Improving the human papillomavirus vaccination in the Philippines

Dear Editor,

I came across an interesting article published in this journal concerning human papillomavirus (HPV) vaccination among adolescents and parents in the United Kingdom. The authors evaluated and reviewed 152 abstracts and 24 publications on the acceptability of these vaccines and identified some barriers that resulted in below pre-COVID levels. The barriers include challenges with obtaining consent for vaccination, perception of risks of vaccination, and sociodemographic factors. ¹ With these barriers, it dawned on me how different the scenario is in the Philippines regarding these barriers; despite the dangers posed by HPV, one of the main barriers to high uptake of HPV vaccination uptake is the issue of its affordability. I will focus on this specific barrier, which can also be evident in other developing countries, and present the latest intervention of the government to address the issue.

HPV is associated with anogenital cancer (including cervical, vaginal, vulvar, penile, and anal), oropharyngeal cancer, and genital warts. The HPV vaccination significantly reduces the incidence of anogenital cancer and genital warts. ² In the Philippines, the World Health Organization (WHO) reported 8549 new cases of cervical cancer cases in 2022 alone, with around 4319 deaths. It is the second leading cause of cancer in women in the country and the fourth leading cause of death among women. ³ The WHO reiterates that the primary target of vaccination is girls aged 9–14 before the start of sexual activity. The vaccination of secondary targets such as boys and older females is recommended where feasible and affordable. Unfortunately, as different barriers continue to affect a successful vaccination program, the vaccine’s high cost weighs significantly. In a study conducted on 435 adult women in the country, over half of the sample (54%) was accepting of HPV vaccination even at a low price, and only 30% and 31% were accepted at the moderate and high cost, respectively. ⁴ In a related study with 143 men as samples, 39% were accepting HPV vaccination at a low price, while 22%–26% were accepting it at moderate and high prices. ⁵ These results imply that HPV vaccine acceptance among Filipino men and women is contingent on affordable pricing. Currently, the country has a 60% HPV immunization rate, which is still low. ⁶

As of this writing, some vaccines, like Gardasil 4 and Gardasil 9, cost almost ₱ 4000 to ₱ 8000 per person, respectively. This high price is nearly equal to the 2-week salary of an ordinary employee. Instead of receiving the vaccine, the family’s breadwinner will allot their income to food. This is indeed one main reason why many Filipinos do not avail of the vaccine. Fortunately, in a recent intervention from the Department of Health (DOH), there will be free HPV immunization for Filipino girls after its funding is included in the 2025 national budget. As of January 6, over half a million Grade 4 students have already been given the first dose of the HPV vaccine through a school-based immunization program. ⁷ This is indeed a good move from the government. However, this will only cover a small portion of the total population involved. That is why a long-term plan is needed to procure free HPV vaccines for wider coverage. This problem can be addressed by regularly allocating sufficient funding, and with the help of donations from private companies, charitable institutions, and foreign aid.