Cost of Introducing Human Papillomavirus Vaccination into Nigeria’s
Expanded Program on Immunization: Lessons from Two Nigerian States
Abstract
Introduction: Cervical cancer is the second highest cause of
cancer-related deaths in women in Nigeria. Human papillomavirus (HPV)
infection, particularly types 16 and 18, causes 95% of this burden. In
2023, Nigeria first incorporated the HPV vaccine into its Expanded
Program on Immunization. While the federal and state governments led the
program, community and partners quickly addressed gaps. This study
estimated the financial costs of HPV vaccine introduction in Nigeria,
examining Bayelsa (southern) and Taraba (northern) states. Methods: The
study employed a mixed-methods approach, combining quantitative (days
worked and doses administered) and qualitative (stakeholders’ insights)
data. Results: The two states achieved high coverage (Bayelsa, 74%;
Taraba, 78%), close to the ambitious 80% national target. The total
financial cost per fully vaccinated girl was also similar, at $6.04
(Bayelsa) and $6.02 (Taraba). Antigen cost $4.99 (82.6% to 83.0%)
per girl and operations cost $1.05 (17.4%) and $1.03 (17.0%) in the
respective states. Transportation, logistics and data tool costs were
the largest proportion of the operational cost (Bayelsa, 38.1%; 39.0%,
Taraba). Service delivery (Bayelsa, 22.2%; Taraba, 22.4%), and the
advocacy, communication, and social mobilization activities (ACSM) costs
(Bayelsa, 20.0%; Taraba, 20.5%) also represented notable operational
cost drivers. Vaccine procurement costs substantially exceeded
operational costs in both states. Discussion: The states’ initial
intensive campaign strategy with community and partners’ continual
collaboration in planning and implementation proved effective in quickly
achieving high coverage. These states’ success in introducing HPV
vaccine through a campaign strategy can serve as a useful model for
other countries.