HPV

First kids in Kosovo vaccinated against HPV as part of routine roll-out

Campaign strategy, geared at inclusion of minority groups, combines vaccination in schools with door-to-door immunisation

27 February 2024
4 min read
by Kelly Warden
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<article> <h1> <span>First kids in Kosovo vaccinated against HPV as part of routine roll-out</span> </h1> <div><p>Campaign strategy, geared at inclusion of minority groups, combines vaccination in schools with door-to-door immunisation</p></div> <ul> <li> <b>27 February 2024</b> </li> <li> <b class="me-2">by</b> <span> <a href="https://www.gavi.org/vaccineswork/authors/kelly-warden" hreflang="en">Kelly Warden</a> </span> </li> </ul> <div> <div> <div> <div> <div> <p> </p><p>On February 20, a cohort of 12-year-olds queued up outside a classroom at Qamil Batalli school in Kosovo's capital, Pristina, waiting nervously to receive the first doses of the cancer-blocking human papillomavirus (HPV) vaccine to roll out as part of Kosovo's routine immunisation schedule.</p><h3>Preventable losses</h3><p>Kosovo is home to just 1.76 million people, but cervical cancer, which is overwhelmingly preventable, kills an estimated 70 women here each year, and is the third commonest cancer afflicting women under 45.</p><p>Those numbers could begin to take a turn this year, as the Ministry of Health works to reach about 12,000 adolescent girls with the HPV vaccine in 2024.</p><blockquote><h2>Door-to-door vaccination was critical to boost immunisation coverage in the war’s aftermath, and became a permanent part of Kosovo’s strategy to reach children in challenging contexts.</h2></blockquote><p>Most of those girls will, like the students at Qamil Batalli, be vaccinated at school. But in a bid to assure the inclusion of girls from the minority Roma, Ashkali and Egyptian communities who have less contact with health and education systems, health workers will also travel door-to-door.</p><h3>Levelling access</h3><p>"The children who are in the school that are Roma, Ashkali and Egyptian, they will be vaccinated in the school," explains Dr Edita Haxhiu, who is working in Pristina with the World Health Organization to help coordinate the launch campaign. "But some of the children don't go to school at all, and those children are hard to reach so we have mobile teams who go door by door." </p><p>Since the end of the Balkan war in 2000, poverty and social exclusion in these groups has <a href="https://minorityrights.org/communities/roma-ashkali-and-egyptians/">remained high</a>, making children especially vulnerable to falling through the cracks of public service provision, including both <a href="https://minorityrights.org/communities/roma-ashkali-and-egyptians/">education</a> and health. Girls from these groups face particularly constrained access to <a href="https://minorityrights.org/communities/roma-ashkali-and-egyptians/">schooling</a>.</p><div><h4>Have you read?</h4><ul><li><a href="https://www.gavi.org/vaccineswork/how-does-hpv-cause-cervical-cancer" hreflang="en">How does HPV cause cervical cancer?</a></li><li><a href="https://www.gavi.org/vaccineswork/vaccine-extremely-effective-no-cases-invasive-cervical-cancer-found-scottish-women" hreflang="en">“The vaccine is extremely effective”: no cases of invasive cervical cancer found in Scottish women vaccinated against HPV</a></li><li><a href="https://www.gavi.org/vaccineswork/we-need-go-viral-cameroonian-nurse-campaigning-against-hpv-linked-cancers" hreflang="en">“We need to go viral”: the Cameroonian nurse campaigning against cancer</a></li></ul></div><p>The tailoring of the HPV vaccine programme to reach girls from these communities is an extension of the Ministry of Health's decades-long commitment to close gaps in routine immunisation coverage over the past two decades.</p><p>Dr Haxhiu, who worked as Kosovo's EPI Manager before joining WHO, has worked on immunisation strengthening in Kosovo during more than one destabilising crisis – from the war of the late 1990s to the COVID-19 pandemic.</p><p>She says door-to-door vaccination was critical to boost immunisation coverage in the war's aftermath, and became a permanent part of Kosovo's strategy to reach children in challenging contexts. But the service was disrupted during the pandemic, as vaccination teams focused on COVID-19 vaccines, leading to a decrease in basic immunisation coverage within minority communities.</p><p>"The coverage among this population [decreased]... in the last survey in 2019, the coverage was around 30%," she says.</p><p>According to Dr Haxhiu, this was about 60 percentage points lower than the average immunisation rate of 90% at the time, but the Ministry of Health expects that these numbers have started to recover since the end of the pandemic.</p><p>"We don't have exact data, but we are in a completely different situation now, so it is much higher," Dr Haxhiu said.</p><h3>Gavi rolls out catalytic financing</h3><p>The introduction of the HPV vaccine was enabled by a relatively new stream of funding that Gavi now offers to middle-income countries and territories, helping open the door to recover routine immunisation rates and introduce new vaccines.</p><p>Via the mechanism, known as vaccine catalytic financing, Gavi helps finance the introduction of three high-impact vaccines, namely the rotavirus, HPV and PCV (pneumococcal conjugate vaccine) jabs, which are often just out of reach for some middle-income countries (MICs).</p><p>"The vaccine introductions of PVC, rota and HPV is actually lower in Gavi-eligible MICs in comparison to the Gavi core countries ," says Gavi's Senior Country Manager for Kosovo, Jan-Christopher Castilhos França.</p><p>By the beginning of 2024, 28 out of the 46 countries eligible for Gavi support under the Middle-Income Countries (MICs) Approach, were missing at least one of the PCV, HPV or rotavirus vaccine from their routine immunisation portfolios, he adds. Under vaccine catalytic financing, Gavi covers the costs of reaching 50% of the target population in the first year, he explains, "to give [countries] that extra nudge towards a successful, equitable and sustainable introduction".</p> </div> </div> </div> </div> </div> <p> <a target="_blank" rel="noopener noreferrer" href="https://www.gavi.org/vaccineswork/first-cohort-kosovan-kids-get-vaccinated-against-cancer-causing-hpv-part-routine">Original article</a> </p><p>This article was originally published on <a target="_blank" rel="noopener noreferrer" href="https://www.gavi.org/vaccineswork">VaccinesWork</a> </p><script>(function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start': new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0], j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src= 'https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f); })(window,document,'script','dataLayer','GTM-M7H54VD');</script><noscript><iframe src="https://www.googletagmanager.com/ns.html?id=GTM-M7H54VD" height="0" width="0" style="display:none;visibility:hidden"></iframe></noscript></article>

