Thursday, January 25, 2024

Remarks from Chief of Child Health and Immunization, Dr. Pavani Ram, at the White House Cervical Cancer Forum

In support of the Biden Cancer Moonshot’s commitment to reduce the impact of preventable cancers and improve support and outcomes for people and families facing a cancer diagnosis, this forum convened leaders to:

  • Align on the greatest challenges domestically and globally that, if addressed, will increase access to cervical cancer prevention and control services.
  • Share progress on work being undertaken to learn from one another about ongoing efforts and explore ways to accelerate these efforts.
  • Generate actions that can be announced publicly and strategies that will spur action to reduce the global impact of cervical cancer.

Dr. Heather White: I'm going to turn it over to you, Dr. Pavani Ram. It's a pleasure to have you here from USAID, Chief of Child Health and Immunization. Thinking about your work with respect to not only the HPV vaccine that USAID is pushing forward, but also how do you contextualize that within some of these larger global initiatives? For example Gavi's commitment to revitalize HPV vaccine? Would love to hear about your work.

Dr. Pavani Ram: Thank you so much, Heather. Really it's such an honor to be here. I'm so moved  by all of what we've heard so far today. I got into global health work because when a woman dies, it devastates a family, but when a woman dies it devastates a community, too, and that is our key driver of our work at USAID–that need to ensure that there is equity. It's unconscionable that women are dying from preventable deaths from vaccines that are highly, highly effective and yet are not accessible yet.

With that, I would say that  we are working incredibly closely across a range of partners to try to support progress on the HPV vaccination. It's great to carry the flag of immunization as a key anti-cancer tool, and I'm just so thrilled to be able to do that. At the end of 2022, it was only about 21% of women globally that had coverage with a single dose of HPV vaccine–that's a long ways away from the 2030 target of 90 percent-plus that we need to be at in order to achieve cervical cancer elimination goals. 

Gavi, the Gavi Alliance, the Global Alliance for Vaccines and Immunologicals, is what it used to be called–but many of us are partners in the room of the Gavi Alliance and we identified that many, many countries had put aside their plans to introduce the HPV vaccine over the course of the Covid-19 pandemic because public health systems were so stretched, and yet we realized we've got to get there, we've got to make progress, and so the alliance has established an incredibly ambitious goal of reaching 86 million girls with the HPV vaccine by the end of 2025. To do that, we've got to work really, really hard and there are a number of challenges. One is countries have to get committed to introducing the vaccine, and Gavi’s got to be able to support them to do that. That commitment for both the introduction and the scale-up, and reaching girls where they are, is really critical.

At USAID, we're also working on our bilateral investments, meaning we work directly with countries to complement what Gavi is going to do both by supporting country immunization systems to be ready to introduce those vaccines, to getting the financing in place to make sure that very mundane things like technical working groups actually meet, work, look at their data, and look at how they're going to make progress. I think what I would say is that we're doing that kind of work in Nigeria as an example, but some of the challenges that we're going to need to address are that many, many girls are not in school, which is often where we're going to reach girls in that 9-plus age group. While immunization programs in the countries that we support have largely been effective, I mean it's a game changer for public health, of course, we're very good at reaching, for the most part, young children. We're not as great at reaching children in that 9-plus age group that should be getting the HPV vaccine. Massive challenge.

We also have a challenge with girls who are in that age group who are out of school, right? We need to reach them and of course, for an agency like USAID, we worry a great deal about girls who live in humanitarian settings, complex emergencies, fragile and conflict affected settings–how are we going to reach those girls? They deserve just as much opportunity to be protected from the devastation of HPV and cervical cancer.  I think those are some of the challenges that we're grappling with as we look ahead and work ambitiously to meet that 86 million girl target for the HPV vaccine. 

Dr. Heather White: I know as many folks have said in the room earlier today, “no one entity can do it alone,” right? And so how do you leverage your partnerships effectively? How do you bring the right people, to the right table, at the right time to start to build and capitalize on momentum behind a call like Gavi's ambitious call for 2025? Would you like to talk a little bit about leadership and where you see folks really stepping up to bring this to the fore?

Dr. Pavani Ram: In the pandemic there was a phrase, “shots in arms,” that people used all the time which I hated, actually, because it sort of took away the people part of that. What I would say is that vaccination is a partnership first and foremost between a mother, a family, a child, and a health worker at every level of the health system. We've got to kind of start there, right? We have to work with families to instill confidence in the HPV vaccine as a critical health tool. Removing stigma is a key part of that for sure, but this is a key health tool. Working with families directly to instill confidence in that vaccine. To promote demand for that vaccine across all layers of the health system, including governments, which need to see there is not only a health benefit here, there's also a human capital benefit here, and there is an economic benefit here, from a critical tool like the HPV vaccine. At every level, instilling confidence and demand for [the HPV vaccine] but then also understanding the drivers of a lack of demand, a lack of confidence, or miss and disinformation around vaccines which we have seen of course emerge across a range of what we call antigens in immunization. Really critical to address that at all levels. 

I think that's one piece around confidence and demand. The other is, and we heard earlier from Dr. Dokubo and from Hannah about the go further partnership, but also the dreams initiative of PEPFAR which really identifies and works with those girls that are particularly at high risk. That is a very unique opportunity for us to dive in deep and say, “how do we reach those girls who might not otherwise be reached by the HPV vaccine if we're going through traditional channels?” Maybe also to say that in our work on the global health side of things at USAID, we're really trying to think about how to reach girls and all children with critical immunization tools that are in those humanitarian and conflict affected settings. I think we have a long way to go. 

Leadership is paramount here as we can see by what has happened since–I remember being here at the White House back in, I think August of 2022, when there was the sort of first global forum of the cancer moonshot to now, it is incredible what this effort has done and that is clearly the leadership of the Cancer Moonshot team, but also of the voices of President Biden and Dr. Jill Biden. We have been so grateful for Dr. Biden's leadership in this area as well as that of the organization of African First Ladies to speak out about how their voices can be instrumental in driving change in communities and in instilling confidence so that we can move the needle on preventing cancer, including cervical cancer.  

We're just really, really impressed with that and I want to just share this last bit which is around a key milestone moment that's going to come up around partnership which is in March. Gavi, the Bill and Melinda Gates Foundation,  and a range of other partners together with USAID are going to be hosting a Cervical Cancer Elimination Forum in Cartagena, Colombia. This is really being spearheaded by the governments of Colombia and Spain and we're so grateful to partner with them on that event because I think it's going to be a moment for implementing countries to commit to reaching their girls with HPV vaccination,  and supporting women to screen and get early diagnosis and treatment. We're just really looking forward to that as the next key Milestone after this one. So very very grateful to be here with you, thank you!

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