The impact of vaccination on gender equity: conceptual framework and human papillomavirus (HPV) vaccine case study

Abstract

Background: Although the beneficial effects of vaccines on equity by socioeconomic status and geography are increasingly well-documented, little has been done to extend these analyses to examine the linkage between vaccination and gender equity. In this paper, evidence from the published literature is used to develop a conceptual framework demonstrating the potential impact of vaccination on measures of gender equity. This framework is then applied to human papillomavirus (HPV) vaccination in three countries with different economic and disease burden profiles to establish a proof of concept in a variety of contexts. Methods: We conducted a literature review examining evidence on the linkage between health outcomes and dimensions of gender equity. We utilized the Papillomavirus Rapid Interface for Modelling and Economics (PRIME) model to estimate cervical cancer incidence and deaths due to HPV types 16/18 by age in each country. We estimated labor force participation and fertility effects from improvements in health, and converted these into inputs consistent with those used to calculate the United Nations Gender Inequality Index to assess gender equity. Results: In our case study, we found that HPV vaccination among girls could help narrow socioeconomic gender disparities by quantifying the main pathways by which HPV vaccination improves health, which enables improvement in gender equity indicators such as labor force participation and maternal mortality ratios. While these improvements are small when averaged over the entire population, the components measuredlabor force participation and maternal mortality ratioaccount for 50% of the index scores. Conclusions: This proof of concept model is a starting point to inform future health and economic analyses that might incorporate the impact of gender equity as an additional impact of vaccination in improving the health and well-being of the population.

Cost and effectiveness of HPV vaccine delivery strategies: A systematic review

“…Toolkits exist for LMICs to estimate the cost of adding HPV vaccines to national immunization programs to prevent cervical cancer ( Hutubessy et al, 2012 ). Portnoy and colleagues synthesized data from different studies to demonstrate the impact of HPV vaccination on gender equity ( Portnoy et al, 2020 ). HPV vaccination decreases the incidence and mortality of cervical cancer, increases life expectancy for females, and subsequently increases labor force participation for women ( Portnoy et al, 2020 ).…”

“…Portnoy and colleagues synthesized data from different studies to demonstrate the impact of HPV vaccination on gender equity ( Portnoy et al, 2020 ). HPV vaccination decreases the incidence and mortality of cervical cancer, increases life expectancy for females, and subsequently increases labor force participation for women ( Portnoy et al, 2020 ). Focusing on women and girls who are most vulnerable to HPV-associated cancers is an economically viable strategy in limited-resource settings.…”

“…While reviews have been conducted on the cost-effectiveness of HPV vaccines, little is known about the cost and effectiveness of vaccination strategies that have been implemented to expand access to HPV vaccines. Studies have also reviewed the impact of HPV vaccination on gender equity ( Portnoy et al, 2020 ) and country-specific HPV vaccination strategies ( Holloway, 2019 ). The latter study focused on HPV vaccination strategies specific to the USA, which highlights the need to understand vaccination strategies across the world.…”

A standardized approach for measuring multivariate equity in vaccination coverage, cost-of-illness, and health outcomes: Evidence from the Vaccine Economics Research for Sustainability & Equity (VERSE) project

“…In response to an increasing push for a multivariate expansion to the assessment of socioeconomic inequality, numerous governmental institutions, and international organizations, including the European Commission ( European Commission, 2021 ), the United States Census Bureau ( Glassman, 2019 ), the government of the United Kingdom ( Vizard and Speed, 2015 ) and the United Nations ( McKnight, 2018 ), have begun expanding beyond a singular focus on income or wealth as the basis for measuring and tracking social equity. However, in examining equity in healthcare access, research on inequality typically focuses on one factor or a series of separate bivariate assessments ( Papageorge et al, 2021 ; Millar et al, 2021 ; Portnoy et al, 2020 ). While this type of sub-group comparison over specific factors is commonplace, a systematic approach for combining and measuring the composite inequality over multiple groups remains lacking, particularly in the context of vaccination ( Bosch- Capblanch et al, 2017 ).…”

Impact of pentraxin 3 genetic variants on uterine cervical cancer clinicopathologic characteristics

“…Approximately 90% of deaths from cervical cancer occur in low-and middle-income countries. The worldwide annual incidence of uterine cervical cancer was reported to be 14.0 per 100,000 populations [17]. Uterine cervical cancer ranked the eighth most common malignancy in female individuals based on 2014 Annual Cancer Registry Report in Taiwan.…”