In July 2023 the International Federation of Gynaecology and Obstetrics (FIGO) published a supplement in the International Journal of Gynaecology and Obstetrics with guidance on the sustainable implementation of vaccination programmes for women. The authors state that member societies can play a key role in assuring lifelong vaccination success for women’s health through ‘research, advocacy and education, training, and interpersonal collaboration”. Therefore, the paper covers these areas with a specific focus on implementation and communication strategies.  

Acknowledging the importance of vaccination in women’s health, the authors refer to two key “events” that draw attention to the “essential role” it plays. The first is HPV vaccination in childhood, which has been proven “critical” in accelerating efforts against cervical cancer. Secondly, the COVID-19 vaccination programme and questions around vaccination in pregnancy highlighted it as an ‘opportune occasion to prevent disease in women and their offspring”. 

Implementation strategies are unique to “cultural, economic, and personnel realities”, but the uniting factor is that the effort put into “structuring the plan upfront” should be “significant”. According to the paper, six areas require prior consideration: vaccine availability, vaccine policies, inventory and supply chain, vaccine delivery, procurement, and vaccine acceptability.  

The supplement states that protective vaccines have been among the “most successful cost-effective health interventions in medical history”, saving millions of lives every year. However, for many women, access to crucial vaccines is not guaranteed. The paper refers to barriers such as “knowledge gaps” and “misinformation” as well as “research gaps” such as grey areas surrounding vaccination in pregnancy.  

“These are exacerbated by inadequate access to health care as well as the persistent inequalities based on gender, lack of trained health providers, or structure of health systems.” 
Health within reach 

Dr Eliana Amaral, Chair of the FIGO Committee on Infections During Pregnancy commented that “global elimination of cervical cancer” and saving the lives of pregnant patients and their offspring is “within our grasp”. 

“It is our responsibility as obstetricians and gynaecologists to educate key stakeholders and to advocate for the implementation of sustainable vaccination programmes for women and girls.” 

Dr Amaral emphasised that FIGO will continue to contribute “global leadership” to encourage a future where “all women are immunised”. FIGO will serve as a support to member societies so that members can use their “scientific credibility and community standing” to become important partners in the efforts of lifesaving vaccinations in every setting.  

We encourage our community to read the supplement if interested!  

Gender inequality is a vaccine challenge 

The authors state that the greatest challenge to vaccine implementation for women derives from gender inequality, from availability to access.  

“Access is disturbingly uneven, with consequent poorer health outcomes and deaths.” 

The paper offers the case of female refugees and migrants as an example, as they have “great difficulty accessing information on health” as well as accessing basic services. Furthermore, the fear that health providers could compromise their status by contacting the authorities may prevent them from seeking health services.  

“To assure women’s rights to health, a strategy should identify means to pre-empt potential discrimination and monitor distribution to ensure equality and avoid discrimination.”  

The authors claim that the key to “lifelong vaccination” is a sustainable approach. This should be informed by repetitive evaluation as “information is obtained” and “new barriers (such as misinformation) are identified”. Considering the “significant economic improvement” and “ethical imperative” of vaccination, the motivation should triumph over barriers, they suggest.  Within the development of strategies, it is important to engage “multiple levels of the stakeholder community”, and to address areas where “capacity or knowledge is limited”.  

Taking action 

The identified goals of eliminating cervical cancer and saving the lives of pregnant women and their children are “within our grasp and our responsibility”. So, what must be done? Firstly, the authors call for “further research and knowledge sharing”. From basic immunology to deployment facilitation, strategies will require support. A “key area” for further investigation is the “management of misinformation and disinformation.  

“There is no time to wait, as women and newborns are dying because of failure to tackle this critical element of lifelong health: vaccinations.” 

If you read the supplement do let us know what you think of the strategies explored. How do you think we can improve access, and uptake, for vaccinations for women? 

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