It is no secret that science and the Church have a somewhat checkered history. This is despite the Church funding many of the world’s hospitals.
The Catholic Church remains steadfastly opposed to contraception, abortion and research using human embryonic stem cells.
In 2014, the Catholic church warned against vaccination of women against tetanus. The Church said the vaccine was laced with a hormone that could cause infertility in women.
The Church, again, in 2015 urged Kenyans to ignore a drive to vaccinate children against polio, saying the vaccine’s safety could not be confirmed.
In 2016, the Catholic church was at it again. It was opposed to campaigns to vaccinate children against measles-rubella and tetanus. The Church said it could not guarantee the safety of the vaccines.
The new frontier of the conflict is now taking shape all over the world, especially in Kenya, in the form of a cervical cancer vaccine.
To eliminate cervical cancer, World Health Organisation proposes vaccinating 90 per cent of girls under the age of 15 by 2030. The strategy involves implementing broader programmes for cancer screening and treatment.
The new human papillomavirus (HPV) vaccine, set to be launched in the country this month, has dragged the country into another quagmire of vaccines and religion. The Catholic Church is locked in a standoff with the Health ministry over the roll-out of the vaccine for all schoolgirls aged 10 years and above.
The girls are to receive two doses of the vaccine, six months apart, in over 9,000 public, private and faith-based hospitals countrywide.
On the Church side is the Kenya Catholic Doctors Association (KCDA), which is advocating monogamy and abstinence before marriage over the use the vaccine. KCDA argues that children who are chaste need not worry about contracting HPV.
“HPV is a sexually transmitted infection and disease and, therefore, children who are chaste and faithful adults are not at risk,” argues KCDA spokesman Kimotho Karanja.
The government is not backing down either, with the Health ministry arguing vaccination is one of public health’s most effective interventions. It adds that 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.
National Vaccines and Immunisation Programme head, Dr Collins Tabu, says most HPV infections are acquired within the first years of sexual activity, as demonstrated by a study of 603 US college students. The study found that approximately 40 per cent of HPV infections are acquired within two years of the first sexual experience. “There is need to protect them before their sexual debut, as the efficacy of HPV vaccination is greatest when given to HPV-naive women,” he says, adding there has been a considerable decline in infectious disease over the last century largely due to vaccines.
The doctors argue 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.
Dr Tabu says HPV can resolve spontaneously, but if it does not go away, it can cause health problems like genital warts and cancer including cancers of the anus, penis, vagina, vulva and back of the throat (oropharyngeal).
He adds that 70 per cent of women with HPV infections became HPV negative within one year and as many as 90 per cent of these resolve within two years. “Nearly all (99.7 per cent) cervical cancers are caused by HPV infections. There is no way to know or predict which people who have HPV will develop cancer or other health problems,” says Dr Tabu.
Women who have battled cervical cancer believe every girl should be vaccinated. This statement especially holds true for Ms Caroline Ogol, who is currently going through her third chemotherapy session at Jaramogi Oginga Odinga Hospital in Kisumu County.
Ogol says the perception of the disease in her community is the reason she is battling it in secrecy. She says she is not willing to even share with her daughter who keeps asking why she is losing her hair.
“This cancer does things to women that just demean and crush their self-worth and it is believed to be sexually contracted. I do not want to be pointed at and be referred to as the woman with that disease,” she says.
Ogol did not know about the vaccine. When HealthyNation explains it to her, she is puzzled. She wonders why there is a debate around it, saying it should be a “no-brainer”.
NGOs have thrown their weight behind the vaccination campaign. Women 4 Cancer chairperson Benda Kithaka says while it is important to advocate abstinence, it is equally key for Kenyans to be practical about the matter. “Let’s not deny our girls this vaccine because if anything were to happen to them, cervical cancer should be the one thing they do not have to deal with,” she says.
Not all doctors share the sentiments of KCDA. There are those who have been pushing the campaign on social media asking parents to get their children vaccinated.
Despite thousands of women getting cervical cancer because of HPV, the message does not seem to sink in. That frustrates Dr Angela McLigeyo, an oncologist at the Jaramogi Oginga Odinga Referral Hospital. She says awareness on the vaccine is low. “There is a lot of ignorance when it comes to not only vaccine, but also matters HPV and cervical cancer. It is not a death sentence and the disease can be prevented with the vaccine,” she says.
