GLOBAL CANCER POLICY-MAKING
Figure 1: The innovation value chain applied to health care innovation
intervention and teachers, parents
and guardians were instructed to
discuss HPV, cervical cancer and the
Basic research Commercialization Delivery/Use vaccine with the targeted age groups
of girls. Third, the Ministry of Health
established partnerships with
technical assistance providers using
in-depth interviews and focus groups
to engage technical experts as well as
local leaders, community health
workers and teachers. Fourth, the
Discovery Development Diffusion Ministry of Health also maintained a
good working relationship with the
Ministry of Finance to sustainably
5
vaccines have been tracked over longitudinal studies , deliver innovations in Rwanda’s health system10.
however there are still questions about its cost, at over In April 2011, a HPV mass vaccination campaign was
US$300 per the 3-dose combination in high-income launched targeted at Rwandan girls in primary grade six with
countries6. Rwanda, a low-income country in sub-Saharan over 92,000+ girls completing all three rounds of HPV
Africa became the first country on the African continent and vaccination. The campaign reached coverage of 95.04% in
the first low-income country in the world to roll-out the round one, 93.90% in round two and 93.23% in round three as
innovative HPV vaccine to its pre-adolescent girl population in reported by government data11. Each round took place over
April 20117. Cervical cancer is the most common cancer among six days with students in schools tracked in the first two days,
8
women in Rwanda and political will was mobilized to tackle the out-of-school girls tracked on day three and the remaining
problem with a vaccine available. The following case study uses three days used for surveillance of potential adverse events.
an innovation value chain perspective to illustrate how Rwanda Rwanda’s pioneering roll-out of HPV implementation in
achieved 93% coverage with its first HPV vaccination roll-out9. resource-poor settings is an example of an emerging health
Impact was achieved through building effective partnerships system leveraging global health ecosystem resources to help
and leveraging global health ecosystem resources. achieve its objectives. Although the first three years of the
Through a series of new partnerships, Rwanda reduced the HPV vaccines were provided at no cost to Rwanda, other
historical two-decade gap in vaccine roll-out between high- delivery logistics and expenditures needed to be secured.
and low-income countries to just five years. First, Rwanda Rwanda acknowledges support from the government, the
built a partnership between the Ministry of Health and a GAVI Alliance (Global Alliance for Vaccines and
supplier of HPV vaccines, Merck, where a memorandum of Immunizations), the President’s Emergency Plan on AIDS
understanding was signed guaranteeing Rwanda three years Relief and the Global Fund to Fight AIDS, TB and Malaria as
of vaccinations at no cost and lower pricing for future doses. key partnerships in implementing the vaccine delivery. The
Second, the Ministry of Health built internal partnerships with roll-out was made possible by Rwanda’s prior commitments to
other ministries including the Ministry of Education, the strengthen its health systems and built upon an existing
Ministry of Gender and Family Promotion, the Centre for national infrastructure where 90% Rwandan infants receive
Treatment and Research on AIDS, TB and Malaria and other all basic immunizations. The mass vaccination campaign
epidemics and built an education strategy to mobilize 60,000 required concentrated efforts of manpower and existing
community health workers. The Ministry of Health did not national resources were leveraged including the 60,000
undertake the national vaccine implementation role alone and community healthworkers already working for the Ministry of
brokered multidisciplinary subcommittees to plan delivery Health and technical assistance partners in civil society. Not
logistics well in advance. Technical committees identified use everyone agrees with the use of scarce resources for a cancer
of cold chains and planned a nationwide education campaign vaccine versus other prevalent epidemics12, but it is now a
regarding the new vaccine. Health care professionals, frequent decision ministries of health need to make in tackling
government and clergy gave speeches and announcements the onset of noncommunicable diseases in developing
were made through media channels such as newspapers, radio countries.
and magazines. The vaccination was a voluntary opt-out Rwanda’s actions in choosing to combat cervical cancer and
22 CANCER CONTROL 2013