Home Journals Articles Updates About
CN
image
收藏切换
Strengthening human papillomavirus vaccination programs through multi-country peer learning: lessons from the CHIC initiative
收藏切换
PDF
Christopher Morgan1, Mary Carol Jennings1, Dur-e-Nayab Waheed2, Nicolas Theopold3, Anissa Sidibe1, Ana Bolio4, Elaine Charurat1, Felix Ricardo Burdier2, Emilie Karafillakis4, Shana Kagan1, Alex Vorsters2
Cancer Biology & Medicine | 2025, 22(9) : 997 - 1001
Less
收藏切换
Cancer Biology & Medicine | 2025, 22(9): 997-1001
• Perspective •
Strengthening human papillomavirus vaccination programs through multi-country peer learning: lessons from the CHIC initiative
Full
Christopher Morgan1, Mary Carol Jennings1, Dur-e-Nayab Waheed2, Nicolas Theopold3, Anissa Sidibe1, Ana Bolio4, Elaine Charurat1, Felix Ricardo Burdier2, Emilie Karafillakis4, Shana Kagan1, Alex Vorsters2
Affiliations
  • 1Jhpiego, Baltimore, MD 21231, USA
  • 2Centre for Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp 2000, Belgium
  • 3Gates Foundation, Seattle, WA 98102, USA
  • 4London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK
About Author:

Author contributions

Christopher Morgan: Writing—review & editing, Writing—original draft, Supervision, Methods, Investigation, Formal analysis, Data curation, Conceptualization, Funding acquisition. Mary Carol Jennings: Writing—review & editing, Visualization, Methods, Investigation, Formal analysis, Data curation, Funding acquisition. Dur-e-Nayab Waheed: Writing—review & editing, Supervision, Methods, Investigation, Data curation, Validation. Nicolas Theopold: Writing—review & editing, Validation. Anissa Sidibe: Writing—review & editing, Investigation, Formal analysis, Validation. Ana Bolio: Writing—review & editing, Investigation, Formal analysis, Data curation. Elaine Charurat: Writing—review & editing, Supervision, Methods, Data curation, Conceptualization. Felix Ricardo Burdier: Writing—review & editing, Investigation, Methods, Data curation. Emilie Karafillakis: Writing—review & editing, Investigation, Methods. Shana Kagan: Writing—review & editing, Visualization, Methods, Supervision. Alex Vorsters: Writing—review & editing, Supervision, Methods, Formal analysis, Funding acquisition.

