YUNUSA Bawa dedicates his efforts to educating people about the human papillomavirus (HPV) vaccine, which is crucial for preventing cervical cancer. Despite his dedication, in the rural regions of Nigeria where he works, only a few families consent to vaccinate their daughters each day.
The challenge in Sabo community, on the outskirts of Nigeria’s capital, Abuja, is the persistent, unfounded rumour that the HPV vaccine causes infertility in young girls. ‘The rumour is too much,’ said Bawa, 42, tells The Associated Press (AP).
As more African countries strive to increase HPV vaccination rates, Bawa and other health workers face significant obstacles, particularly due to misinformation. The World Health Organisation’s (WHO) Africa office estimates that about 25 percent of the population still harbours doubts about the vaccine, reflecting concerns seen globally during early vaccination campaigns.
HPV, a common sexually transmitted virus, can lead to cervical cancer, other types of cancer, and genital warts. While most infections are harmless, some can persist and cause cancer. In 2020, cervical cancer caused the deaths of approximately 190 women daily across Africa, accounting for 23 percent of cervical cancer deaths worldwide. Eighteen of the 20 countries with the highest cervical cancer rates are in Africa, yet vaccination rates remain low.
Over half of Africa’s 54 nations have introduced the HPV vaccine into their immunisation programmes, but only five have achieved the 90 percent coverage target set for 2030. Currently, just 33 percent of young girls in the region are vaccinated against HPV, a stark contrast to most European countries where both girls and boys receive the vaccine.
One reason for Africa’s high cervical cancer burden is limited access to screening for women, said Emily Kobayashi, head of the HPV Programme at the vaccines alliance Gavi. ‘The elimination strategy is a long game… but vaccination is the strongest pillar and one of the easiest to implement,’ Kobayashi noted.
However, introducing the vaccine is only the first step. ‘It is one thing to introduce the vaccine, but if the vaccine remains in the fridge, it doesn’t prevent cervical cancer,’ Charles Shey Wiysonge, head of the vaccine-preventable diseases programme in the WHO’s Africa region, told AP. Wiysonge emphasised the importance of disseminating accurate information through trusted community members.
Vaccine hesitancy in many African countries often stems from a lack of trust in the government. This hesitancy is sometimes fuelled by conspiracy theories and misinformation from social media influencers and religious leaders
Vaccine hesitancy in many African countries often stems from a lack of trust in the government. This hesitancy is sometimes fuelled by conspiracy theories and misinformation from social media influencers and religious leaders, according to a study published in the Nature science journal in May.
In Zimbabwe, where cervical cancer is the most common cancer among women, Village Health Workers have been trained to raise awareness about cervical cancer and the HPV vaccine in rural areas. They face significant hesitancy from religious sects that discourage followers from using modern medicines, instead advocating for prayers and ‘anointed’ water and stones.
Zanele Ndlovu, a health worker on the outskirts of Bulawayo city, said that women who agree to be screened for cervical cancer often do so in secret. ‘The spiritual leaders have so much influence that a lot of our time is taken trying to educate people about the safety of vaccines, or that they are not ungodly,’ Ndlovu explained.
Despite these challenges, there have been success stories in Africa. Ethiopia, for example, has achieved a 90 percent vaccination rate by relying heavily on religious leaders, teachers, and hotline workers. Rwanda, the first African country to implement a national HPV vaccination program in 2011, also reached a 90 percent coverage rate through school-based campaigns and community outreach programmes, according to Dr. Theoneste Maniragaba, director of the cancer programme at Rwanda Biomedical Centre.
Mozambique has achieved an 80 percent coverage rate with the first of two HPV vaccine doses through school-based programs, door-to-door approaches, and mobile outreach for girls in remote areas. In Tanzania, which began using the HPV vaccine in 2018, authorities launched a campaign in April to target over 5 million girls and further raise coverage, which currently stands at 79 percent for the first dose.
Nigeria has recently launched one of Africa’s largest HPV vaccination drives, targeting girls ages 9-14 with nearly 15 million doses procured with the help of the UN children’s agency. This initiative aims to provide single doses that the WHO’s African immunisation advisory group has deemed as effective as the regular two doses.
One significant challenge is explaining the importance of the HPV vaccination to young girls before they become sexually active, especially in conservative societies. Dr. Aisha Mustapha, a gynaecologist in northern Kaduna state who has been successfully treated for cervical cancer, uses her personal experience in her outreach efforts. She leads the Medical Women Association of Nigeria in Kaduna and focuses on making the girls feel comfortable and understand the importance of the vaccine, sometimes using comic books and singing.
‘The (cervical) cancer… is no respecter of any identity,’ she said. ‘The vaccine is available, it is free, it is safe, and effective.’
As the fight against cervical cancer continues, health workers across Africa are dedicated to overcoming misinformation and increasing vaccination rates. Their efforts are vital in ensuring that the HPV vaccine reaches those who need it most, ultimately saving lives and reducing the burden of cervical cancer on the continent.