Qamil Batalli school became the first school to start vaccinating girls as part of the HPV vaccine introduction in Kosovo. Credit: Bukurije Seljimi, WHO office in Pristina

On February 20, a cohort of 12-year-olds queued up outside a classroom at Qamil Batalli school in Kosovo's capital, Pristina, waiting nervously to receive the first doses of the cancer-blocking human papillomavirus (HPV) vaccine to roll out as part of Kosovo's routine immunisation schedule.

Preventable losses

Kosovo is home to just 1.76 million people, but cervical cancer, which is overwhelmingly preventable, kills an estimated 70 women here each year, and is the third commonest cancer afflicting women under 45.

Those numbers could begin to take a turn this year, as the Ministry of Health works to reach about 12,000 adolescent girls with the HPV vaccine in 2024.

Door-to-door vaccination was critical to boost immunisation coverage in the war’s aftermath, and became a permanent part of Kosovo’s strategy to reach children in challenging contexts.

Most of those girls will, like the students at Qamil Batalli, be vaccinated at school. But in a bid to assure the inclusion of girls from the minority Roma, Ashkali and Egyptian communities who have less contact with health and education systems, health workers will also travel door-to-door.

Levelling access

"The children who are in the school that are Roma, Ashkali and Egyptian, they will be vaccinated in the school," explains Dr Edita Haxhiu, who is working in Pristina with the World Health Organization to help coordinate the launch campaign. "But some of the children don't go to school at all, and those children are hard to reach so we have mobile teams who go door by door."

Since the end of the Balkan war in 2000, poverty and social exclusion in these groups has remained high, making children especially vulnerable to falling through the cracks of public service provision, including both education and health. Girls from these groups face particularly constrained access to schooling.

Have you read?

The tailoring of the HPV vaccine programme to reach girls from these communities is an extension of the Ministry of Health's decades-long commitment to close gaps in routine immunisation coverage over the past two decades.

Dr Haxhiu, who worked as Kosovo's EPI Manager before joining WHO, has worked on immunisation strengthening in Kosovo during more than one destabilising crisis – from the war of the late 1990s to the COVID-19 pandemic.

She says door-to-door vaccination was critical to boost immunisation coverage in the war's aftermath, and became a permanent part of Kosovo's strategy to reach children in challenging contexts. But the service was disrupted during the pandemic, as vaccination teams focused on COVID-19 vaccines, leading to a decrease in basic immunisation coverage within minority communities.

"The coverage among this population [decreased]... in the last survey in 2019, the coverage was around 30%," she says.

According to Dr Haxhiu, this was about 60 percentage points lower than the average immunisation rate of 90% at the time, but the Ministry of Health expects that these numbers have started to recover since the end of the pandemic.

"We don't have exact data, but we are in a completely different situation now, so it is much higher," Dr Haxhiu said.

Gavi rolls out catalytic financing

The introduction of the HPV vaccine was enabled by a relatively new stream of funding that Gavi now offers to middle-income countries and territories, helping open the door to recover routine immunisation rates and introduce new vaccines.

Via the mechanism, known as vaccine catalytic financing, Gavi helps finance the introduction of three high-impact vaccines, namely the rotavirus, HPV and PCV (pneumococcal conjugate vaccine) jabs, which are often just out of reach for some middle-income countries (MICs).

"The vaccine introductions of PVC, rota and HPV is actually lower in Gavi-eligible MICs in comparison to the Gavi core countries ," says Gavi's Senior Country Manager for Kosovo, Jan-Christopher Castilhos França.

By the beginning of 2024, 28 out of the 46 countries eligible for Gavi support under the Middle-Income Countries (MICs) Approach, were missing at least one of the PCV, HPV or rotavirus vaccine from their routine immunisation portfolios, he adds. Under vaccine catalytic financing, Gavi covers the costs of reaching 50% of the target population in the first year, he explains, "to give [countries] that extra nudge towards a successful, equitable and sustainable introduction".