Published: 2025-09-15 doi: 10.20892/j.issn.2095-3941.2025.0388
Outline
收藏切换
Christopher Morgan, Mary Carol Jennings, Dur-e-Nayab Waheed, Nicolas Theopold, Anissa Sidibe, Ana Bolio, Elaine Charurat, Felix Ricardo Burdier, Emilie Karafillakis, Shana Kagan, Alex Vorsters. Strengthening human papillomavirus vaccination programs through multi-country peer learning: lessons from the CHIC initiative[J]. Cancer Biology & Medicine, 2025 , 22 (9) : 997 -1001 . DOI: 10.20892/j.issn.2095-3941.2025.0388
Full Text
Less
Introduction
Less
Human papillomavirus (HPV) vaccination is a cornerstone of cervical cancer prevention, particularly in low- and middle-income countries (LMICs), where the burden of disease remains high1.
The World Health Organization (WHO) HPV Vaccine Introduction Clearing House reported that 147 countries (of 194 reporting) had fully introduced the HPV vaccine into their national schedules as of 20242. After COVID-19 pandemic disruptions, global coverage is again increasing. For 2024, the WHO reported that global complete vaccination coverage (which varies according to national schedules) was 28% among eligible girls worldwide. Among countries that have introduced vaccination, immunization programs have achieved an average 63% coverage with at least one vaccine dose in 20243. To achieve global cervical cancer elimination targets4, first, more countries, particularly highly populous countries, must introduce HPV vaccination into national schedules; second, national programs must find ways to achieve 90% vaccination coverage of girls by the age of 15 years.
Despite global support and country commitment, challenges persist in the introduction, scale-up, and sustainability of HPV vaccination programs. This perspective explores the role of multi-country peer learning as a strategy to address these challenges, by drawing on the experience of the Coalition to Strengthen the HPV Immunization Community (CHIC), a multi-year initiative supported by the Gates Foundation5. The CHIC initiative emphasizes participatory dialogue, country-led action planning, and evidence translation to support HPV vaccine implementation in LMICs6.
The CHIC initiative: structure and objectives
Less
The CHIC initiative is designed to support HPV vaccine implementation in low-resource settings by fostering the development of an HPV vaccination community; translating evidence into practice; and amplifying the voices of country-level stakeholders, particularly in countries eligible for support from Gavi, the Vaccine Alliance (Figure 1). The initiative, guided by a diverse advisory group comprising international and national experts, focuses on 2 primary activities: (1) developing technical products to synthesize evidence and support tailored solutions, and (2) organizing multi-country regional symposia. These symposia serve as platforms for peer learning, which enable countries in various stages of HPV vaccine introduction to share experiences, identify common barriers, and co-develop solutions.
Peer learning symposia: format and participation
Less
CHIC symposia, which are carefully planned through consultation with major local and international stakeholders, are structured to foster peer-to-peer exchange rather than top-down dissemination. Each symposium includes countries that have not yet introduced the vaccine, those in the planning phase, and those with established programs. Countries are selected on the basis of extensive mapping of their regional context; the status of their HPV vaccine programs; and specific strategic needs identified by the advisory group and local scientific committees. Participants typically include 2 to 4 representatives per country, encompassing program managers and technical experts. Representatives are invited according to their roles in national immunization programs; their expertise in HPV vaccine implementation, cervical cancer elimination, and adolescent health; and their ability to contribute actively to peer discussions.
The agenda consists primarily of country-led presentations that share experiences, lessons learned, best practices, and innovations. These presentations are complemented by participatory discussions and action planning sessions, during which each country develops and iterates an action plan. The content of these discussions informs topics for subsequent meetings and technical outputs. A small proportion of the agenda is reserved for international updates from regional and global partners, including the World Health Organization (WHO); Gavi, the Vaccine Alliance; the United Nations Children’s Fund (UNICEF); the World Bank; and non-governmental organizations working in immunization. These updates provide context, share current global guidance, and inform subsequent country-driven discussions. Between 2022 and 2024, symposia were held in Ethiopia, India, Côte d’Ivoire, and the Philippines, and engaged a community of practice comprising more than 500 participants from more than 60 countries (Table 1).
Themes emerging from peer learning symposia
Less
From peer learning discussions at CHIC symposia, several recurring themes have surfaced. Sustaining vaccine supply and program funding remains a central concern, and countries have expressed interest in regional cooperation and better strategies to advocate for increased domestic financing. Participants have emphasized that integrating HPV vaccination into existing immunization platforms is insufficient without additional resources for outreach, particularly in schools and communities7. Additional priorities that have emerged from peer learning discussions include the importance of articulating the evidence for single-dose schedules8, and upgrading immunization data and information systems, including digital records.
