LARA ADEJORO writes on the barriers to accessing the Human Papillomavirus vaccine in Nigeria and how it threatens the elimination of cervical cancer in the country
The failure of the Federal Government to integrate the Human Papillomavirus vaccine into the country’s national immunisation schedule is knocking off hopes for the prevention and elimination of cervical cancer in Nigeria.
Many Nigerian girls and women are left out without protection against the deadly yet preventable disease, simply because they are out of reach as a result of the cost and limited doses.
HPV is the most common viral infection of the reproductive tract, mainly transmitted through sexual contact, and most people become infected with HPV shortly after the onset of sexual activity.
Meanwhile, HPV vaccines are vaccines that prevent infection by certain types of Human Papillomavirus. The HPV vaccines have the potential to prevent more than 90 per cent of HPV-attributable cancers.
In Nigeria, an estimated 14,000 women are diagnosed with cervical cancer, and 7,968 women die from the disease every year.
The World Health Organisation said two HPV types (16 and 18), which are common in Nigeria, are responsible for nearly 50 per cent of high-grade cervical pre-cancers.
However, vaccination against HPV and screening and treatment of pre-cancer lesions are cost-effective ways to prevent cervical cancer.
A 2021 report from the Information Centre on HPV and Cancer showed that Nigeria has a population of 56.2 million women ages 15 and older who are at risk of developing cervical cancer.
“Cervical cancer ranks as the second most frequent cancer among women in Nigeria and the second most frequent cancer among women between 15 and 44 years of age,” the report says.
“About 3.5 per cent of women in the general population are estimated to harbour cervical HPV-16/18 infection at a given time, and 66.9 per cent of invasive cervical cancers are attributed to HPVs 16 or 18.”
Failed promise
On March 16, 2020, the Vice President of Nigeria, Prof. Yemi Osinbajo, promised that the HPV vaccines would be introduced into the national immunisation schedule in a couple of months, but 35 months later, the government is yet to fulfil the much-anticipated promise.
In his remarks at the flag-off event for the Integrated Medical Outreach Programme, Osinbajo said, “The Federal Government is fully responsible for providing the required immunisation vaccines in collaboration with our global partners, to ensure consistent and sustainable availability of life-saving vaccines for all eligible children in Nigeria.
“We would ensure in the next couple of months that Rotavirus and Human Papillomavirus vaccines are introduced into the national immunisation schedule, to prevent childhood diarrheal diseases and reduce the incidence of cervical cancer in women. It is the firm commitment of the Federal Government that no child or individual should be without access to life-saving vaccines and primary health care services,” he said.
While the FG launched the Rotavirus vaccine into routine immunisation in August, 29 months after the promise, it has yet to introduce the HPV vaccines into routine immunisation as promised.
The Executive Director and Chief Executive Officer of the National Primary Health Care Development Agency, Dr Faisal Shuaib, said the introduction proposal had been submitted to the Global Alliance for Vaccine and Immunisation and the country has received provisional approval to introduce the vaccine in the third quarter of 2023.
He explained, “The HPV vaccine is to prevent HPV infection, which is the leading cause of cervical cancer in women in the country and globally. The planned introduction of the HPV vaccine into the country’s routine immunisation schedule for girls (at the age of nine) is on track.
“The pre-introduction activities have already commenced. The introduction is going to be phased and completed in 2024, and then run as routine immunisation in the country.”
Also, the Minister of Health, Dr Osagie Ehanire, recently said the HPV vaccine would be introduced soon but failed to mention the exact date it will be introduced.
Dr Ehanire said, “We shall very soon be trying the malaria vaccine, we have applied to receive the malaria vaccine, and that will also be introduced, as well as the application and the permit to be given the Human Papillomavirus vaccine.”
But experts say girls and women should not have to wait years to receive the life-saving HPV vaccination.
A professor of oncology at the Lagos University Teaching Hospital, Idi-Araba, Lagos, Francis Durosinmi-Etti, said, “The HPV vaccination helps protect against cancers, and without urgent intervention, this will undermine cervical cancer elimination in the country.
