African countries face the challenge of protecting girls from HPV

As health workers arrived at Upendo Primary School on the outskirts of Tanzania’s capital, they told the girls, who will turn 14 this year, to line up to get vaccinated. Ms. Quinn Chengo had an urgent whisper consultation with her friends. What was the injection for? Could it be the Covid vaccine? (They had heard rumors about it.) Or was it to keep you from having children?

Chengo was worried, but remembered that his sister had been vaccinated against the human papillomavirus last year. So she got in line. However, she sneaked away and some girls hid behind the school building. When some of Chengo’s friends came home that night, they were confronted with questions from his parents. Parents were worried that it would make their children more comfortable with the idea of ​​having sex—even if some didn’t want to come out and say it right away.

The HPV vaccine, which provides near-total protection against the sexually transmitted virus that causes cervical cancer, has been administered to adolescents in the United States and other developed countries for almost 20 years. However, it is only just beginning to be widely adopted in low-income countries, where 90% of cervical cancer deaths occur.

Tanzania’s experience of misinformation, cultural and religious discomfort, and supply and logistical obstacles are some of the challenges countries face in implementing what is considered a key health intervention in the region. is highlighted.

Cancer screening and treatment is limited in Tanzania. The injection could significantly reduce deaths from cervical cancer, the deadliest cancer for women in Tanzania.

HPV vaccination efforts have been hampered across Africa for many years. Many countries planned programs to start in 2018 in collaboration with Gavi, a global organization that supplies vaccines to low-income countries. However, Gabi was unable to score.

In the United States, the HPV vaccine costs about $250. Gabi, which typically negotiates heavy discounts from pharmaceutical companies, was aiming to pay $3 to $5 per dose for the large doses of vaccines it sought to procure. But high-income countries were also expanding their programs, and vaccine makers Merck and GlaxoSmithKline targeted those markets, leaving few in the developing world.

“We insisted that we needed to be supplied by manufacturers, but it never happened,” said Aurelia Nguyen, chief strategy officer at Gavi. “And the 22 million girls that countries requested to be vaccinated did not have vaccine supplies at the time.

Low-income countries are having to decide where to allocate limited amounts of vaccine. Tanzania chose to first target 14-year-olds, who are considered the most likely to initiate sexual activity, as the oldest girls to be targeted. Girls begin to drop out at that age before transitioning to secondary school. The country had planned to distribute the vaccine mainly in schools.

But Dr Florian Tinuga, program manager for the Ministry of Health’s Immunization and Vaccine Development Division, said vaccinating teenagers with HPV vaccines is not like vaccinating babies for measles. . Even 14-year-olds would agree. But they’re not adults yet, so their parents need to be persuaded too. That means talking openly about sex, a sensitive issue in this country.

And since the 14-year-olds were considered young women of almost marriageable age, rumors quickly spread on social media and messaging apps about what was really in the shots: this one. is a stealth contraceptive campaign from the West?

The government didn’t anticipate the problem, Dr. Tinuga said regrettably. For those with limited understanding of research and scientific evidence, this rumor has been difficult to refute.

The COVID-19 pandemic has further complicated the HPV campaign as it has disrupted health care systems, forced school closures and created a new level of vaccine hesitancy.

“Parents drag their children out of school when they hear that vaccinations will start,” said Kalila Mbou, who heads the Tanzania office of Girl Effect, a non-governmental organization that Gabi funds to stimulate demand for vaccines. says Mr. “After COVID-19, the issue of vaccination has skyrocketed.”

Girl Effect is a radio drama, sophisticated poster, chatbot, social media campaign Encourage girls to give injections. However, this and other efforts in Tanzania have failed to fully consider the power of other gatekeepers, such as religious leaders and school officials, who have a strong voice in decisions, and have failed to motivate girls to accept vaccines. Mr. Mbou said the focus is on

Asia Shomali, 16, was horrified last year when medical workers came to her school in the suburbs of Dar es Salaam. The students hadn’t been briefed, so she didn’t know what the shooting was for. Shomari said it was a Muslim school and no one talked about sex. She hid behind a toilet block with a few friends of hers until her nurses left.

