Health and economic impact of the human papillomavirus (HPV) vaccine in Mozambique

2 Abstract Mozambique is among the countries with the highest cervical cancer (CC) incidence rates in the world. Yet, in sub-Saharan Africa, only 5% of CC patients receive appropriate treatment. In 2021, Mozambique integrated the prophylactic human papillomavirus (HPV) vaccine into its national immunization program as a primary prevention strategy. As part of a qualitative research effort on participatory modeling, this study aimed to quantify the magnitude and distribution of expected health and economic outcomes of the current nationwide HPV vaccination program, hypothetical scale-up scenarios, and global targets. We applied and extended a closed cohort model to quantify the vaccine program’s direct potential population health benefits (in averted CC cases and deaths), financial savings to patients (in direct medical treatment costs saved and in financial risk protection provided), health provider benefits measures in saved labour (full-time equivalents, FTEs) and distribution of benefits across the entire country under empirically informed and potential vaccination coverage scenarios. With a coverage of 18.9% in 2021, the vaccination program is estimated to avert up to 9.7% of expected CC cases and deaths (from 4.0% in the highest socioeconomic quintile (HQ) to 11.6% in the lowest socioeconomic quintile (LQ)). Across the lifetime of a single vaccination cohort, an average of US$106,532 (min: US$48,382, max: US$157,811) in direct medical CC treatment expenditure for patients and the time equivalent to 3.3 (2.6 – 3.9) full-time healthcare workers is saved per year. Over 30 years, 50% vaccination coverage could prevent 23.9% of predicted cases and fatalities (LQ: 25.2% to HQ: 14.8%). With a gradient in vaccine coverage favoring higher socioeconomic quintiles in urban areas, the benefits in the LQ rural population are estimated to be six times greater than in the LQ urban population. These findings can contribute to fair and efficient planning decisions from various stakeholder perspectives in policy dialogues around the HPV vaccination programme in Mozambique, and at a global level. Key messages This study evaluates the health and economic effects of Mozambique’s HPV vaccination program using a cohort-based modeling approach, estimating reductions in cervical cancer cases, financial burden, and healthcare system demands. At 50% vaccine coverage, the program could avert 26% of expected cervical cancer cases and deaths, with the highest impact observed among lower-income populations who face greater disease burden and limited access to care. The financial benefits extend beyond individual health gains, as the program could reduce catastrophic health expenditures, alleviate pressure on the healthcare workforce, and contribute to more equitable health outcomes. These insights support strategic decision-making on HPV vaccination expansion, highlighting the need for targeted efforts to maximize both effectiveness and equity in Mozambique’s cancer prevention initiatives. Competing Interest Statement The authors have declared no competing interest. Funding Statement PC and TH acknowledge funding from the MRC Centre for Global Infectious Disease Analysis (reference MR/X020258/1), funded by the UK Medical Research Council (MRC). This UK funded award is carried out in the frame of the Global Health EDCTP3 Joint Undertaking. The study was part of a doctoral study programme (for PC) that was supported by the London Interdisciplinary Social Science Doctoral Training Programme (LISS DTP), funded by the Economic and Social Research Council (ESRC). Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Footnotes Updated details in methodology and supplement. Discussion updated with contextualization of findings. Data Availability All data produced in the present study are available upon reasonable request to the authors