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Questions and Answers
1. What were the difficulties encountered during the Uganda demonstration project?
A participant asked the Uganda HPV vaccine team to discuss more of the problems they found with
implementing vaccinations, in addition to the successes. Dr. Bamwine mentioned the difficulty of
following up with girls who change schools or drop out of school. Further, some girls did not get dose 1
of the vaccine when the project began: they waited to see if there were side effects in those who got
vaccinated. Then they came to the session for dose 2, but they needed dose 1. Their dose 2 would be
needed one month later, but vaccinators would not be at the school for five months, when dose 3 was
needed for the first group. Another problem was that girls might not retain vaccination cards, or might
forget to bring them to school for doses 2 and 3.
Dr. Ssekitto reiterated the problem of age determination that was discussed for the CDP vaccination
strategy.
Dr. Seruyange related that Uganda had done a cold chain inventory just prior to the initiation of the HPV
vaccine project, so UNEPI knew where the problems were and was able to fix them. She recommended
that anyone starting an HPV vaccination program do a cold chain assessment first. Dr. Seruyange also
commented on the variability in quality of training: not all trainers are equally good, and this will show
up in how health workers perform their tasks. Microplanning also depends on the efforts that people
put into it, and this causes variations in quality of the program. Another difficulty is finding the target
population if census data are old. New schools may even have been established since the last census,
and program managers must be sure their information is up to date.
Dr. Jumaan commented on the cost analyses for the project. She noted, “We know that the price of the
vaccines is coming down rapidly and eventually may reach as low as $0.50 for three doses, for the
country co-payment, once GAVI is able to support HPV vaccinations. Uganda is a GAVI-eligible country,
and we are waiting to see what support GAVI will be able to contribute, with its current economic
problems."
Dr. Jumaan also responded to a question about the difference between the vaccine coverage found in
the routine administrative data versus that found by the coverage survey. As noted in the presentations,
this was a result of the difficulty of determining ages for the target population. However, in spite of the
fact that the coverage of 10-year-old girls was around 60 percent (coverage survey) quite a number of
girls outside this age group were vaccinated, because they were estimated to be 10 years of age at
school but families later reported that they were not the target age. This means that these girls are now
vaccinated and are protected, just as the 10-year-olds are, so the community did receive this benefit.
Dr. Katahoire commented that one reason cultural factors did not prevent families from agreeing to the
vaccination program was that the initial formative research helped the team build appropriate messages
into the IEC materials. She emphasized the point that if people are well-informed, acceptability goes up.
Their fears must be addressed, not avoided.
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