“Most of us decided to run away,” she said. When she went home and detailed what had happened, her mother said she was right about what she had done and that vaccines involving her reproductive organs were suspect.

But now her mother, Piri Abdalla, is starting to change her mind. “Girls her age are sexually active and have a lot of cancer,” she says. “If you can protect her, that’s fine.”

Girl Effect was also aimed at mothers, but the reality is that in most families, fathers have the final say, Mbo said. “Girls don’t have the power to decide.”

Despite all the difficulties, Tanzania has managed to reach almost three-quarters of 14-year-old girls with the first vaccination in 2021. (Tanzania reached its primary coverage target twice as fast as the United States.) Persuading people to return for a second dose was even more difficult, with a second dose six months later. Only 57% received it. Similar disparities persist in most sub-Saharan countries that have initiated HPV vaccination.

Because Tanzania relies primarily on temporary school clinics for vaccinations, some girls miss out on a second dose because they quit school before health workers return.

Rama Saeed was vaccinated at school in 2019 when he was 14 years old, but dropped out soon after because he failed to pass the exams to advance to secondary school. She said Ms. Saeed had made several attempts to get a second vaccination at her neighborhood public health clinic, but none had one and she gave up last year.

Tanzania is most likely to switch to a single-dose regimen next year, Dr Tinuga said.there is Increasing Evidence Supporting Single-Dose HPV Vaccine In 2022, WHO recommends countries to switch to single-dose vaccination campaigns to improve costs and supply of vaccines and remove the challenges of trying a second dose for girls, as they provide sufficient protection.

Another cost-cutting measure, public health experts say, is to move away from school-based vaccinations and make HPV vaccination one of the routine vaccines offered at health centers. Making this change requires a massive and sustained public education effort.

“They don’t usually come to the facility for other interventions, so we have to make sure the demand is very strong,” said Nguyen of Gabi.

Now, Nguyen said, the supply of the vaccine has finally increased and new versions of the vaccine are on the market from companies in China, India and Indonesia. Supply is expected to triple he by 2025.

Countries with large populations such as Indonesia, Nigeria, India, Ethiopia and Bangladesh plan to introduce or expand use of vaccines this year, and even expanding supplies could be difficult. But the hope is that countries will soon have enough doses to vaccinate every girl between the ages of 9 and 14, Nguyen said. If the infection spreads, vaccination for 9-year-old children will become a routine vaccination.

“We have set a goal of 86 million girls by the end of 2025,” she said. “This will prevent 1.4 million deaths.”

Chengo and her friends burst into giggle and cramped at the mere mention of sex, but in fact many girls in her grade are already sexually active, and Tanzania vaccinated girls at the age of nine. He said it would be better if he could be vaccinated. .

“It’s too late for Eleven,” said Restuta Chunja, shaking her head melancholy.

The bright-eyed 13-year-old Chengo plans to become a pilot when he finishes school. His mother told him vaccines would protect him from cancer, but she said he shouldn’t think about it, she said.

“She told me I shouldn’t get married or participate in sexual activity because it’s not good and I could catch diseases like HIV.”

HPV vaccines are available for boys as well as girls in high-income countries, but because 90% of HPV-related cancers affect women, WHO prioritizes girls in developing countries with existing vaccine supplies. I recommend that

“From Gabi’s point of view, we are not yet at the stage of having more boys,” Nguyen said.

Dr. Mary Rose Jattas, a cervical cancer expert and Tanzanian medical director of Zipiego, a medical nonprofit affiliated with Johns Hopkins University, believes any remaining hesitation can be overcome. . She talks about Australia when educating the public about this shot.

“Forget the rumours. Cervical cancer is nearly eradicated in Australia. Why? Because they vaccinate. And even if the vaccine causes fertility problems, they don’t.” We will know it because it was one of the first countries to use

Misunderstandings can be resolved with “biteful” evidence, she says. “What I want to say is that our Ministry of Health is taking serious steps in testing medicines. Medicines do not come directly from Europe to your clinic. Say, ‘Unfortunately, neither you nor I were able to get vaccinated because of our age, but I wish we could get vaccinated now.