School-based HPV vax scheme a success in Singapore

An immunization program implemented in Singapore schools has achieved high coverage in vaccinating students against the human papillomavirus (HPV), reports a study.

“Strong partnerships with stakeholders and constant groundwork evaluation and adaptation are key factors for success, while peer influence may have had some positive impacts on uptake rates and should be studied in greater detail,” the researchers said. “This implementation model can be applied to future health prevention programs in the school-going age group.”

Study authors Karuppiah Vijayalakshmi and Anne Hui Yi Goei, both from the Youth Preventive Services, Health Promotion Board, Singapore, reviewed the newly implemented school-based HPV vaccination program and the factors that led to its success.

Beginning as a rollout dose in 2019, fully subsidized HPV vaccinations were offered to all secondary 1 female students on an opt-in basis. A one-time catchup vaccination was also recommended to secondary 2‒5 female students. Enrolment data provided by Ministry of Education schools were used to identify eligible participants.

Overall, 19,144 students across 139 schools were offered the rollout dose, while a total of 20,854 students across 140 schools were offered the catchup doses.

The introduction of this school-based program achieved high vaccine uptake rates of 80.6 percent to 87.3 percent, which translated to a vaccine coverage of 90.3 percent to 93.4 percent. Only a small proportion of the students did not take advantage of the program (1.5 percent to 1.9 percent per cohort). [Singapore Med J 2022;doi:10.11622/smedj.2022053]

A low rate of 1 in 1,000 side effects was reported. Among vaccinated students who experienced any side effect, those who received the second dose did so uneventfully.

“Prior to the school-based HPV immunization program, studies suggested that only 13.6 percent of women aged 18–26 years had been vaccinated, and from our field data, only 3.0 percent of the secondary 1 cohort and 6.2 percent of the secondary 4 and 5 cohorts had been vaccinated before the field visit,” the researchers said. [Sage Open 2014;4]

“The marked improvement in HPV vaccine coverage after introduction of the school-based programme could be attributed to various factors,” they added.

Involvement of stakeholders and partnerships with the Ministry of Education, the Singapore Cancer Society, the Islamic Religious Council of Singapore, healthcare vendors, the school and its operations manager ensured the smooth implementation of the vaccination program.

Inclusion of an HPV vaccination program in schools is not new. As early as 2007, Malaysia and Canada have implemented such scheme. Many countries offer it to grade 7 or 8 girls, while Canada and the UK include males in their vaccination program. [BMC Public Health 2018;18:1402; Vaccine 2017;35:5700-5707; Vaccine 2020;38:3149-3156]

“As the HPV vaccine takes root in the school-based immunization program, teenagers and their parents are likely to become more acquainted with it, and increased familiarity and acceptance can be expected,” Vijayalakshmi and Goei said.

“Further studies can be conducted to explore ideas and concerns regarding the HPV vaccine, and efforts to raise awareness and correct misconceptions regarding the vaccine should be expanded,” they added.