The stalling of the world immunization coverage in 2023 has left an additional 2.7 million children un- or under-vaccinated compared to pre-pandemic levels in 2019.
According to the latest WHO and UNICEF estimates of national immunization coverage (WUENIC) - which provide the world's largest and most comprehensive dataset on immunization trends for vaccinations against 14 diseases - the alarming decline in childhood immunizations is most prevalent in fragile settings where children are more likely to experience disruptions in access to health services and nutrition. As a result, access to potentially life-saving vaccines such as the HPV vaccine remains below target, exposing millions of girls and women to cervical cancer.
Speaking following the release of the data, Dr. Norah Obudho, East Africa Regional Director of WomenLift Health, said: "One of the most important characteristics of a prosperous society is the health of women and girls. The human papillomavirus (HPV) is the leading cause of anogenital cancers worldwide, with cervical cancer being the most common cause of cancer-related deaths among women. In low-income countries, inadequate cancer management strategies contribute to over 90% of fatalities."
While the latest estimates indicate that the share of adolescent girls globally who received at least one dose of the HPV vaccine, which protects against cervical cancer, increased from 20% in 2022 to 27% in 2023, and that the HPV vaccine is available to over 50% of eligible girls in African countries, HPV vaccine coverage across the continent is well below the 90% target to eliminate cervical cancer as a public health problem, reaching only 56% of adolescent girls in high-income countries and 23% in low- and middle-income countries.
To overcome this challenge, Dr. Obudho called on national and regional leaders to make HPV vaccination a top priority in their health plans and create policies that will enable them to achieve the goal of 90% of vaccinations needed to eradicate cervical cancer as a public health concern.
"Strengthening health systems through healthcare worker training and improved vaccine supply chain logistics will ensure consistent availability and effective administration," she said.
Several factors specific to the HPV vaccine and the vaccination process influence its acceptability and uptake, including knowledge and perceived risk of HPV disease, misinformation about vaccine safety, and gender-unequal leadership.
"Despite substantial efforts across the health sector, women continue to be underrepresented in leadership roles, limiting their influence and impact and thus impeding progress toward diversity and gender parity in health leadership," she said. "This underrepresentation significantly affects the design and delivery of healthcare, which has a significant impact on health outcomes for women and girls with the potential to impede the vast adoption and accessibility of the HPV vaccine. Research has shown that women leaders are more likely to prioritize and comprehend women's health issues, such as family planning and sexual and reproductive health, thereby ensuring that these are adequately addressed in health policies and programs."
Empowering women to end cervical cancer
"Women leaders in health can play a critical role in amplifying the need for greater investment in HPV vaccination programs," she said. "In addition to advocating for policy changes, mobilizing resources, and raising public awareness, they can help prioritize HPV vaccination within national health agendas. Their leadership is essential in building partnerships, securing funding, and expanding vaccine access. This will protect numerous women and girls from the threat of cervical cancer."
"Women leaders in health must be deeply involved in HPV vaccine adoption to promote HPV vaccine acceptance," she said.
"Studies have highlighted the crucial role of parents and caregivers in HPV vaccine adoption and the importance of educating parents about cervical cancer prevention. However, low levels of involvement among the caregivers of adolescent girls in vaccination efforts and limited knowledge of the vaccine have been identified as potential barriers to vaccine adoption," she said. "It is important to improve girls' and women's health because the health of women has a huge impact on society as a whole. To support efforts to prevent cervical cancer, women in positions of power in the health care system must stress the importance of increasing funding for HPV vaccination programs."
"Demystifying HPV, promoting HPV vaccination, and providing a cost-effective means of health education delivery should all be top priorities in underserved areas where adolescent girls are more likely to be unvaccinated or not in school," she said.
Breaking barriers to better health
WomenLift Health advocates for Gender Transformative Leadership as a means to address the significant gender disparities in health decision-making, particularly in the African context, where men still make most decisions about women's health.
"Women constitute around 70% of health workers globally, over 80% of nursing and midwifery roles, and 90% of the health and social care workforce; however, they remain vastly underrepresented in leadership roles," she said. "Gender transformative leadership seeks to cultivate individuals, especially decision-makers, who empower themselves and their organizations to critically examine gender power structures and discriminatory practices, both formal and informal, to advance gender equity."
"In environments where men predominately make decisions regarding women's health, the integration of gender transformative leadership in health organizations can significantly improve health outcomes among girls and women, especially in the African context," said Dr. Obudho. "This approach challenges stereotypes, discrimination, and power disparities contributing to leadership gaps. By increasing the representation of women in leadership positions and decision-making processes, health policies and programs can be more effectively tailored to meet the unique needs and experiences of women."
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She added that by increasing women's representation in leadership, health policies can be tailored to meet the unique needs of women and girls, leading to more effective and equitable health interventions. "This inclusivity leads to more effective and equitable health interventions which, in turn, improve health outcomes. Furthermore, investment in the education and professional development of women improves their leadership abilities, thereby contributing to the development of health strategies that are both comprehensive and responsive," she said.
Dr. Obudho concluded with a point about male allyship. "Active male allies can be the harbingers for change in an industry where women, despite representing a large portion of the global health workforce, are significantly underrepresented in decision-making roles. This incongruity is not just a matter of fairness; it is a systemic failure that hampers the effectiveness and inclusivity of health services. Moreover, male allies must be willing to relinquish some power, share the spotlight, listen more, and speak less. They need to leverage their positions to advocate for changes in institutional policies that often subtly, yet powerfully, contribute to gender disparities."
"Only when women in health rise into leadership roles will we see progress in HPV vaccine uptake and get to the 90% vaccination target," she said.