The success of the HPV vaccine might take time since it is too early. However, the marked reduction in vaccine type HPVs, which are responsible for more than 70 per cent of the cervical cancer burden portends a marked reduction in cervical cancer cases.
Dr Karanja says there is no scientific guarantee, or otherwise, that any suppressed cancer-causing HPV subtypes will not mutate over the next 20 years and become more dangerous.
Dr Tabu, however, argues by saying vaccination does not suppress cancer-causing HPV subtypes. He adds that it protects the individual from infection with these cancer-causing HPV subtypes. “HPV vaccines are not complete viruses. They are virus-like particles from surface components which induce strong neutralising antibody responses against HPV infection. They have no capability of causing disease or mutating, since they lack the viral genome. Without vaccination, it is the HPV that actually has potential to mutate and cause cancer,” he says.
The Catholic doctors have presented examples of case studies in various countries like Italy, Japan and India to support their argument. “Italy reports adverse effects after HPV vaccines at a rate of 219/100,000. This is 10 times higher than most other vaccines administered in Italy. The cervix cancer rate in Italy is 7.7/ 100, 000,” they say.
Dr Tabu says the figures provided by KCDA are erroneous. “No peer reviewed or published literature is available to validate the figures quoted above,” he says.
The Health ministry says the decision to introduce the HPV vaccine was subject to independent advisory opinion of various institutions and structures such as the Kenya National Immunisation Technical Advisory Group, National Immunisation Interagency Coordinating Committee. It adds that the ministry made the vaccine introduction a priority due to the number of cervical cancer, having conclusively determined risk groups, ensured sustainable availability of an effective vaccine, ability of vaccination services to cover more than 80 per cent of at risk-population in order to break transmission.
The Catholic doctors have asked parents to demand information on benefits and recorded adverse outcomes associated with HPV vaccines, so as to make an informed choice for their children. “As a parent, please know that when scientific papers say the risk of adverse reactions is low, they are talking about general statistics, not your child specifically. If your child suffers any injury, it will be 100 per cent for her for the rest of her life. The truth is that to science, your daughter will just be another statistic,” says Dr Karanja.
The government says while it’s true that an informed parent is able to make an informed decision concerning the welfare of their children, it is important for them to know that no single drug, vaccine or therapeutic procedure is devoid of adverse events.
“If the above argument would hold, then nobody should ever go near a health facility or healthcare worker for that matter. Medicines and vaccines seek to balance and ensure the benefits far outweigh any possible adverse effects. This is the principle behind vaccination and, indeed, all medical interventions globally,” says a Health ministry statement.
What parents will do with the information remains to be seen.
CASE FOR BOYS
There are fears boys will miss out on vaccination that protects them against several forms of cancer.
The argument is that there should not be a discrepancy based on sex for a vaccination that can save lives.
Rights group in western countries like the UK and Ireland, who rolled out the vaccine for girls a decade ago, say immunising boys will have direct benefits for them as well.
Other than cervical cancer which affects women, HPV also causes about 90 per cent of anal cancers and 50 per cent of penile cancers and some cancers of the head and neck as well as about 90 per cent of genital warts.
HPV is the most common sexually transmitted virus. Up to 80 per cent of men and women will become infected by 50 years of age. No treatment exists for HPV infection.
In Ireland, for example, the Health Information and Quality Authority has now recommended that HPV vaccine be offered to boys as well. “Extending it to include boys would reduce HPV-related disease in males and females in Ireland,” it says.
HPV infection causes skin or mucous membrane growth (warts) which is usually harmless and goes away by itself as your immune system fights it.
But some HPV types can lead to cancer or genital warts in ones vulva, cervix, rectum, anus, penis, and scrotum as well as the mouth and throat. These are spread mainly during sexual contact. HPV can become a repetitive infection. Having multiple sexual partners increases the risk of infection. Having sex with a partner who has had multiple sex partners also increases the risk.
Whereas HPV is sexually transmitted, penetrative sex is sometimes not required for transmission. Skin-to-skin genital contact is also another mode of transmission. HPV can be passed even when an infected person has no signs or symptoms. Anyone who is sexually active can get HPV, even if you have had sex with only one person.
It takes 15 to 20 years for cervical cancer to develop in women with normal immune systems. It can take only five to 10 years in women with weakened immune systems, such as those with untreated HIV infection.
Additional reporting by Irene Otto