Too many African women die from cervical cancer when we know what causes it and how to prevent it, writes Dr. Ifeanyi Nsofor, director of Policy and Advocacy for Nigeria Health Watch, in a guest column for AllAfrica.
Ten years after the United Kingdom introduced a nationwide Human Papilloma Virus (HPV) vaccination programme for girls aged 12 and 13, results show a 90 percent drop in pre-cancerous cervical cancer among girls in Scotland. This finding is huge and has the potential to reduce the number of new cervical cancer cases in the future.
In Africa, there are at least 68,000 cases of cervical cancer cases reported every year, accounting for 22 percent of all cancers in women on the continent. Every year 46,000 women diagnosed with cervical cancer in Africa die. South Africa reports 12,983 cases of cervical cancer a year, with 5,595 deaths. In Nigeria 14,943 cases of cervical cancer cases are reported, and 10,403 die from the disease.
Simply put, too many women on the African continent die from a sexually transmitted disease of which we know the cause and how to prevent it. This unconscionable and should not continue.
Cervical cancer is a sexually-transmitted infection and the organism responsible is HPV, which is transmitted via oral, vaginal and anal sex with an infected person. HPV types 16 and 18 are responsible for 70 percent of cervical cancer cases. Apart from cervical cancer, HPV is implicated in cancers of the vagina, penis, anus, vulva and pharynx.
A key lesson from the Scotland experience is ensuring that HPV immunisation is universal. In the UK's National Health Service, it is free for all girls aged 12 to 18 years, which means that poverty is not a barrier to access to HPV vaccine. To be fully immunized, two doses of HPV vaccines are given – the first dose to those aged between 12 and 15 and the second dose from six to 12 months after the first.
The high number of cervical cancer cases in Africa is attributable to poor access to preventative and curative health services, especially among poor and under-served communities.
There are three ways to replicate the success of HPV vaccination in Scotland in Africa. For these to succeed, there must be involvement of multiple stakeholders – governments, ministries of health, schools, civil society, pharmaceutical companies and others.
First, too many people in Africa, especially rural dwellers, do not have access to healthcare. In addition, out-of-pocket expenditure for healthcare in sub-Saharan Africa accounts for 36.2 percent of health expenditure.
A mix of poverty, lack of access and out-of-pocket payments mean that women who need HPV vaccine are unable to have it. Therefore, if Africa is to provide HPV vaccination and cervical cancer screening services to every girl on the continent, universal health coverage – having access to healthcare when it is needed without suffering financial hardship – is essential.
Second, universal access to HPV vaccination can be achieved if African governments ensure that HPV is included in routine immunization. Nationwide vaccination programs help reduce costs and can reach usually under-served communities.
In South Africa, a single dose of HPV vaccine costs $39 in public and $71 in private health facilities. This is not within the reach of most people who live in extreme poverty. National health insurance schemes and Health Maintenance Organisations (HMOs) in Africa should add HPV vaccination and cervical cancer screening services as components of health plans that can be purchased by families. In the long run, it is cheaper to provide these preventative services than to treat cervical cancer.
Third, at the age HPV vaccine is given, most eligible girls are meant to be in high school. To target them requires working with ministries of education, school proprietors, principals, parents and school girls.
School outreach should begin with by communicating the risks of cervical cancer to these stakeholders, educating them about its prevalence, causes, prevention, treatment and prognosis. Supplemental vaccination campaigns conducted in schools with the permission of school authorities and the consent of parents is a quick way of immunizing all who are eligible.
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It was estimated in 2014 that 93.2 million children in sub-Saharan Africa, more often than not girls, were not at school. Thus any intervention must include plans to vaccinate children who are not in school. To achieve this, governments and civil society should conduct medical outreach in poor communities where this is a problem.
In addition, cervical cancer screening must be part of a holistic approach to preventing the disease. And because HPV is sexually transmitted and causes cancers of the penis, anus and pharynx, HPV vaccination for boys is imperative -- and will ensure that these cancers are prevented among men who have sex with men.
The United Kingdom has shown that it is possible to prevent cervical cancer by deploying nationwide HPV vaccination. It is inexcusable to allow women (and men) to die from preventable diseases. African governments must show leadership by replicating the UK programme across the continent.
Dr. Nsofor is also the chief executive of EpiAFRIC, a public health consulting group, an Atlantic Fellow for Health Equity at George Washington University in Washington, DC, and a 2018 New Voices Fellow at the Aspen Institute.
