Experts raise concern over low uptake of HPV vaccine

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When Julius Ng'etich saw the devastating effects of cancer on one of his family members, he vowed to do everything in his power to stop anyone else in his family from going through the same.

"The pain I saw her going through is an experience I do not wish for anyone, much less my daughter," he says.

As a father of an 11-year-old girl, he was intrigued when the Ministry of Health announced the roll-out of a vaccine that offered protection from the Human Papillomavirus (HPV), a virus that could cause cancer later in life.

"I had fears as a parent about having my daughter vaccinated, but the greater fear was 'what if she got cervical cancer simply because I abdicated my role as a parent," says Ng'etich, a resident of Syokimau.

Cervical cancer is a leading cause of cancer-related deaths, and the second most common cancer among women. More than 5,250 new cases and 3,268 deaths from cervical cancer are reported annually, according to data from Global Cancer Observatory (GLOBOCAN) and at least nine women die of cervical cancer in Kenya daily. The cases are estimated to increase to 22, by 2040.

Dr Juliet Maina, a clinical and radiation oncologist at Nanyuki Teaching and Referral Hospital, said HPV vaccine allows the body to create antibodies which fight against HPV virus, which causes cervical cancer.

However, even with the roll-out of the jab by former President Uhuru Kenyatta in 2019, following a successful pilot program in Kitui between 2013 and 2015, there is hesitancy in the uptake of the vaccine.

The Ministry of Health targeted to vaccinate 3.2 million girls across the country by June 2023, but so far, only 1.7 million girls, representing 53 percent have been vaccinated, with some 876,800 (27.4 percent) receiving the second jab.

Top counties in uptake of the first dose of the vaccine include Nyandarua, Nyeri, Bungoma, Nyamira, Kirinyaga, Siaya, Vihiga and Taita taveta.

The top counties have vaccinated at least 50 percent of the targeted girls.

Counties of West Pokot, Marsabit, Samburu, Turkana, Isiolo, Wajir, Garissa and Mandera have recorded the lowest uptake of the jab, with only 20 percent of targeted girls vaccinated.

Dr Shyreen Khalid Abubakar, the Directorate of Medical Services, Preventive and Promotive Health attributed low uptake of the vaccines to inadequate knowledge of the HPV vaccine by the caregivers, and hesitancy due to myths and misconceptions.

"HPV vaccination is being integrated with programmes targeting similar age groups, and engaging all stakeholders at the community level," said Dr Abubakar.

Dr Joel Okumu, a clinical and radiation oncologist based at Kenyatta National Hospital (KNH) said at least 78 percent of cases of cervical cancer are caused by HPV virus, adding that the best way of preventing it is to vaccinate girls before the first day of their intercourse.

"It takes between 15 and 20 years to have the vaccine work. If you are infected now, you might not have it now, but in the next 20 years, you can see. If vaccinated now, results will be 10 years later," said Okumu.

To boost the uptake of the jab, Okumu said the government should fight misinformation associated with the vaccine, through sensitization at the community level.

"Vaccination of our girls with HPV vaccine is the only sure way of fighting cervical cancer. We have to protect the future generation by vaccinating our girls," added Okumu.

But Dr Maina attributed the low uptake of the vaccine to a lack of awareness.

"There is not enough awareness about the HPV vaccine, among the population, including medical practitioners, who do not understand what they are vaccinating, and what is being prevented.

"It is worrying that the disease is killing people left, right and center, yet we are not utilizing the solution with us," said Dr Maina.

There are three different types of HPV strains, with over 100 serotypes (different viruses), of which, 14 are divided into high-risk, intermediate and low-risk, according to Maina.

The high-risk strain is mostly associated with cervical cancer.

The vaccines contain ingredients of the strains, which allows the body to create antibodies, which fight the virus that triggers cancer.

The HPV vaccines are administered as a two-dose schedule, at zero then after six to twelve months. A three-dose schedule is offered to persons above 15 years.

"Pre-teen and pre-adolescents are the main targets in HPV vaccination, because they have the lowest sexual activity, unlike adults, who are most likely to have been exposed to any one of the HPV subtypes

If vaccination was initiated early, the morbidity and the burden that comes with cervical cancer significantly reduce," said Dr Maina.

The expert further encouraged women to undertake regular screening, for earlier detection of cervical cancer.

But due to low uptake of screening and late diagnosis, most patients present with locally advanced stage.

Cancer has a protracted period, which takes about 10 years to present symptoms.

"Screening is essential because it will help detect cancer at an earlier stage. But the majority presents at stages 3 and 4, when they have abnormal bleeding, cases attributed to delayed presentation from patients, and delayed clinical presentation," Maina said.

There are three methods of screening cervical cancer, namely the use of visual inspection, pap smear and HPV DNA testing.

Visual inspection is applied in remote areas like Isiolo and Wajir, where visual inspection is done to examine the cervix, to identify abnormality, by use of Lugol's, iodine or acetic acid.

HPV DNA test is a blood test that examines if a patient has any of the subtypes associated with cervical cancer.

Women are encouraged to undertake cervical cancer screening regularly, up to the age of 69 years.

"Before we start putting funding into treatment, we should actually emphasize primary prevention, to reduce morbidity and mortality associated with the actual treatment," said Maina.

Lack of data is also a hitch in the fight against cervical cancer, according to the expert.

"Unfortunately, we do not have enough studies in Kenya, that actually show how our patients are being treated, and the outcome of treatment. This is data that is missing, that has left us in the dark. We have studies but specifically, in Kenya, we are still struggling to have the data," said Dr Maina.

According to 2020 data by the National Cancer Institute of Kenya, breast cancer was leading with 6, 799 (16.1 percent), cervical cancer 5, 236 (12.4 percent), prostate 3, 412 (8.1 percent), oesophagus 2, 974 (7.1 percent), and colorectum 2, 724 (6.5 percent).

As per the institute, at least 8 in 10 women in Kenya have heard of cervical cancer, but 2 in the 8 go for early screening.