June 2025 — In 2022, Eritrea launched its first-ever HPV vaccination campaign targeting girls aged 9 to 14 through the Multi-Age Cohort (MAC) strategy. This initiative marked a significant public health milestone, as this age group had not previously been included in routine immunization. The campaign aimed to protect adolescent girls from cervical cancer, a leading cause of cancer-related deaths among women globally. It was a bold step toward reducing preventable mortality and improving adolescent health.

Reaching the Hardest to Reach

The campaign faced considerable challenges in reaching its target population, particularly out-of-school girls and those living in remote or underserved areas. Eritrea’s diverse geography—including mountainous regions and isolated villages—posed logistical difficulties in transporting vaccines and setting up vaccination sites. Despite these barriers, the campaign achieved a 93% coverage rate in its first round and ultimately reached over 96% of the target population. Nearly 80% of out-of-school girls were vaccinated, a testament to the campaign’s inclusive and community-centered approach.

Building Momentum Through Advocacy and Policy

The campaign’s success was rooted in strong advocacy and policy support. Stakeholder engagement began early, with meetings and workshops involving government officials from health and education sectors, healthcare providers, and community leaders. These engagements emphasized the importance of HPV vaccination for protecting girls from cervical cancer and helped secure political and financial backing. Advocacy efforts also focused on integrating the HPV vaccine into Eritrea’s national immunization policy, ensuring long-term sustainability and cooperation with the education sector.

Empowering Front-Line Workers

To support the MAP strategy, front-line workers—including nurses, community health workers, and volunteers—were trained in vaccine administration, cold chain management, communication skills, and the management of adverse events for HPV vaccination. They were also equipped with educational materials and practical tools to support their outreach efforts and conversations with young girls and parents about HPV vaccination. This investment in human resources ensured that health workers were confident, informed, and capable of delivering vaccines safely and effectively for a novel target group in Eritrea.

Mobilizing Communities for Participation

Social mobilization was a key strategy in ensuring the success of the HPV vaccination campaign. To reach eligible girls—especially those out of school and in remote areas—community health workers conducted door-to-door visits to raise awareness, address concerns, and encourage participation. Health fairs were organized across communities, offering free health check-ups, educational sessions, and vaccination services in a welcoming and festive environment. These events not only facilitated access to vaccines but also created opportunities to engage families on broader issues affecting adolescent girls. In addition to promoting immunization, community workers provided counselling on the importance of school attendance, personal hygiene, and preventive health practices. This integrated approach helped reinforce positive health and education behaviors, contributing to the overall well-being of girls beyond the scope of the vaccination campaign.

Engaging Schools and Local Leaders

Schools played a central role in the campaign, partnership between the health and education sectors were essential to ensuring vaccination of young girls. Teachers were trained to provide accurate information about the HPV vaccine and to support school-based vaccination drives. Educational sessions were held for students and parents, creating a supportive environment for vaccine uptake. Religious and traditional leaders were also engaged to endorse the campaign and share accurate information through sermons, community meetings, and advocacy events. Their involvement helped dispel myths and build trust within communities.

Communicating Across Channels

A multi-channel communication strategy ensured that accurate, culturally relevant information reached a wide audience. Radio and television programs featured interviews with healthcare professionals, testimonials from vaccinated girls, and Q&A sessions. Print materials such as flyers, posters, and brochures were distributed in schools, health centers, and public spaces. Social media platforms were used to engage young people through videos, live sessions, and interactive content, helping to normalize the vaccine and celebrate its benefits.

Monitoring Progress and Ensuring Safety

Robust monitoring and evaluation mechanisms were established to track progress and ensure accountability. Real-time data collection tools were used to monitor vaccination coverage, identify gaps, and respond to emerging challenges. Post-campaign evaluations assessed the effectiveness of SBC strategies and gathered community feedback through focus group discussions and interviews. These evaluations revealed high levels of parental acceptance, driven by trusted community figures and school-based education sessions. Communication channels such as radio, community meetings, and printed materials were found to be particularly effective in dispelling myths and increasing vaccine confidence. Adverse events following immunization were minimal and mostly minor, reinforcing the safety of the vaccine and the effectiveness of the campaign’s response systems.

Results That Inspire

The campaign’s reach was extensive, covering over 1,400 schools, 300 health stations, 250 temporary vaccination sites, and 60 mobile clinics. High levels of parental acceptance were observed, driven by community meetings, school-based activities, and the trusted voices of religious and traditional leaders. The campaign was supported by significant funding from GAVI and technical assistance from UNICEF, WHO, and other immunization partners. This collaboration ensured that the campaign had the resources and expertise needed to succeed.

Lessons Learned and the Road Ahead

The Eritrean experience offers valuable lessons for future immunization efforts. Community engagement proved essential in building trust and ensuring participation. Multi-stakeholder collaboration between ministries, supportive partners, and local leaders provided the foundation for success. Tailored communication strategies helped address local concerns and increase vaccine acceptance. Continuous capacity building and real-time monitoring ensured that the campaign remained responsive and effective.

Looking forward, Eritrea plans to integrate the HPV vaccine into its routine immunization program under the Ministry of Health’s Expanded Programme on Immunization (EPI). Ongoing community engagement will be maintained through regular meetings, school activities, and continued involvement of local leaders. Efforts will also focus on strengthening health systems, particularly in remote areas, and scaling up cervical cancer screening programs to complement vaccination. Continuous research and data collection will guide future strategies and ensure long-term impact.