Geospatial Planning and the Resulting Economic Impact of Human Papillomavirus Vaccine Introduction in Mozambique

Abstract

Background: Research has shown that the distance to the nearest immunization location can ultimately prevent someone from getting immunized. With the introduction of human papillomavirus (HPV) vaccine throughout the world, a major question is whether the target populations can readily access immunization.

Methods: In anticipation of HPV vaccine introduction in Mozambique, a country with a 2015 population of 25,727,911, our team developed Strategic Integrated Geo-temporal Mapping Application) to determine the potential economic impact of HPV immunization. We quantified how many people in the target population are reachable by the 1377 existing immunization locations, how many cannot access these locations, and the potential costs and disease burden averted by immunization.

Results: If the entire 2015 cohort of 10-year-old girls goes without HPV immunization, approximately 125 (111-139) new cases of HPV 16,18-related cervical cancer are expected in the future. If each health center covers a catchment area with a 5-km radius (ie, if people travel up to 5 km to obtain vaccines), then 40% of the target population could be reached to prevent 50 (44-55) cases, 178 (159-198) disability-adjusted life years, and US $202,854 (US $140,758-323,693) in health care costs and lost productivity. At higher catchment area radii, additional increases in catchment area radius raise population coverage with diminishing returns.

Conclusions: Much of the population in Mozambique is unable to reach any existing immunization location, thereby reducing the potential impact of HPV vaccine. The geospatial information system analysis can assist in planning vaccine introduction strategies to maximize access and help the population reap the maximum benefits from an immunization program.

Figure 1

Potential disease and economic impact of HPV immunization.

Figure 2

SIGMA visualizations of immunization location catchments with progressively larger HPV catchment area radii. Purple circles represent each HPV immunization location and its catchment area. The underlying green shading represents the HPV target population density, with darker green representing greater density. Any green areas not covered by a purple circle are thus not currently reachable by an HPV immunization location. Each figure represents a different HPV immunization location catchment area radius: (A) 3 km, (B) 5 km, (C) 7 km, (D) 15 km, (E) 20 km, and (F) 35 km.