Reaching underserved populations—such as youth who are out of school, and those located in conflict zones, or difficult-to-reach or marginalized communities—is another key cross-cutting focus. Peer learning conversations have enabled participants to cross-pollinate awareness of diverse efforts to reach such populations. Country leaders have highlighted the importance of tailoring communication strategies and building partnerships with professional associations, cultural and community leaders, and youth organizations9, to support long-term trust in vaccines. Linking HPV vaccination to cervical cancer screening and treatment has consistently been considered a promising approach to enhance program impact and community engagement10.
Earlier publications have reported on deliberations in CHIC symposia in Africa and South Asia6,11. As an example, we present a brief overview of the most recent cross-country symposium, held in Manila, Philippines, in October 2024. This event involved 98 participants across 17 countries from Southeast Asia and the West Pacific, who gathered for 3 days of cross-country learning and peer-to-peer sharing of common practices in diverse HPV vaccination programs4. Participants involved in national immunization programs, technical experts, and implementation partners exchanged their experiences, lessons learned, and practical strategies drawn from their diverse HPV vaccination programs. Key priorities included scale-up from subnational to national levels, thereby ensuring program sustainability; strengthening policies and implementation practices; and addressing coverage challenges. Through a combination of interactive sessions, country snapshots, workshops, and roundtable discussions, each country developed a country-specific action plan for a more sustainable HPV vaccination program, highlighting next steps, good practices, and a list of priority actions to pursue after the symposium.
Other CHIC outputs
Less
Beyond symposium activities, the CHIC initiative produces a range of supporting technical outputs (including slide decks and evidence briefs on topics including the support of single-dose schedules and similar emerging topics) and facilitates high-level conversations among global decision-makers. These efforts are aimed at translating established evidence into formats useful to decision-makers and implementers, in a manner that sustains the HPV community of practice.
In one such engagement, the Secretariat presented its peer-to-peer approach, along with regionally relevant work, at the 22nd Annual Meeting of the China National Cervical Cancer Consortium and Symposium on Cervical Cancer Prevention. China remains one of the high-population countries yet to undertake national scale-up of HPV vaccination (as of August 2025). We hope that increased peer-learning efforts across provinces will help demonstrate the feasibility of, and demand for, HPV vaccination.
CHIC also organizes post-symposium online engagement sessions after each symposium. These sessions facilitate continued peer-learning, promote collaborations, provide a forum for structured country updates, enable breakout group discussions of emerging issues, and help identify key topics for future symposia. Participants include symposium attendees, regional stakeholders, researchers, advocacy groups, and policy advisors. This structured approach reinforces regional ownership and ensures continued momentum toward strengthening HPV vaccination programs and shaping regional and global dialogues.
CHIC outputs additionally comprise publication of evidence derived from LMIC presentations at symposia and the outcomes of working group discussions; these efforts enable implementers and early career researchers to build their publication profiles and make grass-roots perspectives available to the wider immunization and cervical cancer communities of practice. Some outputs of the CHIC initiative approach to peer learning have been captured in detail in several key areas: discussion of sustainable delivery strategies by program implementers attending the first Africa symposium12; cross-country comparisons of program status11; the roles of health care professionals as immunization allies13; lessons learned in effective communication14; and the application of lessons learned from pandemic resilience to HPV vaccination programs15. Between annual symposia, CHIC continues engagement through webinars and, in limited cases, support of country-specific action plans. CHIC materials are openly accessible at www.stophpv.org.
Future directions
Less
Future topics for evidence generation include considerations for countries to consider in expanding vaccination beyond the primary target of girls 9–14 years of age, to secondary targets such as older girls, young women, and potentially boys. Articulating the return on investment of HPV vaccination, improving electronic data systems, and introducing innovations to identify and reach priority populations are also on the agenda. These efforts align with global strategies such as the Immunization Agenda 2030; the WHO call for cervical cancer elimination; and other initiatives, including the HPV Vaccine Acceleration Program Partners Initiative Consortium (HAPPI), The Linked Immunization Action Network (“Linked”), and the HPV Prevention and Control Board.
