A major concern, however, is Nigeria and the African continent's continued dependence on foreign aid to improve its health outcomes.
...it is a lot of progress for the Nigerian government to introduce the HPV vaccine into its routine immunisation schedule, with the aim of reaching 7.7 million girls with an initial roll out in 16 states and another in 21 states by May 2024. By the end of 2025, 16.6 million girls between the ages of nine and 14 should have been vaccinated.
About 22 women die daily from cervical cancer in Nigeria, according to the estimates of the International Agency for Research on Cancer (IARC). Let's dwell on this for a bit. According to IARC, this estimate was derived using the "mean of the rates from Ibadan (2015-2017), Abuja (2013-2018), Calabar (2016-2017) and Ekiti (2013-2018) cancer registries, which were scaled to Western Africa." This is sourced from the unpublished data of the African Cancer Registry Network (AFCRN). It screams tricky, which is not surprising, as it clearly depicts the low presence of data for decision making, which affects proper planning and policy formation. We will surely get it right soon in this regard.
In 2020, it was estimated that 12,075 women were diagnosed with cervical cancer, with a 66 per cent death rate (7,968), thus making it the second leading form of female cancer and cause of female cancer mortality in Nigeria (the HPV Centre). The primary cause of cervical cancer is persistent or chronic infection with one or more of the "high-risk" types of Human Papilloma Virus (HPV), particularly types 16 and 18, which together are responsible for approximately 70 per cent of cervical cancer cases. Fortunately, cervical cancer is highly preventable through vaccination, the screening and the treatment of pre-cancerous lesions, and palliative care (WHO). Of the three, vaccination remains the most cost-effective of prophylaxis.
However, middle, and low income countries have performed poorly in responding to this avoidable threat. As of 2020, less than 25 per cent and 30 per cent of low income and lower middle income countries had introduced the HPV vaccine into their national immunisation schedules, in comparison to 85 per cent in high income countries. This inequitable distribution is largely due to high vaccine cost, supply challenges and the lack of political will.
Pertaining to cost, in 2011, through GAVI, the price of one dose of the HPV vaccine was $4.5, down from $13, while it costs more than $100 in high-income countries. In December 2020, the World Health Organisation (WHO) updated its recommendation, approving the use of the single-dose vaccine, rather than the two or three doses previously stipulated. Despite this, if Nigeria would embark on a campaign to vaccinate 90 per cent of its female population between the ages of nine and 14, from 2023 to 2030, which is one of the WHO's targets for the elimination of cervical cancer, the country would need to vaccinate about 4.5 million girls yearly for seven years (using estimates from the National Population Commission alongside a few assumptions, given that a two-year old girl in 2023 would be eligible for the vaccine by 2030).
Going by the average cost of a single vaccine dose, the Nigerian government will spend N16.3 billion yearly to vaccinate girls against HPV. This would mean spending 21 per cent of the 2023 budget allocation to GAVI/immunisation and two per cent of the country's total 2023 health budget. I'd argue that this is highly feasible, but depends on priorities.
In terms of supply, UNICEF had stated in 2019 that the global availability of the HPV vaccine is currently insufficient to meet the aggregate demand.
On the level of political will, in November 2020, the Minister of Health had said that the country would introduce the HPV vaccine into its immunisation schedule by 2021, but sadly this never happened. The National Strategic Plan on Prevention and Control of Cervical Cancer in Nigeria (2017-2021) targeted reaching 4.5 million girls over a five-year period, but this failed. It was the same for the National Cancer Control Plan (2018-2022), which aimed to have a 90 per cent HPC vaccination coverage by 2022.
Given the aforementioned, it is a lot of progress for the Nigerian government to introduce the HPV vaccine into its routine immunisation schedule, with the aim of reaching 7.7 million girls with an initial roll out in 16 states and another in 21 states by May 2024. By the end of 2025, 16.6 million girls between the ages of nine and 14 should have been vaccinated.
GAVI is co-financing this effort, given its recent plan to revitalise access to the vaccine, and UNICEF has procured nearly 15 million HPV vaccines on behalf of the government of Nigeria.
A major concern, however, is Nigeria and the African continent's continued dependence on foreign aid to improve its health outcomes. The continent's over-reliance on aid for driving its health agenda is not sustainable, and this ought to be a major concern of the 'Renewed Hope' administration. With N16 billion yearly, if the estimates are to be relied on, Nigeria could have prevented the deaths of tens of thousands of women who have died from the virus (sadly, this is the same case with many other diseases that plague citizens of the country). Poverty cannot be the excuse for this, given the government's propensity for waste (new cars for lawmakers, excessive pensions for government officials, foreign trips, etc.; and the list is endless).
Nigeria certainly needs to rethink its healthcare. With the changes in the healthcare leadership, with a new Minister of Health, Muhammad Ali Pate; the ED/CEO of the National Primary Health Care Development Agency (NPHCDA), Muyi Aina; and the CEO of National Health Insurance Authority (NHIA), Kelechi Ohiri, all of whom have impressive records in the health sector, we hope this brings a lot of change and progress to Nigeria's health situation and seeming over-reliance on donor organisations to fix problems that matter to us!
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In conclusion, as expected, purveyors of fake news have hit the screen with misinformation about the vaccine as another 666 implantation, etc. Parents should please have their daughter get the vaccines immediately for FREE. A HPVV awareness study by Sydani group in eight states in Nigeria, among other things, reflected that 76 per cent of respondents (4,074 caregivers) think that the vaccine is a threat to a girl's health. This shows the need for very extensive re-orientation, etc., for this roll-out be a success. Furthermore, data collection on the number of girls immunised, vaccine utilisation, wastage, etc. should be highly prioritised. Lastly, while prioritising vaccination, the screening and treatment of older women must be done quickly, lest we create more needless cervical cancer deaths, and hopefully, we don't have to wait for GAVI again! The Nigerian government has its hands full.
Dapo Awobeku is a management consultant who has supported governments at the federal and sub-national levels in the design and implementation of strategies to strengthen Nigeria's health system. He writes from Bristol, UK.
