placed in a safety box that is within arm’s reach for the vaccinator, immediately after use. The USAID guide Immunization Essentials presents information on waste management.

Photo: PATH/Robin Biellik

Transporting HPV vaccine on motorcycle

Additional resources

Print version: Implementing HPV Vaccination Programs (RHO Cervical Cancer website)

Watch videoHPV vaccination video and transcript

Case study: HPV vaccination in Africa

Case study: HPV vaccination in Latin America

Shaping Strategies to Introduce HPV Vaccines: Formative Research Results from India, Peru, Uganda, and Vietnam (RHO Cervical Cancer website)

Conducting Formative Research for HPV Vaccination Program Planning (RHO Cervical Cancer website)

Evaluating HPV Vaccination Pilots (RHO Cervical Cancer website)

HPV delivery strategies that achieved high coverage in low- and middle-income countries (PDF)

Vaccination (RHO Cervical Cancer website)

World Health Organization position paper on human papillomavirus vaccines (PDF)

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