Prospects and Challenges in the Introduction of Human Papillomavirus Vaccines in the Extended Middle East and North Africa Region

•Adolescent vaccinations are generally weak; tetanus coverage for girls is about 58%.•Abu Dhabi (UAE) introduced HPV vaccine to school girls aged 15–17 years in 2008.•Morocco's ITAG recommends HPV vaccination for girls aged 11 years.•Cost is a major hurdle for MENA countries because many are not GAVI eligible.•Cultural and religious norms need to be addressed when designing IEC materials.

The development of effective and safe human papillomavirus (HPV) vaccines provides a great opportunity to prevent a devastating disease, cervical cancer, and a host of other related diseases. However, the introduction of these vaccines has been slow in the Extended Middle East and North Africa (EMENA) region. Only one country has introduced the vaccine and few countries plan HPV vaccine introduction in the coming 5 years. Several factors influence the slow uptake in the region, including financial constraints, weak infrastructure for adolescent vaccine delivery, competition with high priority vaccines, and lack of reliable data on the burden of HPV disease. Other barriers include cultural and religious sensitivities, as the vaccines are offered to prevent a sexually transmitted disease in young girls. Recommendations to enhance HPV vaccine introduction in EMENA countries include establishing a regional joint vaccine procurement program, enhancing the adolescent vaccination platform, documenting the burden of cervical cancer, strengthening local National Immunization Technical Advisory Groups and designing Information, Education and Communication material that address cultural concerns.This article forms part of a regional report entitled “Comprehensive Control of HPV Infections and Related Diseases in the Extended Middle East and North Africa Region” Vaccine Volume 31, Supplement 6, 2013. Updates of the progress in the field are presented in a separate monograph entitled “Comprehensive Control of HPV Infections and Related Diseases” Vaccine Volume 30, Supplement 5, 2012.