| Preparation |
Planning processes should include representatives from the ministries of health, education and finance. |
| National immunisation programme involvement is critical for effective vaccine delivery |
| Communications |
Social mobilisation in communities should begin early (at least one month before vaccination, earlier if possible). |
| Messages should focus on: cervical cancer prevention; safety and efficacy, including lack of fertility impact or long-term adverse effects, government endorsement, delivery timing and venues and the need to return for a second dose |
| Members of government or WHO representatives should issue responses to rumours as quickly as possible. |
| Consent processes should be consistent with existing routine EPI consent policy to avoid rumours. |
| Delivery |
In areas with variable school attendance, specific mobilisation of out-of-school girls and an opportunity for them to receive the vaccine should be provided. |
| If resources allow, planning a two-stage delivery of each dose can be successful in reaching those girls who initially refused vaccination. |
| Countries need to be aware that HIV infected girls require 3 doses and should develop specific strategies to offer them the 3-dose regimen. |
| Vaccination teams can include teachers and CHWs in order to decrease the number of qualified nurses needed for vaccine delivery sessions |
| Achievements |
Including a component of school-based delivery can yield high coverage, if resources allow. If school enrolment is low, a mixture of strategies could be important in order to attain good coverage. |
| More evaluation of health facility only strategies is needed. |
| An opportunity for girls who missed doses to receive the vaccine should be supplied, either at return visits to schools or referral to health facility or outreach sites, depending on the resources available. |
| Sustainability |
More research should be conducted on scale-up experiences. |
| Where feasible (e.g. in terms of funding and country experience with introducing vaccines), consider phased national implementation rather than demonstration projects |
| Further exploration of sustainable funding options should be conducted and disseminated, to encourage countries to scale-up demonstration projects |
| Integration |
Rigorous evaluation of combined interventions with HPV vaccine delivery is needed to assess the effect on implementation, coverage, workload and cost. Funding agencies should systematically encourage this. |
| Gradual integration of processes into routine processes should be planned and formalised after the first round of vaccination is completed. |
| Opportunities to initiate or strengthen existing school health programmes and/or pre-adolescent/adolescent health should be seized through on-going collaboration with partners (e.g. MOE, reproductive health departments). |
