Uganda yet to embrace HPV vaccination

he magic bullet to stop the infamous cervical cancer rise, according to experts lies in Human papillomavirus (HPV) vaccination. Countries have since launched several vaccination campaigns as recommended by different world health bodies and specific organisations in the cancer battle. 

Also, in a global plan aimed at tackling the growing cancer crisis in developing countries, Universal coverage of HPV and HBV vaccination, was among the nine targets listed in cancer declaration that was adopted by more than 60 high-level policy makers, leaders and health experts. 
They sought to have cancer-causing infections and human papillomavirus (HPV) covered by universal vaccination programmes.  

Uganda, whose cervical cancer cases rank highest in the world, enrolled a vaccination campaign in 2015. Launched in Kasese, the campaign targeted more than 850,000 girls aged 10-13 years. These were meant to get two doses given in six months intervals. Completion of such doses would protect the targeted girls from getting cervical cancer, which is the leading cause of cancer morbidities and mortalities among women.

However, the progress of this campaign and the attitude parents have towards the vaccine seems to suggest that the magic bullet to cervical cancer as experts note, is not appreciated.
Several districts are yet to hit their set targets as many girls are either yet to be vaccinated or complete their dosage which piles worries on District health authorities.

Laxity
Dr Edward Muwanga, the Kyotera District health officer, which targeted to vaccinate 20,000 girls notes that since the launch of the campaign, 16,402 girls have been vaccinated but only 8,233 completed the dose with the rest yet to complete, although the six months elapsed already.
“Tracing the girls for the second dose is hectic as many change schools yet they have gotten their first dose in their previous schools,” Dr Muwanga says.

In Rakai District, the story is not any different. Of the 23,000 targeted girls, only 14,240 got the first dose and 6,780 turned up for the second dose as Dr Rasto Muhangi, the assistant district health officer, explains.
Nationally, the progress is not so convincing after the launch of the programme five years ago.
Dr Alfred Driwale, the assistant commissioner in charge of vaccines and immunization at the Ministry of Health, disclosed that only 67 per cent of the targeted 850,000 girls nationwide have started on their vaccination, and only 60 per cent completed their second dose.
What is derailing progress?

Appearing on NTV’s Doc talk show, Dr Driwale noted that there was a plan to immunize at least 1.2m girls in April this year, during (integrated child days plus) but these were not reached because of the closure of schools in a bid to stop the spread of the Covid-19 pandemic.

But this has just happened after four years of the programme’s inception, meaning progress could have been realised earlier. It also cannot expalin the seeming poor performance of vaccination of a disease that claimed lives of 4,301 women in 2019 as 6,413 were diagnosed, according to data from the Uganda Cancer Institute.
Moses Muwulya, a cancer awareness activist in Masaka City, suggests that the myths attached to vaccination by parents could be playing a big role.
“In general, parents have the wrong perception on vaccines, not cervical cancer alone. People do not know the potential grave effects such diseases have,” he says.

Sensitisation
Muwulya, who is the communications officer for Kitovu Mobile, a medical and community empowered organisation that offers cancer screening, awareness and palliative care services, notes that people deserve to know the magnitude of cervical cancer and the lives it claims daily.
“And this has to be done through sensitising the public on prevention methods and this role has to be spearheaded by the government,” he says.

He adds: “There are television screens in waiting areas of many health facilities. However, these are mostly used just to entertain patients as they wait to receive treatment. Why don’t concerned stakeholders show such information in local languages as part of health awareness initiatives?” he asks.

When asked while in the queue  at Kalisizo Hospital in Kyotera District why her daughter was yet to be vaccinated, Josephine Nakimuli replied that her grandparents lived longer yet they were not vaccinated.
Such perceptions, according to Muwulya, could derail the progress of the campaign as it reflects the mindset of many Ugandans.

Cervical cancer signs
According to the Uganda Cancer Institute website, cervical cancer signs include menstrual bleeding that is longer and heavier than usual, pain during sexual intercourse, blood spots or high bleeding following periods, bleeding after intercourse, and increased vaginal discharge among others.

Dr Ritah Nabulya, the manager medical services at Kitovu Mobile in Masaka City, says the HPV vaccine gives antibodies that help fight the virus in the body. She says it is normally given to children under the age of 12 because they are usually not yet sexually active.
About the period in which the vaccine should be applied, Dr Nabulya explains that one is entitled to two doses whereby the first dose is given in the first month and the second one given after six months. 

“However, since covid-19 affected the first dose this year and some children may not have been vaccinated for the second time, Dr Nabulya says one’s first vaccination can be cancelled and restarted. 
She says those at risk of acquiring cervical cancer include people living with HIV/Aids, teenagers engaging in sexual intercourse at an early stage, diabetic patients and those with other types of cancer.

What is Hpv?
 According to the World Health Organization, Human papillomavirus (HPV) is the most common viral infection of the reproductive tract. 

The peak time for acquiring infection for both women and men is shortly after becoming sexually active. HPV is sexually transmitted, but penetrative sex is not required for transmission. Skin-to-skin genital contact is a well-recognised mode of transmission.