Cost of introducing human papillomavirus vaccination into Nigeria's expanded program on immunization: Lessons from two Nigerian states

In 2023, Nigeria incorporated the Human papillomavirus (HPV) vaccine into its Expanded Program on Immunization to reduce the burden of HPV-related cervical cancer. This study estimated the financial costs and explored implementation experiences of HPV vaccine introduction in Nigeria, focusing on Bayelsa (southern) and Taraba (northern) states – two geographically challenging areas. A mixed-methods approach was used. Quantitative costing captured vaccine and operational expenditures using program documents, including the approved vaccine introduction grant and activity reports, reflecting actual 2023 costs. Costing was conducted from the provider perspective, with all costs reported in 2023 US dollars. Key informant interviews provided additional insights to contextualize quantitative findings. Both states achieved high coverage (Bayelsa, 74%; Taraba, 78%), approaching the ambitious 80% national target. The total financial cost per fully vaccinated girl was similar – $5.76 (Bayelsa) and $5.75 (Taraba). Vaccine accounted for $4.73 (≈82%) per girl, while operational costs were $1.04 and $1.02 in the respective states. Operational costs were mainly driven by transportation, logistics and data tool costs (Bayelsa: 40.74%; Taraba: 42.20%). Service delivery (Bayelsa, 22.2%; Taraba, 22.4%), and advocacy, communication, and social mobilization (ACSM) costs (Bayelsa, 16.42%; Taraba, 16.70%) were also notable cost drivers. Qualitative insights from key stakeholders highlighted strong leadership, coordination, ACSM and partners collaboration, as critical in achieving high coverage, while need for context-specific resource allocation was evident due to difficult terrains. HPV vaccine introduction in Bayelsa and Taraba demonstrated that an initial intensive campaign strategy, supported by strong community engagement via ACSM and partners collaboration, can rapidly achieve high coverage in hard-to-reach terrains. Vaccine procurement remains the largest cost, highlighting the need for sustainable financing. Terrain-related differences emphasize the need for context-specific resource allocation. This experience provides a practical model for other low– and middle–income countries planning nationwide HPV vaccine scale-up and health-system strengthening. • Human papillomavirus (HPV) vaccination is essential to reducing cervical cancer, a leading cause of cancer-related death among women in Nigeria. • Sustainability of vaccination programs is threatened in resource-limited countries as donor funding declines. • Estimated financial cost of introducing HPV vaccination in Bayelsa and Taraba States is $5.76 per girl. • Findings highlight financial and operational challenges of HPV vaccine introduction and provide a model for scale-up in similar low-resource settings.