There are over 100 types of Human Papilloma Virus (HPV). Out of these, 14 types cause cancers. And two particularly notorious ones; types 16 and 18, are responsible for cervical cancer.
Also, about 40 of the HPV virus types can be transmitted through sex (vaginal, anal or oral) and that is why the vaccine developed to prevent infection, is best administered before one is sexually active.
While the vaccine is available, it doesn’t seem to be popular.
Most mothers across Kenya say ‘they want girls to get the cervical cancer jab,’ but only a handful are ready to vaccinate their daughters.
“I am waiting for a signal from my friends. But all they talk about are other girls but not their own daughters,” says Ann Kabura from Kinoo, Kiambu County, who runs a boutique in Nairobi.
“My girl is only 10, too young to have known anything about boys. I will wait till she is at least 14 or 15.”
In August, Health Chief Administrative Secretary Mercy Mwangangi pleaded with parents to take their girls for cervical cancer vaccination because the numbers were not adding up.
“There has been a severe decline in coverage of HPV (human papillomavirus) vaccine for 10-year-old girls, which currently stands at 46 per cent,” she said at a media briefing.
The current campaign to vaccinate 800,000 girls, aged 10, across the country started in 2019, but targets have not been achieved.
The national rollout follows two earlier pilots in Eldoret in 2013 and Kitui County in 2015. While both had similar objectives the approach and outcomes were totally dissimilar.
In Eldoret, 3,083 girls from 10 schools were targeted with three doses of the HPV vaccine for which they were to present at a medical facility.
Uptake was poor with about 64 per cent getting the second dose and only 39 per cent presenting for the third and final dose.
The requirement that vaccination should be done in hospital, and distance were largely blamed for the poor uptake. Consequently, for the next piloting in Kitui County in 2015 the vaccine was taken to the girls within their schools.
This time, uptake for the now two-dose vaccine was high reported at 95 per cent covering 22,500 girls within their schools.
But there was a problem, the donor, Gavi- the Vaccine Alliance, said the school approach was too expensive and unsustainable hence the national rollout is being carried out in hospitals with predictable poor uptake.
Studies are currently underway at the Kenya Medical Research Institute to endorse a single dose HPV vaccine, which is expected to be cheaper for donors to finance and easier to comply with. But doctors who have been close to the exercise say parents may be the biggest cause of the slow uptake despite most appreciating the importance of a cancer jab.
A team of reproductive health experts from Moi University, Eldoret and Ghent University, Belgium, says there is overwhelming support for the jab especially among mothers of adolescent girls.
The doctors had engaged 300 mothers and guardians of adolescent girls on the HPV vaccine in Eldoret.
Majority of the mothers, 70 per cent, were willing to have their daughters vaccinated, and only 90 or 30 per cent declined.
However, only 28 or about nine per cent of the mothers had initiated vaccination for their daughters, the team reports in a study published in February.
The study led by Dr Hillary Mabeya, says positive attitudes alone do not lead to parents accepting their daughters to be vaccinated.
“It is like faith without action,” suggests the study published in the Pan African Medical Journal.
In Nairobi, things are no different either. Dr Omondi-Ogutu, a gynaecologist and colleagues at the University of Nairobi engaged 50 mothers and guardians of Standard Five girls from four primary schools in Langata Constituency. They assessed mothers’ acceptance of the HPV vaccine and willingness to have their daughters vaccinated.
“Sixty eight per cent of parents and guardians accepted that vaccination should be done but only 58 per cent agreed that their daughters should be vaccinated,” says the report published in the East African Medical Journal.
Last year, Koleck Chester Omondi of the University of Nairobi also assessed the willingness of parents to have their daughters take the HPV vaccine.
In his unpublished study, Omondi, now a pharmacist in Migori County engaged 195 parents who were attending various clinics at Kenyatta National Hospital.
“Eighty three per cent of parents were willing to vaccinate their children with higher acceptance in women than men,” reports Omondi.
“More females than males were also willing to recommend the vaccine to their friends,” wrote Omondi though he did not report on actual uptake.
A study among 348 mothers attending Mbagathi District Hospital in Nairobi also had 68 per cent rooting for girls to get the HPV jab.
In Kitui South, a Church led initiative - Children And Mothers Partnerships (Champs) says parental resistance to HPV vaccination and cancer screening for their daughters is a major challenge for cancer control.
Most of the declining mothers, in these studies, said they were concerned over possible side effects, vaccines not being readily available, cost of travel to the hospitals, girls being too young or that their daughters would become promiscuous.
“Vaccination of my daughters will prompt early sexual activity,” a mother told researchers in Eldoret.
“I would refuse because it can encourage teenagers…. they would begin to indulge in sexual activity…… Because they will not have any more fear,” said a participant at Mbagathi hospital.
Thirteen per cent of parents in the KNH study expressed fears of adolescents’ early sexual debut upon HPV vaccination.
A significant number of mothers were also concerned that if it was known that their daughters had been vaccinated they may be stigmatized and labeled as being promiscuous.
Many mothers were of the opinion that ages 9 to 10 were too early, indicating they may be able to consider the jab when their daughters are between 11 and 13 years.
Dr Omondi-Ogutu however, explains that the idea is to catch them early before they are sexually active.
“The prevention of HPV infection is achievable if vaccination is carried out early before sexual debut, and this is the reasoning behind the recommendation of early vaccination.”