GLOBAL MEETING ON CERVICAL CANCER PREVENTION PROGRAM, NEW YORK

GLOBAL MEETING ON CERVICAL CANCER PREVENTION PROGRAM, NEW YORK

29TH NOVEMBER – 2 DECEMBER 2010

INTRODUCTION OF NATIONAL  HPV 
IMMUNISATION PROGRAM : SHARING 
MALAYSIA’S EXPERIENCE
MALAYSIA’S EXPERIENCE
Dr. Saidatul Norbaya Buang
Dr. Rohani Jahis
Department of Public Health
Ministry of Health Malaysia
 MALAYSIAN POLICY ON HPV 
IMMUNISATION
• Mother Policy
Mother Policy
– Free HPV immunization to 13 years old Malaysian 
girls starting 2010
• Operational Policy
– Voluntary  HPV immunization  Program : require 
written parental consent 
– School based immunization for all Form 1 (Year 7) 
students irrespective of actual age 
t d t i ti f t l
– Clinic based immunization for out of school 13 
years old girl
years old girl
2
Global Meeting on Cervical Cancer Prevention Program, NY; 29 Nov ‐ 2 Dec, 2010
MALAYSIAN HPV IMMUNISATION 
SCHEDULE
Dose Schedule
Dose 1
Dose 1 0 month
0 month

Dose 2 1 month after dose 1

Dose 3 6 months after dose 1

3
Global Meeting on Cervical Cancer Prevention Program, NY; 29 Nov ‐ 2 Dec, 2010
WALKING THROUGH THE HPV 
IMMUNISATION PROCESS
IMMUNISATION PROCESS

Global Meeting on Cervical Cancer 
Prevention Program, NY; 29 Nov ‐ 2 Dec,  4
2010
 Global Meeting on Cervical Cancer 
Prevention Program, NY; 29 Nov ‐ 2 Dec,  5
2010
Parents received 
consent forms 
together with Leaflet
together with Leaflet 
explaining the 
importance of HPV 
immunisation

Global Meeting on Cervical Cancer 
Prevention Program, NY; 29 Nov ‐ 2 Dec,  6
2010
 MINOR AEFI FORM

HPV i
HPV immunisation
i i cardd
Global Meeting on Cervical Cancer 
Prevention Program, NY; 29 Nov ‐ 2 Dec,  7
2010
 PUBLIC OPINION ON HPV 
IMMUNISATION
Cervical cancer vaccine: It's more pragmatic to rely on better tests
2010/11/25
B.J. FERNANDEZ, Shah Alam, Selangor
letters@nst.com
Share|

THE HHealth
lth Mi
Ministry
i t recently
tl came outt with
ith ffull-page
ll advertisements
d ti t promoting
ti the
th Human
H P ill
Papilloma Vi
Virus (HPV) vaccine
i that
th t apparently
tl helps
h l to
t preventt cervical
i l
cancer.
According to the New England Journal of Medicine, 2002, women whose partners were sexually active early (before age 17) and often had sex (having at least six
partners) were more likely to get cervical cancer than those whose partners had been less-sexually active.

I doubt very much if Malaysian teenagers fall within this category. HPV is just like other sexually-transmitted diseases where awareness and prevention should take
priority.

