By Caroline Katana
Human papillomavirus (HPV) is the leading cause of genital cancers globally with cervical cancer as the top cause of cancer–related deaths in women.
Over 90 percent of these deaths occur in low-income and middle-income countries where cancer control strategies remain inadequate.
HPV vaccination protects against HPV types 16 and 18 which are responsible for approximately 70 percent of cervical cancer cases.
The optimal age of vaccination is in the early adolescent period, before sexual debut with possible HPV infection.
Studies have shown that children residing in low and middle settlements are at risk of early initiation of sexual activity.
Adolescent vaccination programs would provide an avenue to link other health promotion strategies targeting this age group that has hitherto been left out of many health interventions in 2019.
Kenya introduced the HPV vaccine to be given to 10-year-old girls, intake has been sub-optimal with only 33 percent of the targeted population receiving the first dose in 2020 and 16 percent returning for the 2nd dose.
While the disruption of immunization programs by the COVID-19 pandemic contributed to the low coverage, other factors such as low demand fuelled by misinformation have also played a role.
HPV vaccines are effective in preventing HPV infection when administered in young boys and girls before their sexual debut.
In countries with high vaccine coverage like Australia which reported an HPV vaccine coverage of 80 percent in females and 76 percent in males in 2019, a significant decline in vaccine-type HPV infection and high-grade precancerous cervical lesions has been reported with a substantial impact on cervical cancer incidence expected in the coming years.
Adolescent vaccination is one of the strategies for implementing the life course immunization approach set out in the Immunization Agenda 2030.
This approach expands routine immunization coverage to other age groups outside infancy. Also, it seeks to improve coverage in under-served populations under the mantra of reaching everyone, everywhere.
Since 2020, 30 percent of girls of 10 years in Kwale County received HPV 1 vaccine, while 26 percent completed the two doses of PHV 1 and 2 vaccine that are administered at an interval of six months.
During an exclusive interview at Kwale health headquarters, Kwale County immunization Coordinator Mgallah Samson said the ongoing HPV vaccine exercise is implemented using a stakeholder approach between facility, community, and schools to reach many girls.
“We are working closely with different partners, community influencers, county, and national government to sensitize community and teachers to understand the importance of the HPV vaccine to their children, we believe teachers are good mobilizers of parents once they get the clear concept of the vaccine they can translate the message well to the young girls and parents,” said Samson.
The coordinator said that studies have shown that the average sexual age is 10 years, saying there is a need for the two HPV vaccine doses to be administered before they are exposed to sex.
“In Kwale the sexual debut is 9 years so there is a need to prevent young girls from the Human Papillomavirus that is carried by men who then transmit the virus to women during sexual intercourse, so before young girls are exposed to sex, it’s good to take HPV vaccine for their safety,” he added.
Samson said Kwale County Health Department is adapting the national government health system in a paradigm shift to prevent virus transmissions.
“We are now moving from curing to prevention, this is a game changer for cancer, we want to have firm health structures and vibrant community health promoters at the grassroots levels linked to a community unit that is attached to a facility and every community health promoter to attend at least ten households per month, this means will mean good health system at the community levels, and this will give us room to sensitize, detect and cure early stage of cancer, “said the coordinator.
The health officer said they are focusing on the Primary Care Network system in all health facilities in Kwale County for easy access to health services in the community.
“We are decentralizing special health services at the grassroots level whereby patients with a special health problem will no longer travel long distances looking for health services at the referral hospitals, instead our health experts will attend to patients at the health facilities at the grassroots level,” he said.
Samson confirmed the health department has initiated sexual education programs in schools to counter sexual intercourse among teenage girls and avoid contracting the Human Papilloma Virus.
“Lack of sexual education is the cause of many teenage girls engaging in sex without protection, outdated traditions and cultures of not discussing matters sex with children are also to be blamed for the current predicament,” said Samson
Schools are considered better for vaccination programs targeting school-age children and adolescents, there is increased acceptability among parents and caregivers as teachers are seen as trusted custodians of children and schools as safe havens for the welfare of children.
Phyllis Koki, a teacher, said teachers’ knowledge and attitude about vaccination play a major role in ensuring the success of school-based vaccination programs.
She said over three hundred girls of 9 to 14 years in Kwale primary school have received the HPV vaccine.
“At first it was not easy there was resistance and fear from parents that the HPV vaccine is meant for family planning hence exposing young girls to early sex but after sensitizing them on the importance of the HPV vaccine at least 90 percent gave consent for their girls to be vaccinated and the progress is good,” said Koki.
