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Human papilloma virus vaccination programs reduce health inequity in most scenarios: a simulation study

Natasha S Crowcroft123*, Jemila S Hamid145, Shelley L Deeks13 and John Frank367

Author Affiliations

1 Infectious Diseases, Public Health Ontario, 480 University Avenue, Suite 300, Toronto, Ontario, M5G 1V2, Canada

2 Laboratory Medicine and Pathobiology, University of Toronto, 1 King's College Circle, Toronto, Ontario, M5S 1A8, Canada

3 Dalla Lana School of Public Health, University of Toronto, 155 College Street, Health Science Building, 6th floor, Toronto, Ontario, M5T 3M7, Canada

4 Clinical Epidemiology and Biostatistics, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada

5 Pathology and Molecular Medicine, McMaster University, 1280 Main Street West, Hamilton, Ontario, L8S 4L8, Canada

6 Scottish Collaboration for Public Health Research and Policy, Edinburgh, Ontario, Canada

7 University of Edinburgh, Old College, South Bridge, Edinburgh, Scotland, EH8 9YL, UK

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BMC Public Health 2012, 12:935  doi:10.1186/1471-2458-12-935

Published: 31 October 2012



The global and within-country epidemiology of cervical cancer exemplifies health inequity. Public health programs may reduce absolute risk but increase inequity; inequity may be further compounded by screening programs. In this context, we aimed to explore what the impact of human papillomavirus (HPV) vaccine might have on health equity allowing for uncertainty surrounding the long-term effect of HPV vaccination programs.


A simple static multi-way sensitivity analysis was carried out to compare the relative risk, comparing after to before implementation of a vaccination program, of infections which would cause invasive cervical cancer if neither prevented nor detected, using plausible ranges of vaccine effectiveness, vaccination coverage, screening sensitivity, screening uptake and changes in uptake.


We considered a total number of 3,793,902 scenarios. In 63.9% of scenarios considered, vaccination would lead to a better outcome for a population or subgroup with that combination of parameters. Regardless of vaccine effectiveness and coverage, most simulations led to lower rates of disease.


If vaccination coverage and screening uptake are high, then communities are always better off with a vaccination program. The findings highlight the importance of achieving and maintaining high immunization coverage and screening uptake in high risk groups in the interest of health equity.