A Review of the Implementation Status of and National Plans on HPV Vaccination in 17 Middle-Income Countries of the WHO Western Pacific Region

The World Health Organization’s Western Pacific Region is responsible for one-fourth of the global cervical cancer burden, and nearly 90% of that burden is concentrated in middle-income countries (MICs). Applying a conceptual model of implementation of population-based interventions, we synthesized the current implementation status of human papillomavirus (HPV) vaccination and national plans that form the basis of its implementation in 17 MICs. We gathered information from a range of governmental documents, published studies, and global databases. For all available national cancer-related plans and immunization plans, we examined the description of HPV vaccination. We found that, as of July 2021, only four countries (24%) had a mature HPV vaccination program with a high first-dose coverage; three (18%) had introduced HPV vaccination, but needed further efforts to scale it up, seven (41%) had not been able to introduce it after conducting demonstration projects, and three (18%) did not have any experience in HPV vaccination. In the national plans, most of the countries recognized the importance of HPV vaccination, but only 10 (59%) provided an implementation strategy on how it would be introduced or scaled up. Countries with a mature program were more likely to have their implementation strategy detailed in their national cancer control plan. Successful implementation of HPV vaccination requires overcoming known challenges and having a clear national plan. Positioning HPV vaccination clearly in the overall national cancer control plan may be key to accelerating its nationwide implementation.

Creation and development of the National Cancer Control Plan in Russia.

10524 Background: The absence of the National Cancer Control Plan (NCCP) did not allow to develop оncology in Russia. Methods: Since 2015 experts of the N.N. Blokhin Russian National Comprehancive Center and Russian Oncology Association has initiated the creation of a National Anti-Cancer Strategy. Results: In 2016, the working group presented the first version of this Strategy to the professional community for wide discussion, which was transferred to the Russian Ministry of Health after a broad discussion in 2017. This strategy included prevention, screening, early diagnosis, treatment, rehabilitation and palliative care in patients with malignant tumors. In parallel, we created National Clinical Cancer Guidelines, which were approved by the professional community, and then we submited them to the Ministry of Health in 2017. Also in the period of 2017-2018, updated principles of creating clinical and statistical groups (CSG) were developed based on the calculation of the real costs of each type of surgery, radiation therapy and drug treatment. More than 1,000 different standards we established for each case of hospitalization and their cost has been calculated. Then, based on these calculations, we ranked four types of treatment (surgery, radiation therapy, chemotherapy and chemoradiation), each of which has 3, 5, 10 and 6 levels, respectively. These calculations formed the basis of the NCCP approved by the Government and the President starting from 2019 with an unprecedented additional level of funding of almost 1 trillion rubles (an increase of almost two times). The major goal of the Russian NCCP is to decrease mortality level from 202 to 185 (8,5%) per 100 000 population by the year of 2024. Conclusions: The еffort of the professional community with due consideration and consolidation with the Ministry of Health allows implementation of the NCCP on a national level.

Policy Report: Introducing an Effective National Cancer Control Plan in the Maldives

Background and context: There is no National Cancer Control Plan (NCCP) in the Maldives. The Health Plan has identified cancer as an area with a need for development of separate policy, strategy paper while it is also reflected in the Multi-Stakeholder Action Plan for NCDs. Aim: The main aim of the project is to produce a policy report to guide the development of an effective National Cancer Control Plan (NCCP) in the Maldives. The objectives are to estimate the total period prevalence of cancer in the Maldives (2013-2014); to understand the views of key stakeholders; and synthesize this to develop a policy report and applying the “Cancer Control, Knowledge into Action: WHO Guide for Effective Programmes - in Low and Middle Income Countries”, to the Maldives context to identify priority components in light of the prevalence estimates and views of the key stakeholders. Strategy/Tactics: The policy report will bring together the findings from secondary analysis of quantitative data, analysis of key informant in-depth interviews from stakeholders, using the framework analysis method for qualitative data analysis and applying the “WHO Guide for Effective Programmes - in Low and Middle Income Countries”, to the Maldives context and identify priority components in light of the prevalence estimates and views of the key stakeholders. Outcomes: Among a population of 344,023 people, the estimated total period prevalence for all cancers in the period of 2013-2014 in Maldives is 0.92% (920 cases per 100,000 population). The estimated prevalence is 0.84% for males and 1.01% for females. Oral cancers (including lip, tongue, gum, mouth, and palate) is the most common cancer, followed by eye, breast (with carcinoma in situ), sinuses, skin (melanoma and skin cancers and carcinoma in situ). How common eye cancers and sinus cancers could be reflected as an anomaly in the data as these are uncommon when regional prevalences are compared or is an area where further research is warranted. Thyroid, prostate, lymphomas, leukemias and lung cancers are among the top 10 cancers. The key informant interviews, revealed that there are very limited services available for cancer prevention, diagnosis, treatment and care. What was learned: It is evident that there is a substantial amount of work to be done with regard to cancer control in the Maldives. The high prevalence of cancer and the views of the respondents from the study emphasizes the need for developing a National Cancer Control Plan (NCCP) as an initial step toward comprehensive cancer control efforts in the Maldives. A comprehensive cancer prevention strategy with early detection-early diagnosis and screening should be a priority component for the NCCP, with improvement of diagnosis and treatment services and establishment of a comprehensive palliative and psychosocial care program across the cancer care continuum. This policy report will provide guidance to development of an NCCP with priorities identified.

Developing a National Cancer Control Plan Through Effective Partnerships: A Case of Kenya National Cancer Control Strategy 2017-2022

Background and context: A National Cancer Control Strategy (NCCS) provides a strategic framework that guides the systematic approach toward cancer prevention and control based on the existing cancer burden, risk factor prevalence and available resources. Though Kenya developed her first Kenya National Cancer Control Strategy in 2011, its implementation was characterized with various shortcomings. Aim: The Kenyan Ministry of Health set out to develop the second edition of the National Cancer Control Strategy with a focus on greater partnerships, evidence-based interventions and shared accountability of roles informed by lessons learnt from the NCCS 2011-2016. Strategy/Tactics: The Head of the National Cancer Control Program at the Ministry of Health was identified as the National Coordinator to lead the process and keep each stakeholder on track. A clear road map for developing the strategic plan was drawn with specific timelines. The process was further aligned to the Ministry of Health performance contracting system, a mechanism under the Government's public sector reforms aimed at improving performance. Program/Policy process: The Ministry hosted an integrated mission of Program for Action on Cancer Therapy (imPACT) coordinated by the International Atomic Energy Agency in August 2016 that reviewed the implementation of the NCCS 2011-2016. Following submission of the final imPACT report to the Ministry in November 2016, a steering committee led by the National Coordinator was established in December 2016. An initial one-day stakeholder meeting held in January 2017 developed consensus on the general outline of the document. Two multistakeholder retreats were held between March and April to develop the content for the strategy with an intervening review meeting to further refine the draft which was submitted to a set of 3 external reviewers. A final stakeholder validation meeting was held in May 2017 followed by proofreading and printing of the document. The process culminated with a national launch of the second National Cancer Control Strategy held in July 2017. Outcomes: A National Cancer Control Plan covering the entire continuum of care with interventions around 5 key pillars: prevention, screening and early detection; diagnosis and registration; treatment, palliative care and survivorship; coordination, partnerships and financing; monitoring, evaluation and research. The document was developed and launched in a record 6 months and contains an elaborate implementation matrix with clear indicators. What was learned: It is important to identify a focal person to steer the NCCS development process guided by a clear road map with specific timelines. A well-coordinated multisectoral partnership is crucial to developing such a comprehensive document.