GLOBAL MEETING ON CERVICAL CANCER PREVENTION PROGRAM, NEW YORKGLOBAL MEETING ON CERVICAL CANCER PREVENTION PROGRAM, NEW YORK29TH NOVEMBER – 2 DECEMBER 2010

INTRODUCTION OF NATIONAL  HPV IMMUNISATION PROGRAM : SHARING 

MALAYSIA’S EXPERIENCE

Dr. Saidatul Norbaya Buang

MALAYSIA’S EXPERIENCE

Dr. Rohani JahisDepartment of Public HealthMinistry of Health Malaysia

MALAYSIAN POLICY ON HPV IMMUNISATION

• Mother PolicyMother Policy– Free HPV immunization to 13 years old Malaysian girls starting 2010

• Operational Policy– Voluntary  HPV immunization  Program : require written parental consent 

– School based immunization for all Form 1 (Year 7) t d t i ti f t lstudents irrespective of actual age 

– Clinic based immunization for out of school 13 years old girlyears old girl

Global Meeting on Cervical Cancer Prevention Program, NY; 29 Nov ‐ 2 Dec, 20102

MALAYSIAN HPV IMMUNISATION SCHEDULE

Dose Schedule

Dose 1 0 monthDose 1 0 month

Dose 2 1 month after dose 1

Dose 3 6 months after dose 1

Global Meeting on Cervical Cancer Prevention Program, NY; 29 Nov ‐ 2 Dec, 20103

WALKING THROUGH THE HPV IMMUNISATION PROCESSIMMUNISATION PROCESS

Global Meeting on Cervical Cancer Prevention Program, NY; 29 Nov ‐ 2 Dec, 

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Global Meeting on Cervical Cancer Prevention Program, NY; 29 Nov ‐ 2 Dec, 

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Parents received consent forms together with Leaflettogether with Leaflet explaining the importance of HPV immunisation

Global Meeting on Cervical Cancer Prevention Program, NY; 29 Nov ‐ 2 Dec, 

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MINOR AEFI FORM

HPV i i i dGlobal Meeting on Cervical Cancer 

Prevention Program, NY; 29 Nov ‐ 2 Dec, 2010

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HPV immunisation card

PUBLIC OPINION ON HPV 

Cervical cancer vaccine: It's more pragmatic to rely on better tests

IMMUNISATION2010/11/25B.J. FERNANDEZ, Shah Alam, Selangorletters@nst.comShare|

THE H lth Mi i t tl t ith f ll d ti t ti th H P ill Vi (HPV) i th t tl h l t t i lTHE Health Ministry recently came out with full-page advertisements promoting the Human Papilloma Virus (HPV) vaccine that apparently helps to prevent cervical cancer.According to the New England Journal of Medicine, 2002, women whose partners were sexually active early (before age 17) and often had sex (having at least six partners) were more likely to get cervical cancer than those whose partners had been less-sexually active.

I doubt very much if Malaysian teenagers fall within this category. HPV is just like other sexually-transmitted diseases where awareness and prevention should take priority.

Furthermore, according to the World Health Organisation (WHO), if those who have been vaccinated don't go for annual screenings because they wrongly believe that they are fully protected against cervical cancer, the number of deaths could even increase, especially as the vaccine protection wanes.

According to the United States Centers for Disease Control and Prevention, as of Sept 1, last year, there were 44 reports of death among US women who received the vaccine.Twenty-seven of these reports had been confirmed and 17 remain unconfirmed due to lack of patient information. In the 27 confirmed reports, there were no unusual pattern or clustering of deaths that suggested they were caused by the vaccine Earlier reports indicated that this vaccine would cost RM150 to RM200 million a year

Friday August 20, 2010Vaccination against HPV is dangerous and unnecessary

pattern or clustering of deaths that suggested they were caused by the vaccine.Earlier reports indicated that this vaccine would cost RM150 to RM200 million a year.It seems that the main beneficiaries are the pharmaceutical companies.

