By Vivian Ihechu
When Mrs Mary James informed her friends that she would be taking her daughter, Faith, 13, to get a dose of Human Papillomavirus (HPV) vaccine, they exchanged perplexing glances.
Her friends, Mrs Hope Uwa and Mrs Yemi Adams questioned her decision, based on many yet to be founded concerns on HPV vaccine.
However, James, a health worker, allayed their fears explaining that “ HPV vaccination is about the most effective approach to prevent cervical cancer.
“And, when girls of nine to 14 years get that vaccination, it lowers their chances of developing cervical cancer especially, and other cancers associated with HPV’’.
HPV is an infection that can lead to some cancers especially cervical cancer; a common female cancer that claims the lives of no fewer than 340,000 women worldwide every year.
Current estimates for Nigeria in 2023 by the Human Papillomavirus (HPV) Centre indicate that every year, 12,075 women are diagnosed with cervical cancer and 7,968 die from the disease in the country.
About 3.5 per cent of women in the general population are estimated to habour cervical HPV-16/18 infection at some point, and 66.9 per cent of invasive cervical cancers are attributed to HPVs 16 or 18.
About 70 per cent of all known cases of cervical cancer are caused by the HPV serotypes 16 and 18, which are most commonly transmitted through sex. HPV can also be transmitted through the use of contaminated hospital equipment and from mother-to-child during pregnancy.
It can also be transmitted through direct skin or mucosa contact.
According to the National Cancer Institute, HPV can cause six types of cancers including anal cancer, cervical cancer, oropharyngeal (throat) cancer, penile cancer, vaginal cancer, and vulvar cancer.
While one’s immune system usually controls HPV infections to be cleared by the body, within a year or two, high-risk HPV infections can persist causing cancer.
The WHO and UNICEF Estimates of National Immunisation Coverage (WUENIC) provides the world’s largest and most comprehensive dataset on immunisation trends for vaccinations against 14 diseases.
WUENIC latest report says the share of adolescent girls globally who received at least one dose of the HPV vaccine, which provides protection against cervical cancer, increased from 20 per cent in 2022 to 27 per cent in 2023.
This is largely driven by strong introductions in Gavi-supported countries, including Nigeria.
WUENIC report says that the use of the single-dose HPV vaccine schedule also helped boost vaccine coverage.
But, of concern is that though the HPV vaccine is now available to over 50 per cent of eligible girls in African countries, HPV vaccine coverage is well below the 90 per cent target to eliminating cervical cancer as a public health problem, reaching only 56 per cent of adolescent girls in high-income countries and 23 per cent in low- and middle-income countries.
The Federal Government of Nigeria, in October 2023, through the National Primary Health Care Development Agency launched a free rollout of 7.7 million HPV vaccine doses for girls.
The single-dose HPV vaccine is introduced into the routine immunisation programme, in the fight against HPV-related cancers, including cervical cancer.
The phased HPV vaccination campaign aims to protect no fewer than 16 million girls by 2025.
It is expected that within the next two years, the programme will reach over three million nine-year-old girls and 14 million girls between 10 to 14 years old, making it the largest roll-out of the single-dose schedule to date.
However, in spite the high prevalence of HPV infections and cervical cancer in Nigeria, the utilisation of the HPV vaccine as a highly effective preventive measure remains low.
Culture and gender dynamics, trust, fertility and promiscuity concerns influence people’s attitudes, alongside lack of adequate access and information.
For instance, on the introduction of the mass HPV vaccination programme, a group from a geographical region called on teenage females and their parents to reject cervical cancer vaccination from the Federal Government.
They saw it as a depopulation programme, demonic agenda, and giving consent for children to be used as “guinea pigs’’ for medical experiments.
According to them, some of the vaccines are targeted at creating infertility among the men and women in Africa, particularly among the highly fertile race.
Dr Obinna Ebirim, a Public Health Professional and Health Promotion Specialist, spoke on some of the culture and gender dynamics influencing people’s attitudes toward immunisation in general, and the HPV vaccine in particular.
He says: “Cultural and gender dynamics significantly influence attitudes toward immunisation, including the uptake of HPV vaccine.
“Some communities refuse any item from the Western world, including clothing and vaccines.
“Specifically for HPV vaccines, some cultures still falsely believe that HPV vaccines will make girls sterile and unable to conceive, thus reducing the population of their communities.
