Leading research for policy change in Mongolia

Introduction

In Mongolia, the lack of local data on the HPV vaccine was detrimental to the success of the first campaign in 2012, with no or very few insights about the acceptability of the population as well as local research on the safety and efficacy of the vaccine. CSO engagement, in collaboration with local and international researchers, in generating local data on efficacy, safety and acceptability was instrumental in informing the decision of the government to reintroduce the HPV vaccine programme, a process which started in 2022 and is still ongoing. 

Background

In Mongolia, cervical cancer is the second leading cancer. The pilot HPV vaccination programme started in 2012. However, the programme stopped the same year due to misinformation, community resistance and overall negative perception of HPV. There was no local data about the efficacy and safety of the vaccine. Therefore, this lack of knowledge and local data led to resistance and mistrust from health professionals, stakeholders and the broader population in Mongolia.

Actions

In order to address the information gap and negative perceptions, a local research group led by the National Cancer Council of Mongolia (the Council), the leading cancer CSO in the country, was initiated in 2016. The group, composed of researchers from universities, research centres and hospitals, conducted a series of research studies, including evaluation of the vaccine effectiveness and formative studies. The studies were jointly conducted with Australian scientists through a collaborative project with the Council. The studies were published in 2019-2020 and compiled in a book released in 2023*.

Findings indicated that, compared to the three doses scheduled, the single dose was effective after six years for girls vaccinated during the first campaign, informing the single dose schedule for the reintroduction of the vaccine. 

The research also provided evidence that the vaccine had no impact on fertility which was a persistent misconception that led to vaccine hesitancy in the population.

Studies showed that acceptability remained a challenge, showcasing the critical need for community-based mobilisation, with teachers, health professionals as well as parents of adolescent children. The study highlighted that the fragmented sources of information were detrimental to vaccine uptake and showed that there was a need to establish a nationwide trusted source of information.

The Council organised several conferences to present and discuss the data, with the national advisor  y group on immunisation as well as with the government.

The findings were critical to making holistic changes and became the main source of data used for policy changes towards the re-introduction of HPV vaccination by the MoH. The amendments to the law are in the process of being discussed in 2023. 

Results

There were three types of studies, the effectiveness of the three-dose schedule on the prevalence of HPV, then the effectiveness of the single-dose schedule on the prevalence of HPV as well as formative research on information and education material for population acceptability.

The single-dose study, based on a cohort of 475 girls enrolled in the study, including 118 in the vaccine group and 357 in the control group, demonstrated that the prevalence in the vaccine targeted group   was reduced by 92% in the first group (90% of the vaccinated group remained seropositive after six years after vaccination) compared to 58% in the unvaccinated group during the same period. The study was taken into account by the government in the consideration of the single dose schedule.

Conclusion

Taking into account the high prevalence of HPV in the country, this data showcased the importance  to re-initiate access   to the HPV vaccine. In this sense, the research constituted an important advocacy tool. Particularly, the data issued by the studies led by the National Cancer Council of Mongolia    in collaboration with academia were instrumental in informing the re-introduction of the HPV vaccine in Mongolia, particularly on the effectiveness of the vaccine from locally driven research, demonstrating that it does not represent a risk to girls, and to adapt the programme to the specific needs of communities in Mongolia.