The impact of Covid-19 on HPV vaccination drive

hpv vaccine, cervical cancer
HPV vaccine
Photo credit: SHUTTERSTOCK

What you need to know:

  • In Kenya, the prevalence of HPV infection among women above 15 years is high, ranging between 14 and 51 per cent — depending on the region and increasing with age.
  • The biggest risk from this virus is cervical cancer. Nearly all (99.7 per cent) cervical cancers are caused by HPV infections.

When Heldah Amariati, 41, a health professional based in Nairobi, decided to take her10-year-old daughter to a private health facility for the human papillomavirus (HPV) vaccine, she had to pay Sh2,300.

Her daughter got her first HPV vaccine in February 2021 and the second dose in September the same year. 

“Being a mother and understanding that my daughter is heading into teenagehood, while also working in a field that gives me a chance to come face to face with the wrath of cervical cancer, I didn’t hesitate to have her vaccinated,” explains Heldah.

This is despite the negative talk that she heard about the vaccine. “At one time a friend tried to convince me otherwise, arguing that the vaccine is still on trial thus not safe,” she says.

Heldah is one of the few parents in the country who have willingly taken their daughters for the HPV vaccine since it was officially rolled out by the government towards the end of  2019 amid skepticism.

“Since HPV is a sexually transmitted disease, vaccination has to start before the onset of sexual activity,” explains Prof Mansoor Saleh, the chairman of Haematology-Oncology Department at Aga Khan University Hospital.

Currently, the Ministry of Health is vaccinating girls aged between 10-14 years in all public health facilities. The HPV vaccine is given in two doses, six months apart, and is meant to protect against HPV infection. 

“Normally, it stimulates the human immune response to develop protective antibodies that fight off the virus in case of an infection. The vaccine targets the HPV subtypes, which are accountable for more than 70 per cent of cervical cancers,” says Prof Mansoor.

But despite these benefits, some parents and a section of the clergy have opposed the vaccine. 

Further, there have been arguments that over 90 per cent of all HPV infections resolve spontaneously and are destroyed by the body’s natural immunity, hence there is no need for mass vaccination.

“It is true that a large proportion of HPV or any viral infections can be overcome by the patient’s immune system. However, infection by the cancer-causing HPV strain can quickly transform the cervical cells to develop cancer and the immune response may not be protective. Many patients have a defective immune system and may not mount adequate protection. Women who get infected multiple times due to multiple sexual partners are at higher risk,” explains Prof Mansoor.

The HPV vaccine uptake has faced various hurdles, the main one being the Covid-19 pandemic, which according to Dr Andrew Mulwa, acting Director, Medical Services, Preventive and Promotive Health, has disrupted essential services including routine immunisation and community mobilisation due to the prolonged closure of schools.

Sensitisation programmes about the HPV vaccine were affected, leaving caregivers with little knowledge on the same.

“When Covid hit the country, most people migrated to rural areas, schools closed and only a few guardians took their girls for vaccination in health facilities. People were also anxious about going to hospitals for the fear of contracting Covid-19 in the facilities,” adds Dr Mulwa.

The implication of this, according to Dr Mulwa, is girls missing the opportunity for vaccination and therefore being at risk of developing cervical cancer.

In Kenya, the prevalence of HPV infection among women above 15 years is high, ranging between 14 and 51 per cent — depending on the region and increasing with age.

“The virus can cause health problems like genital warts and cancers of the anus, penis, vagina, vulva and back of the throat (oropharyngeal). Certain strains of HPV pose a higher risk of inducing cervical cancer; specifically HPV 16/18,” explains Prof Mansoor.

But the biggest risk from this virus is cervical cancer. Nearly all (99.7 per cent) cervical cancers are caused by HPV infections.

According to the World Health Organization, cervical cancer is a major public health concern globally, with about 604,000 new cases and over 340,000 deaths reported in 2020. Over 21 per cent of these cases and 26 per cent of the deaths occur in Africa, where cervical cancer is the second leading cancer in incidence and the leading cause of cancer deaths.

In East Africa, cervical cancer is one of the top two most common cancers together with breast cancer.  “Cervical cancer is the leading cause of cancer-related deaths in Kenya. Over 5,000 cases of cervical cancer and more than 3,000 deaths are reported annually. About nine women die daily from cervical cancer,” says Dr Mulwa, adding that the economic and social burden of cervical cancer in the family level, community and the country cannot be underestimated. To eliminate cervical cancer, WHO proposes vaccinating 90 per cent of girls under the age of 15 by 2030. 

“In Kenya, so far 1.3 million girls have been vaccinated against a target of three million,” says Dr  Mulwa. To address the low coverage, Dr Mulwa says the Ministry of Health has been conducting catchup vaccination campaigns. 

“We had 100 days of ramping up HPV vaccination,  which began in November last year. Through this, we supported drives targeting  girls eligible for the vaccine, for instance in schools. During this period, we have managed to reach more than 1.2 million girls.”

“However, we have had challenges like dealing with anti-vaxxers as well as scarcity of resources like the HPV vaccine itself, thus we weren’t able to reach as many areas as we had targeted,” observes Dr Mulwa.

Heldah Amariati , cervical cancer, hpv jab
Ms Heldah Amariati, a health professional based in Nairobi.
Photo credit: DIANA NGILA | NATION MEDIA GROUP