“Some communities falsely believe the HPV vaccine can lead to promiscuity among girls, making parents hesitant to vaccinate their daughters.
“These are just some examples of cultural beliefs that deny children lifesaving vaccines.’’
“In some communities, the belief that boys should be prioritised over girls for vaccinations due to traditional gender roles can result in lower coverage among girls especially when HPV vaccine introduction programmes target only girls.
“The HPV vaccine is often administered through school-based programmes.
“ However, in communities where gender and cultural norms discourage girls from attending school because boys should be the ones in school while girls are at home, in the market or the farm helping their mothers, these girls miss out on the vaccine’’.
“Women in many cultures require permission from their husbands to access healthcare services, including vaccinations for their children.
“If the husband is not convinced of the benefits, the children may not receive their vaccines.
“ Additionally, women may lack the financial means to cover transportation costs to vaccination sites, limiting their ability to seek these services,’’ he explains.
According to Ebirim, addressing these cultural and gender dynamics requires targeted interventions that involve community engagement, education, and the empowerment of women.
He says that efforts to promote girls’ education can indirectly improve HPV vaccine coverage.
“Additionally, in areas where girls are more likely to be absent from school for reasons such as household chores, being in the market, farming or early marriage, targeted outreach and alternative vaccination strategies are necessary.
“By understanding and addressing these specific barriers, we can improve vaccination coverage and protect more children and women from preventable diseases’’.
To advance progress to ensure that girls and women everywhere have access to life-saving HPV vaccines, he says there are opportunities to tap into to increase HPV vaccine uptake.
“In Africa, there are many out-of-school girls. So, while school-based initiatives are crucial to drive HPV vaccine uptake, there should be a greater focus on initiatives to reach out-of-school girls.
“How can we reach the many young African girls who work as nannies, who are traders in formal and informal market settings, or who work on farms or engage in various forms of child labour?.
“This requires targeted approaches and ministries of health working together with other sectors such as ministries of education, agriculture, and commerce to enhance HPV vaccine uptake among both in-school and out-of-school girls.’’
He also elaborates the roles of community health workers, training, partnerships and collaborations.
“Community health workers play an important role in reaching women and caregivers in underserved populations.
“By training and deploying them to educate communities about the importance of the HPV vaccine and support vaccinations, African countries can significantly increase vaccine uptake.
“These community health workers can easily identify and address specific barriers faced by out-of-school girls since they reside in these communities and better understand the context’’.
On partnerships and collaborations, he says they remain vital.
This is as non-governmental organisations (NGOs), international agencies, multi-laterals and the private sector can provide additional resources and support for HPV vaccination programmes and innovative approaches.
These may include mobile outreaches and public-private partnerships that enhance access to vaccines.
Also, comprehensive health education campaigns that address misconceptions and provide accurate information about the HPV vaccine are helpful.
“But, they should be culturally sensitive and utilise channels and languages that resonate with targeted local communities,’’ he advises.
Advocating policies that support vaccine accessibility, affordability, and integration into routine immunisation schedules can create a sustainable framework for increasing HPV vaccine coverage, he says.
Additionally, African communities need to unlearn cultural and gender norms that create barriers to vaccination.
Ebirim stresses that the economic and social empowerment of women is critical to improving vaccination rates.
“Programmes that provide financial support or reduce transportation costs such as demand-side incentive (DSI) programmes, as well as initiatives that educate and engage men on the importance of vaccines, can help overcome these barriers.
“Promoting women’s autonomy in healthcare decisions can have a positive impact on immunisation rates.
“African girls and women are strong and resilient, and with a little support to address some barriers, they can overcome any remaining obstacles to get themselves and their children vaccinated’’.
In support, Prof. Isaac Adewole, a former Minister of Health, Nigeria and Co-Founder, African Cancer Coalition, said that it takes about an average of 20 to 30 years for cervical cancer to develop.
Hence, the HPV vaccination offers a window of opportunity to kick against the cancer.
Prof. Margaret Stanley of Cambridge University, UK and Past President of the International Papillomavirus Society (IPVS), assures that HPV vaccines are safe, effective, and can prevent up to 90 per cent of cervical cancer cases.
Moving forward, positive, assured and sustained actions are needed to demystify cultural and gender barriers inhibiting girls and women from accessing HPV vaccination.
This will increase uptake in order to save and protect our girls and women by preventing cervical cancer and making elimination a reality.
Ihechu is a Senior Health Editor with the News Agency of Nigeria
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