Lancet Global Health
Jul 2016 Volume 4 Number 7 e427-e501
http://www.thelancet.com/journals/langlo/issue/current
Editorial
The right(s) approach to Zika
The Lancet Global Health
Summary
The Zika virus epidemic is spreading: 63 countries are now reporting transmission, over 1500 cases of related microcephaly or CNS malformations have been confirmed this year, and knowledge on the disease is advancing slowly. Adding to the tension around Zika, at the epicentre of the outbreak, Brazil is bracing for a large-scale mass gathering: the Olympic and Paralympic Games 2016 in Rio de Janeiro. Conflicting opinions on the need to postpone or cancel the Games have been expressed, but during the 69th World Health Assembly last month, the WHO issued clear public health advice on the matter: the Games will not significantly change the international spread of the virus and travellers can reduce their risk of contracting the disease by following simple prevention measures such as avoiding mosquito bites with repellents and adequate clothing, practising safe sex, staying in air-conditioned housing, and avoiding areas with poor water and sanitation.

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Comment
Global disparities in HPV vaccination
Ophira Ginsburg
Summary
Cervical cancer is the fourth most common cancer in women globally, but remains the second most common cancer (after breast cancer) in many low-income and middle-income countries, and is still more common than breast cancer in sub-Saharan Africa.1 Most new cervical cancer cases (85%) and deaths (88%) occur in low-income and middle-income countries, where health systems are often fragmented or fragile, and where most have not yet implemented effective national cervical cancer screening programmes.

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Articles
Global estimates of human papillomavirus vaccination coverage by region and income level: a pooled analysis
Laia Bruni, Mireia Diaz, Leslie Barrionuevo-Rosas, Rolando Herrero, Freddie Bray, F Xavier Bosch, Silvia de Sanjosé, Xavier Castellsagué
Summary
Background
Since 2006, many countries have implemented publicly funded human papillomavirus (HPV) immunisation programmes. However, global estimates of the extent and impact of vaccine coverage are still unavailable. We aimed to quantify worldwide cumulative coverage of publicly funded HPV immunisation programmes up to 2014, and the potential impact on future cervical cancer cases and deaths.
Methods
Between Nov 1 and Dec 22, 2014, we systematically reviewed PubMed, Scopus, and official websites to identify HPV immunisation programmes worldwide, and retrieved age-specific HPV vaccination coverage rates up to October, 2014. To estimate the coverage and number of vaccinated women, retrieved coverage rates were converted into birth-cohort-specific rates, with an imputation algorithm to impute missing data, and applied to global population estimates and cervical cancer projections by country and income level.
Findings
From June, 2006, to October, 2014, 64 countries nationally, four countries subnationally, and 12 overseas territories had implemented HPV immunisation programmes. An estimated 118 million women had been targeted through these programmes, but only 1% were from low-income or lower-middle-income countries. 47 million women (95% CI 39–55 million) received the full course of vaccine, representing a total population coverage of 1·4% (95% CI 1·1–1·6), and 59 million women (48–71 million) had received at least one dose, representing a total population coverage of 1·7% (1·4–2·1). In more developed regions, 33·6% (95% CI 25·9–41·7) of females aged 10–20 years received the full course of vaccine, compared with only 2·7% (1·8–3·6) of females in less developed regions. The impact of the vaccine will be higher in upper-middle-income countries (178,192 averted cases by age 75 years) than in high-income countries (165,033 averted cases), despite the lower number of vaccinated women (13·3 million vs 32·2 million).
Interpretation
Many women from high-income and upper-middle-income countries have been vaccinated against HPV. However, populations with the highest incidence and mortality of disease remain largely unprotected. Rapid roll-out of the vaccine in low-income and middle-income countries might be the only feasible way to narrow present inequalities in cervical cancer burden and prevention.
Funding
PATH, Instituto de Salud Carlos III, and Agència de Gestió d’Ajuts Universitaris i de Recerca (AGAUR)