Human papillomavirus vaccine delivery strategies that achieved high coverage in low- and middle-income countries

The global burden of cervical cancer is large and is increasing and it disproportionately affects low-resource countries.In 2008 there were approximately 529 000 new cases and over 270 000 deaths, of which nearly 85% occurred in developing countries,1 most often among women serving as caregivers and breadwinners in their communities. Cervical cancer prevention programmes in developed countries, which are based on regular Papanicolaou (Pap) smears and appropriate treatment of precancerous lesions, have succeeded in reducing disease incidence and mortality since the 1970s, but this expensive approach may prove difficult to implement and sustain in low-resource settings. However, the Expanded Programme on Immunization (EPI), which has helped to reduce infectious disease rates and infant and child mortality throughout the world, provides a tested and effective infrastructure that could be used to prevent cervical cancer by adding the human papillomavirus (HPV) vaccine to the schedule.