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

Haidari, Leila A. MPH; Brown, Shawn T. PhD; Constenla, Dagna PhD; Zenkov, Eli BS; Ferguson, Marie MSPH; de Broucker, Gatien MHS; Ozawa, Sachiko PhD; Clark, Samantha MHS; Portnoy, Allison MSPH; Lee, Bruce Y. MD, MBA

Sexually Transmitted Diseases: April 2017 - Volume 44 - Issue 4 - p 222–226
doi: 10.1097/OLQ.0000000000000574
Original Studies

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.

Geospatial information system analysis found that much of population in Mozambique is not reached by any existing immunization location, reducing the potential for human papillomavirus vaccine to avert significant disease burden and costs.

From the *Pittsburgh Supercomputing Center (PSC), Carnegie Mellon University, Pittsburgh, PA; †Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; ‡Division of Practice Advancement and Clinical Education, UNC Eshelman School of Pharmacy, University of North Carolina-Chapel Hill, Chapel Hill, NC; §Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA; and ∥Public Health Computational and Operations Research (PHICOR), Johns Hopkins Bloomberg School of Public Health, Baltimore, MD

Acknowledgements: Research reported in this publication was supported by the International Society for Infectious Diseases (ISID) and Pfizer via the SIGMA grant and the Agency for Healthcare Research and Quality (AHRQ) via grant R01HS023317, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Office of Behavioral and Social Sciences Research (OBSSR) and the Global Obesity Prevention Center (GOPC) via grant U54HD070725, NICHD via grant U01HD086861, the National Institute for General Medical Science (NIGMS) via the MIDAS 5U24GM110707 grant, and the Centers for Disease Control and Prevention (CDC) via contract 200-2015-M-63169. The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

Conflict of Interest: None declared.

Correspondence: Bruce Y. Lee, MD, MBA, Department of International Health Public Health Computational and Operations Research (PHICOR) International Vaccine Access Center (IVAC) Global Obesity Prevention Center (GOPC) Johns Hopkins Bloomberg School of Public Health 615 N. Wolfe St. Room 3501 Baltimore, MD 21205. E-mail:

Received for publication September 16, 2016, and accepted December 1, 2016.

© Copyright 2017 American Sexually Transmitted Diseases Association