The Impact of Vaccination on Gender Equity: Conceptual Framework and Human Papillomavirus (HPV) Vaccine Case Study

Gender-related power imbalances contribute to excess female mortality, gender-based violence, and limited health-seeking behaviours. 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 a low-, middle-, and high-income country (Tanzania, India, and the United Kingdom, or UK) with different levels of disease burden (Tanzania - high burden, India - medium, and UK - low) to establish a proof of concept in a variety of contexts.

The researchers conducted a literature review examining evidence on the linkage between health outcomes and dimensions of gender equity. They used 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. (They only assumed vaccination coverage of girls, per the World Health Organization (WHO) recommendations, whereas many countries also vaccinate boys.) Then, they estimated labour force participation and fertility effects from improvements in health, and converted these into inputs consistent with those used to calculate the United Nations (UN) Gender Inequality Index (GII) to assess gender equity.

Based on the UN Human Development Index, the GII provides a quantitative measure of the human development costs of gender inequality along 3 dimensions: (i) reproductive health (e.g., maternal mortality ratio and adolescent birth rates); (ii) empowerment (e.g., proportion of parliamentary seats held and secondary education attainment); and (iii) economic status (e.g., labour force participation).

Overall, HPV vaccination is expected to decrease cervical cancer cases and deaths by approximately 80% in Tanzania, India, and the UK based on PRIME projections. The years of employment gained among women aged 15 to 49 years with averted cervical cancer ranged from 165 to 920 years in Tanzania, 1404-9600 years in India, and 38-78 years in the UK. The averted maternal deaths among women with averted cervical cancer was 1.4 in Tanzania and 2.3 in India.

The researchers say they have likely underestimated the benefits because the model did not include many other benefits of HPV vaccination such as indirect (herd) effects, social stigma associated with cervical and other HPV-related cancers, and effects on non-cervical HPV-related disease.

In short, this study shows that vaccines may "help to narrow gender disparities by a conceptual framework that links improvements in health to dimensions of gender equity, and that the magnitude of such effects can be quantified....Given the importance of gender equity to development, this suggests that decision-making bodies such as national immunization technical advisory groups (NITAGs) and donors may wish to consider vaccine impact on gender equity as one of the decision-making cri-teria around new vaccine introductions."