Furthermore, according to the World Health Organisation (WHO), if those who have been vaccinated don't go for annual screenings because they wrongly believe that
they are fully protected against cervical cancer, the number of deaths could even increase, especially as the vaccine protection wanes.
Friday August 20, 2010
According to the United States Centers for Disease Control and Prevention, as of Sept 1, last year, there were 44 reports of death among US women who received the
Vaccination against HPV is dangerous and unnecessary
vaccine.
Twenty-seven of these reports had been confirmed and 17 remain unconfirmed due to lack of patient information. In the 27 confirmed reports, there were no unusual
pattern or clustering of deaths that suggested they were caused by the vaccine.Earlier
vaccine Earlier reports indicated that this vaccine would cost RM150 to RM200 million a year
year.
THE Consumer’s Association of Penang (CAP) has repeatedly objected to the proposal to vaccinate all 13‐
It seems that the main beneficiaries are the pharmaceutical companies.
year‐old girls from the human papillomavirus (HPV) virus, a sexually transmitted virus because it is 
The ministry must come clean on the procurement process. Are the vaccines bought directly from the manufacturers or through a middleman, and what is the price paid
unnecessary, unscientific and unsafe.
for these vaccines?
In last Tuesday's edition of the Daily Mail, there was an article on how thousands of women's lives could be saved by a dramatic improvement in testing for cervical
Despite numerous objections by many quarters, a sum of RM150mil is to be spent annually by the 
cancer.The test delivers overnight results and is vastly more accurate than the smear test which is currently used to spot early signs of the disease, according to
Government
Government beginning this year on HPV vaccinations for an estimated 300,000 girls in the country as 
beginning
researchers It costs
researchers. only RM75 a this year
time and onbeHPV
could vaccinations
available forDaily
within a year.The
year The an estimated
Mail article also300
stated000 girls inbenefit
that another the ofcountry as was that patients might
the new test
need to be screened only once every five years, instead of three.
protection from only two of the 40 different cervical cancers causing HPV.
Researchers claim that the smear test misses up to a third of all cervical cancer cases but the new method picks up almost all of them.The disease kills around 1,000
HPV is contracted through sexual contact; instead of inoculating our young against a sexually transmitted 
British women every year. This means up to 300 lives can be saved by the new technique.
Global Meeting on Cervical Cancer 
disease (STD), the Government should focus on prevention by educating them on religious and moral 
Unlike the smear test, which checks for abnormal cells, this latestPrevention Program, NY; 29 Nov ‐
test, known as the Cobas test, is able to2 Dec, 
detect HPV which triggers the abnormal cell growth 8
values.
This would be a better approach. When there are more pressing needs for basic medical care,
2010 spending so much on a vaccine that is alien to our lifestyle is not
necessary.
A i i f i i STD ill i f d il ld b l ll d i f l f i
SETTING UP MALAYSIAN NATIONAL HPV 
IMMUNISATION PROGRAM
IMMUNISATION PROGRAM
STEPS INVOLVES TIME FRAME

1. POLICY, PROGRAM
DEVELOPMENT AND FUNDING
2006 -2009

DEC 2009 – JULY

2. PREPARATOTY PHASE
2009

3 IMPLEMENTATION
3. 16TH AUGUST -

4 MONITORING AND
4.
EVALUATION
END JUNE 2009 -
9
 IMPLEMENTATION
IMPLEMENTATION  
CHALLENGES ACTIONS TAKEN
1 Parental acceptance
1. P t l t ‐ Ri
Risk communication 
k i ti
•vaccine “halal” status activities
•Vaccine safety
i f ‐ MOE collaboration
MOE collaboration
‐ Consent form
‐ Halal
H l l certification
tifi ti
2. Inadequate space for  ‐ Vaccine supply with 
vaccine storage
vaccine storage WHO certified fridges
WHO certified fridges
‐ Decentralised vaccine 
storage centres
storage centres
Global Meeting on Cervical Cancer 
Prevention Program, NY; 29 Nov ‐ 2 Dec, 
2010
 MONITORING
CHALLENGES ACTIONS TAKEN
1
1. G tti information
Getting i f ti – on ‐ Set up HPV National, state 
S t HPV N ti l t t
time on daily basis and District Operation room
-Vaccine supply
pp y ‐ Standardised reporting 
p g
-Vaccination coverage format and work processes
-AEFI ‐ Communication channel, 
phone, sms, e‐mail, fax
h il f
2. Short implementation ‐ Determine timeline for 
time in 2010 completion of 1st and 2
completion of 1 and 2nd
- School and major dose
examination ‐ Use of school health team 
-End year school closure and mobilise clinic staffs 
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COST TO THE GOVERNMENT OF MALAYSIA
COST TO THE GOVERNMENT OF MALAYSIA

FUNDING SOURCE ACTIVITIES

1. Approved 2010 MOH a. Vaccine procurement
budget b. Heath promotion &
campaigns
c. Additional consumables

2. Existing Operational a. School Health teams /

Budget at state and Health clinic teams - salary
districts ( cannot be b. Vehicle maintenance and
separated from other petrols
health services) c. Staffs claims
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 LESSON LEARNT
LESSON LEARNT
MALAYSIA’SS STRENGTH
MALAYSIA STRENGTH
1. Strong political will and 
leadership drive
2. Involvement of stake 
holders during planning 
stage
3. Predict and manage 
p
potential risk
4. Importance of Program 
monitoring at all levels

13