Key decision-making factors for human papillomavirus (HPV) vaccine program introduction in low-and-middle-income-countries: Global and national stakeholder perspectives

Figures & data

Table 1. Global stakeholder categories.

Partner Category	Country	Expertise
Academic Partners (n = 7)
	South Africa	Vaccinology
	South Africa	Vaccinology
	Kenya	Obstetrics and gynecology
	UK *	Vaccinology
	UK*	Economics and health systems
	Zambia	Health policy
	Nigeria	Immunology
Partner Category	Region	Expertise
Global Immunization Partners (n = 6)
WHO	AFR, EUR	Vaccine preventable diseases
UNICEF	AFR	Health policy
GAVI	AFR	Health policy
BMGF	AFR	Health policy
IARC	AFR, EUR, AMR	Obstetrics and gynecology
PATH	AFR, SEAR, WPR	Immunization programming

Expertise of the global-level stakeholders interviewed for the study *Researchers based in the UK had ongoing or past programs of HPV vaccine related research in Rwanda and India.

Table 2. National stakeholder categories.

In-country stakeholders	Country	Expertise
National-level stakeholders (n = 10)
	Cote d’Ivoire	National Immunization program and economics
	Ethiopia	National Immunization program and public health
	Kenya	National Immunization program
	Lao PDR	National Immunization program
	Rwanda	National Immunization program
	Zambia	National Immunization program
	Zimbabwe	Health promotion and policy
NGOs representatives (n = 8)
	Cote d’Ivoire	National Immunization program
	East Africa Regional Representative	National Immunization and public health
	Kenya	Gynecology
	Lao People’s Democratic Republic	National Immunization program
	Zambia	National Immunization program
	Zimbabwe	National Immunization program

Expertise of the national-level stakeholders interviewed for the study.

Table 3. Challenges and recommendations in decision-making.

Themes	Challenges at the national level	Challenges at the global level	Actions
Decision-making process	Conflict on program placement at the national level creating competition on resources, resentment among stakeholders which leads to delay in decision-making process; EPI must obtain signoffs from multiple departments with this process varying from country-to-country;	Technical support for completion of Gavi application	Defining a clear pathway for decision-making process
Coordination among stakeholders	Difficulty in engaging different stakeholders due to time and workforce limitation at the national level	Difficulties in reaching a consensus from all stakeholders involved in the decision-making process; Lack of involvement of academic stakeholders and health care providers in decision-making	Explicit framework on engaging stakeholders and defining TORs Global partner support could be helpful
Transparent and participatory process/locally driven processes	Lack of clear framework on national stakeholders’ role	Discordance and lack of clarity on the specific partners to provide technical support; Global priorities and agendas that may not be in-line with country priorities	Defining roles among national partners to ensure ownership among stakeholders Dialogue between global and national stakeholders to ensure priorities correspond; Price transparency; Making vaccine data public within countries
Data for decision-making process	Lack of local data on disease burden delaying the decision making process at certain instances Lack of population data (i.e., number of girls eligible for vaccination) Lack of data available on serotype prevalence often required to support vaccine choice Inadequate human resource to capture data	Lack of costing data	Strengthening of data monitoring systems; Developing initiatives in collaboration with academic stakeholders to collect costing and population? data
Infrastructure and resource consideration		NITAGs are relatively weak which necessitates capacity support from global immunization partners; Resource mobilization; Support for countries that are not Gavi eligible	Heightening capacity support for NITAGs; considerations of financing programs for non-GAVI eligible LMICs

Figure 1. Global and national decision-making processes for HPV vaccine programs.

Data availability statement

Data were collected from participants with an agreement that their names and organizations’ names would not be shared publicly. Therefore, the data will be shared anonymously upon a reasonable request.