1. Cervical cancer elimination as a public health problem has become aworldwide goal led by WHO, with HPV vaccination a central andessential part of the strategy to achieve this l.2. The increased vaccine demand this has produced has resulted invaccine shortages predicted to last another 3–5 years (to 2023–5).3. Strategies to manage during this time of vaccine shortage have beenproposed by the SAGE Committee including temporarily suspendinggender neutral and multi-birth cohort vaccination programs and anoff label protocol of delaying the second dose of vaccine 2–3 years.4. Many countries have multi-year contracts for vaccine for genderneutral and multiple birth cohort vaccination that in the short termare likely to be difficult to alter.5. Due to complex regulatory rules, moving vaccine supplies from onecountry to another may not be possible in the short term, reducingthe desired impact of the recent SAGE recommendations.6. Interrupting existing multiple birth cohort and gender neutral HPVvaccine programs (in developed countries) may be detrimental tovaccine confidence and equity.7. Existing HPV vaccine manufacturers are rapidly scaling up vaccineproduction and new manufacturers (e.g., China and India) are pre-paring to enter the market place.
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