“It is high time the vaccines are introduced and made freely available in the country. This will help save many lives. It is not too much for the government to integrate it into routine immunisation in the country. It is the only way we can move forward, that is what they do abroad and in some other African countries.
“If the vaccines are made available for girls before they have any experience of sexual life, it will ensure the prevention of the possibility of developing cancer of the cervix or other areas.”
Findings show that HPV vaccines in the country are either scarce or expensive for many women and girls in the country, amid the rising cost of living.
The cost may, however, not be unconnected to the high inflation rate and the cost of production.
At the University of Medical Sciences Teaching Hospital Complex, Akure, the vaccine was not available, but an official at the community department of the hospital said an order could be made upon request.
At the Federal Medical Centre, Jabi, Gardasil, and Cervarix vaccines are available for N60,000 and N30,000, respectively.
Also, at the Nisa Premier Hospital, Abuja, Gardasil costs N55,000.
But, at the Garki Hospital, the official at the Immunisation Unit said the vaccine was not available.
Meanwhile, WHO recommends a one- or two-dose schedule for girls aged nine to 14, a one- or two-dose schedule for girls and women aged 15-20; two doses with a six-month interval for women older than 21, a minimum of two doses, and when feasible, three doses remain necessary for those known to be immunocompromised and/or HIV-infected.
By implication, one will spend N120,000, N110,000, or N60,000 to get fully vaccinated.
A professor of Obstetrics and Gynaecology at the College of Medicine, Lagos State University, Ikeja, Oluwarotimi Akinola, said barriers to the uptake of the HPV vaccine have implications for young women’s future sexual, physical, and reproductive health.
Akinola said, “The implication is that people who have HPV might have cancer, and we need more advocacies to make sure that it is available in the country.”
Also, a professor of public health, Tanimola Akande, said “HPV vaccination is mainly targeting the control of cervical cancer. Non-availability of the vaccine will mean a drawback in the effort to reduce the prevalence of cervical cancer in our society.”
HPV vaccines
Meanwhile, some African countries like South Africa, Rwanda, Seychelles, Sierra-Leone, Kenya, Senegal, Malawi, Zimbabwe, Libya, Lesotho, Uganda, Botswana, and Mauritius have introduced the HPV vaccine into their routine immunisation schedules.
In 2011, Rwanda became the first African nation to implement a national HPV vaccination programme.
In 2014, the Ministry of Health in Seychelles introduced the HPV vaccine into its routine immunisation schedule.
In South Africa, the school-based national HPV vaccination programme was introduced in 2014, targeting girls aged nine or older.
In 2018, the HPV vaccine was introduced into Senegal’s national routine immunisation programme.
In 2022, the Sierra Leone government added the vaccine to the routine immunisation schedule and launched a campaign to reach 153,991 girls with the vaccine.
The Kenya Ministry of Health launched the nationwide HPV vaccine introduction in October 2019.
To respond to the high rates of cervical cancer, the government of Zimbabwe launched the introduction of the HPV vaccine into the national immunisation schedule in May 2018.
Meeting WHO target
WHO said to eliminate cervical cancer, all countries must reach and maintain an incidence rate of less than four per 100,000 women.
It said achieving that goal rests on three key pillars and their corresponding targets: fully vaccinating 90 per cent of girls with the HPV vaccine by the age of 15; screening 70 per cent of women using a high-performance test by the age of 35 and again by the age of 45; and treating 90 per cent of women with pre-cancer and 90 per cent of women with invasive cancer.
“Each country should meet the 90, 70, and 90 targets by 2030 to get on the path to eliminating cervical cancer within the next century,” it added.
The global health organisation said averting the development of cervical cancer by increasing access to effective vaccines is a highly significant step in alleviating unnecessary illness and death.
Prof Durosinmi-Etti said, “The government needs to increase the health budget or cut back in some areas. The country needs the HPV vaccine immediately to meet the WHO target. It is highly recommended like they do in other countries.
“The way forward is for us to find money, and it should be prioritised for the prevention of this deadly disease.”