The teacher called upon the national government through the Ministry of Health to ensure constant distribution of the HPV vaccine to reach as many young girls as possible by 2030.
Angelina Peter is among the young girls in Kwale who received two doses of the HPV vaccine.
She applauded the efforts of the national government to link young adolescents to preventive health services.
“I want to applaud the Ministry of Health for this initiative, I don’t take it for granted, it means a lot for our future lives, I have witnessed cancer patients in my village worried because cancer treatment is very expensive, they wish they would get the HPV vaccine earlier to save their lives and money,” she said.
Angelina got inspiration from her parents to take the HPV vaccine and is now challenging her peers to end outdated cultures and traditions of not taking the HPV.
“HPV vaccine has no side effects in our bodies, it is safe for us, the vaccine is not for family planning but to prevent us from human papillomavirus that causes cervical cancer,” she added.
She urged the Ministry of Health to ensure there is no shortage of HPV vaccine to ensure the targeted group benefits by 2030.
Her sentiments were echoed by her peer Mejumaa Ramadhan who completed her two HPV vaccine doses after getting advice from teachers and nurses and called upon her peers who took a single dose to ensure they go for the second dose.
Behavior change
Promoting behavior change as a lone strategy for preventing sexually transmitted infections is ineffective in reducing transmission and would hence not be effective for the prevention of HPV infection as well.
Behavior change must be linked to other prevention strategies such as condom use, vaccination, and screening.
HPV vaccines are licensed for use in both boys and girls between 9 and 26 years of age, with the optimal age of administration being 9- 14 years of age, this is considered to be the most appropriate age for vaccination as most of the children have not had any sexual encounters by then and therefore unlikely to have acquired HPV infection.
The Centre for Behavior Change and Communication (CBCC) in collaboration with UNICEF has been actively engaging various communities through multiple community radio stations to promote the acceptance of routine child vaccinations.
The Ministry of Health’s National Vaccine and Immunization program has identified several key vaccines, including BCG for Tuberclusis, OPV and IPV for Poliomyelitis, Rotavirus for rotavirus and Diarrhea, DPT for diphtheria, whooping cough and tetanus as well as measles, rubella, and HPV for cervical cancer among others.
This extensive campaign has specifically targeted caregivers and teenagers in 31 countries such as Mombasa, Lamu, Taita Taveta, Meru, Tharaka Nithi, Embu, Kitui, Machakos, Makueni, Nyandarua, Nyeri among others.
Challenges surrounding HPV vaccine in Kwale County
Kwale County is not exceptional of misinformation about the HPV vaccine, so parents did not allow their 10-year-old girls to administer the vaccine, among their claims were doubts about safety and efficacy, some parents believed that allowing their young girls to take the HPV vaccine was giving them free rein to engage in premarital sex since the vaccine is meant for family planning.
The top 5 cancer cases in Kwale County
From June 2022 to June 2023, prostate cancer is leading with 19.7 percent, followed by cervical cancer 14.1 percent, Breast cancer at 9.9 percent, and Esophageal and lymphoma cancer at 7 percent.
Kwale County executive committee member in charge of health Francis Gwama said the HPV vaccine is available and administration exercise is ongoing in schools and health centers to reach the targeted group.
“We had few doses of the HPV vaccines but we are expecting more to come, preventive measures such as HPV vaccines play a crucial role in reducing the risk of cervical cancer, however, the uptake of this vaccine is still low but measures are in place to reach many girls,” said Gwama.
He confirmed Kwale County to be among the counties in Kenya that witness high cancer cases, saying plans to open Kwale Oncology Center at a cost of Ksh 60 million are in place.
“We are in the process of licensing the oncology center and making it officially operational, currently the center offers screening services but chemotherapy services will also be available when licensed,” said Gwama.
In Kenya as in many other countries, the reasons for the declining vaccine confidence are highly context-specific and should therefore not be addressed in a uniform approach.
HPV vaccine introduction in Kenya continues to be a learning point for all immunization stakeholders to ensure there is a successful uptake of new vaccines especially where a new cohort is involved.
Despite having done a lot of prior social mobilization and advocacy, confidence in the HPV vaccine was severely compromised by rumors and misconceptions.
It became evident that continuous engagement and public multi-stakeholder dialogue should be employed at all stages of vaccine introduction.