Conclusion
Less
The CHIC initiative exemplifies how structured peer learning can support the introduction and sustainability of HPV vaccination programs in LMICs. By centering on country voices, fostering cross-national collaboration, and translating evidence into actionable plans, CHIC contributes to building resilient immunization systems. As countries navigate evolving challenges—including the growing range of vaccine products, sustaining services for school-age clients, and the integration of adolescent health services—peer learning platforms such as CHIC offer a valuable mechanism for shared problem-solving and policy innovation.
Funding
Less
  • CHIC and the contributions of all co-authors are supported financially by the Gates Foundation (Grant number INV-006006), who are active participants in shaping the initiative’s work.
References
Less
1.
Wu J,Jin Q,Zhang Y,Ji Y,Li J, et al.Global burden of cervical cancer: current estimates, temporal trend and future projections based on the GLOBOCAN 2022.J Natl Cancer Center.2025; 5: 322–9.
2.
World Health Organization.HPV Vaccine Introduction Clearing House [Internet].[cited 2025 Jul 14].Available from: https://www.who.int/teams/immunization-vaccines-and-biologicals/diseases/human-papillomavirus-vaccines-(HPV)/hpv-clearing-house
4.
World Health Organization.Cervical Cancer Elimination Initiative [Internet].[cited 2025 Jul 14].Available from: https://www.who.int/initiatives/cervical-cancer-elimination-initiative
5.
stophpv.org [Internet].CHIC: Coalition to Strengthen the HPV Immunization Community; [cited 2024 Jan 4].Available from: https://stophpv.org/about/
6.
Bolio A,Waheed DE,Mugo N,Garland SM,Wanyoike S,Njambe Tondo Opute E, et al.Overview of CHIC symposia series: summary of Africa and South Asia symposia.Vaccine.2024; 42: S9–15.
7.
Ndiaye C,Kyesi F,Masupha T,Ranyali M,Engel D,Guillaume D, et al.Integrating HPV vaccine service delivery with adolescent health programs – experiences and perspectives from selected countries in Africa.Vaccine.2024; 42: S45–8.
8.
Stanley M,Schuind A,Muralidharan KK,Guillaume D,Willens V,Borda H, et al.Evidence of an HPV one-dose schedule.Vaccine.2024; 42: S16–21.
9.
Sidibe A,Kouassi KS,Ekra D,Bloem P,Mtonga VC,Morgan C, et al.Accelerating and broadening multisectoral partnerships for introducing and rebuilding HPV vaccination programs.Vaccine.2024; 42: S41–4.
10.
Burdier FR,Bolio A,Abraham P,Pimple S,Franco EL,Pempa P, et al.Case studies on the progress in cervical cancer screening programs in Bhutan, India, and Türkiye.Vaccine.2024; 42: S49–53.
11.
Borda H,Bloem P,Akaba H,Guillaume D,Willens V,Jurgensmeyer M, et al.Status of HPV disease and vaccination programs in LMICs: introduction to special issue.Vaccine.2024; 42(Suppl 2): S1–8.
12.
Waheed DEN,Bolio A,Kyesi F,Miano CW,Tefera YL,Kinteh M, et al.Routine HPV vaccination: reflection on delivery strategies based on countries’ experiences.Vaccine.2024; 42: S37–40.
13.
Waheed DEN,Mumba M,Alfred D,Bogale M,Rujumba J,Bakeera-Kitaka S, et al.Identifying key challenges and optimizing approaches for training of health care professionals for HPV vaccination programs.Vaccine.2024; 42: S22–6.
14.
Njogu R,Deb Roy A,Bagudu Z,Borda H,Jurgensmeyer M,Muralidharan K, et al.Effective communication by health care workers to promote HPV vaccination: lessons learned from Kenya, India, and Nigeria.Vaccine.2024; 42: S27–32.
15.
Kouassi KS,Chisupa E,Clarke A,Massenon I,Miano C,Mutuku F, et al.Pandemic-associated resilience in HPV vaccination programs – perspectives from selected countries in Africa on what it will take to vaccinate 90% of girls by 2030.Vaccine.2024; 42: S33–6.
Appendix
Less
Year 2025 volume 22 Issue 9
PDF
7
4
Cite this Article
BibTeX
Article Info
doi: 10.20892/j.issn.2095-3941.2025.0388
  • Receive Date：2025-07-16
  • Online Date：2026-11-07
  • Published：2025-09-15
Article Data
Affiliations
History
  • Received：2025-07-16
  • Accepted：2025-09-01
Funding
CHIC and the contributions of all co-authors are supported financially by the Gates Foundation (Grant number INV-006006), who are active participants in shaping the initiative’s work.
Affiliations
    1Jhpiego, Baltimore, MD 21231, USA
    2Centre for Evaluation of Vaccination, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp 2000, Belgium
    3Gates Foundation, Seattle, WA 98102, USA
    4London School of Hygiene and Tropical Medicine, London, WC1E 7HT, UK

Corresponding:

Correspondence to: Mary Carol Jennings, E-mail:
References
Share
https://castjournals.cast.org.cn/joweb/cbm/EN/10.20892/j.issn.2095-3941.2025.0388
Share to
QR

Scan QR to access full text

Cite this article
BibTeX
Citations
表12种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
关闭全屏
  • BibTeX
  • EndNote
  • RefWorks
  • TxT
Links
Articles
Latest Articles
Most Read
Collections
Updates
Events
News
Multimedia
About
About Us
Contact
No. 86 Xueyuan South Road, Haidian District, Beijing
100081
010-62662699(Operation and Technical Support)
qkjq@cast.org.cn

Copyright © 2025 China Association for Science and Technology. All rights reserved. For all open access content, the relevant licensing terms apply.
Sponsored by the Office of the Leading Group for Cybersecurity and Informatization of CAST, and supported by Science and Technology Review Publishing House