The ministry must come clean on the procurement process. Are the vaccines bought directly from the manufacturers or through a middleman, and what is the price paid for these vaccines?In last Tuesday's edition of the Daily Mail, there was an article on how thousands of women's lives could be saved by a dramatic improvement in testing for cervical cancer.The test delivers overnight results and is vastly more accurate than the smear test which is currently used to spot early signs of the disease, according to researchers It costs only RM75 a time and could be available within a year The Daily Mail article also stated that another benefit of the new test was that patients might

THE Consumer’s Association of Penang (CAP) has repeatedly objected to the proposal to vaccinate all 13‐year‐old girls from the human papillomavirus (HPV) virus, a sexually transmitted virus because it is unnecessary, unscientific and unsafe.Despite numerous objections by many quarters, a sum of RM150mil is to be spent annually by the Government beginning this year on HPV vaccinations for an estimated 300 000 girls in the country asresearchers. It costs only RM75 a time and could be available within a year.The Daily Mail article also stated that another benefit of the new test was that patients might need to be screened only once every five years, instead of three.Researchers claim that the smear test misses up to a third of all cervical cancer cases but the new method picks up almost all of them.The disease kills around 1,000 British women every year. This means up to 300 lives can be saved by the new technique.

Unlike the smear test, which checks for abnormal cells, this latest test, known as the Cobas test, is able to detect HPV which triggers the abnormal cell growthThis would be a better approach. When there are more pressing needs for basic medical care, spending so much on a vaccine that is alien to our lifestyle is not necessary.

Global Meeting on Cervical Cancer Prevention Program, NY; 29 Nov ‐ 2 Dec, 

2010

Government beginning this year on HPV vaccinations for an estimated 300,000 girls in the country as protection from only two of the 40 different cervical cancers causing HPV.HPV is contracted through sexual contact; instead of inoculating our young against a sexually transmitted disease (STD), the Government should focus on prevention by educating them on religious and moral values.A i i f i i STD ill i f d i l ld b l ll d i f l f i

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SETTING UP MALAYSIAN NATIONAL HPV IMMUNISATION PROGRAMIMMUNISATION PROGRAM

STEPS INVOLVES TIME FRAME

1. POLICY, PROGRAM DEVELOPMENT AND FUNDING 2006 -2009DEVELOPMENT AND FUNDING

2. PREPARATOTY PHASE DEC 2009 – JULY 2009

3 IMPLEMENTATION 16TH AUGUST

2009

3. IMPLEMENTATION

4 MONITORING AND

16TH AUGUST -

4. MONITORING AND EVALUATION END JUNE 2009 -

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IMPLEMENTATIONCHALLENGES ACTIONS TAKEN

1 P t l t Ri k i ti

IMPLEMENTATION  

1. Parental acceptance•vaccine “halal” status

i f

‐ Risk communication activitiesMOE collaboration•Vaccine safety ‐ MOE collaboration

‐ Consent formH l l tifi ti‐ Halal certification

2. Inadequate space for vaccine storage

‐ Vaccine supply with WHO certified fridgesvaccine storage WHO certified fridges

‐ Decentralised vaccine storage centresstorage centres

Global Meeting on Cervical Cancer Prevention Program, NY; 29 Nov ‐ 2 Dec, 

2010

MONITORINGCHALLENGES ACTIONS TAKEN

1 G tti i f ti S t HPV N ti l t t

MONITORING

1. Getting information – on time on daily basis-Vaccine supply

‐ Set up HPV National, state and District Operation room

‐ Standardised reporting pp y-Vaccination coverage-AEFI

p gformat and work processes

‐ Communication channel, h il fphone, sms, e‐mail, fax

2. Short implementation time in 2010

‐ Determine timeline for completion of 1st and 2ndtime in 2010

- School and major examination

completion of 1 and 2dose

‐ Use of school health team 

-End year school closure and mobilise clinic staffs 

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COST TO THE GOVERNMENT OF MALAYSIACOST TO THE GOVERNMENT OF MALAYSIA

FUNDING SOURCE ACTIVITIES1. Approved 2010 MOH

budgeta. Vaccine procurementb. Heath promotion &

campaignsc. Additional consumables

2. Existing Operational Budget at state and

a. School Health teams / Health clinic teams - salaryBudget at state and

districts ( cannot be separated from other health services)

Health clinic teams salaryb. Vehicle maintenance and

petrolshealth services) c. Staffs claims

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LESSON LEARNTLESSON LEARNT

MALAYSIA’S STRENGTH

1. Strong political will and leadership drive

MALAYSIA S STRENGTH

2. Involvement of stake holders during planning stagestage

3. Predict and manage potential riskp

4. Importance of Program monitoring at all levels

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