Table 5 Using local evidence to assess the availability of resources with a view to informing a decision regarding options

An increasing number of countries are adding the new human papillomavirus (HPV) vaccine to routine immunisation schedules or are considering doing so. The vaccine is highly effective against the strains of the virus responsible for approximately 70% of cervical cancers and has been recommended for routine immunisation in adolescent girls in the United States.

However implementation across the country is thought to be uneven. A study was undertaken in an area of North Carolina which had high rates of cervical cancer. The study explored barriers to vaccine delivery and uptake as perceived by healthcare providers. Medical practices noted a number of key concerns including: inadequate reimbursement by insurance companies of the vaccination costs, the high cost of the vaccine (given that many consumers who needed it did not have adequate health insurance), the burden on practices in ascertaining the availability of insurance cover for each patient (given the varying policies of different insurers), and the high up-front cost to practices of purchasing and storing the vaccine. The study authors note that these resource concerns may act as barriers to the implementation of the national vaccination policy [41].