HPV vaccination against cervical cancer is increasing in African countries, but hesitations remain

Dr Yunusa Bawa spends a lot of time talking about the human papillomavirus vaccine, which is responsible for almost all cases of cervical cancer. However, most of the time, only two or three people allow their girls to be vaccinated in the rural area of Nigeria where he works.

The issue in the community of Sabo, on the outskirts of the capital Abuja, is the unfounded rumour that the HPV vaccine will prevent young girls from bearing children in the future.

As an increasing number of African countries strive to administer more HPV vaccines, Mr Bawa and other health workers face challenges that are slowing progress, including misinformation about the vaccine. The WHO office for Africa believes that around 25% of the population still has doubts about the vaccine, which mirrors the concerns seen in other parts of the world when the vaccine was first promoted.

In average, 190 women died every day from cervical cancer in Africa in 2020, accounting for 23% of deaths worldwide and making cervical cancer the leading cause of death among women in the 47-country WHO African Region. Africa has 18 of the 20 countries with the highest rate of cervical cancer in the world. Yet vaccination rates against HPV are low in the region.

Over half of Africa’s 54 countries – 28 – have introduced the vaccine into their immunisation programmes, but only five have reached the 90% coverage the continent hopes to achieve by 2030. Overall in the region, 33% of young girls have been vaccinated against HPV.

Compare this with most European countries, where both girls and boys are vaccinated against HPV.

According to Emily Kobayashi, head of the HPV programme at the Gavi Alliance for Vaccines, one of the reasons why cervical cancer is so widespread in Africa is that women have limited access to screening.

“The elimination strategy is a long-term job… but we know that vaccination is the strongest pillar and one of the easiest to implement,” said Ms Kobayashi.

It is one thing to introduce the vaccine, but if it stays in the fridge, it will not prevent cervical cancer”, said Charles Shey Wiysonge, Head of the Vaccine-Preventable Diseases Programme in the WHO’s Africa Region. 

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Vaccine reluctance in many African countries goes back a long way, and is sometimes linked to a lack of trust in government, as shown by a study published in May in the journal Nature Science, leaving room for conspiracy theories and misinformation from social media influencers and religious leaders.

Recently, in Zimbabwe, where cervical cancer is the most common cancer among women, a group of women known as the Village Health Workers was formed to raise awareness of cervical cancer and the HPV vaccine among rural populations. However, they encountered great resistance from religious sects, who discouraged followers of modern medicines, asking them to rely instead on prayers, “anointed” water and stones.

Those women who finally agree to be screened for cervical cancer do so in secret, said Zanele Ndlovu, one of the health workers on the outskirts of the city of Bulawayo.

According to Zanele Ndlovu, even in a deeply religious country like Zimbabwe, “spiritual leaders have so much influence that a lot of our time is spent trying to educate people about the safety of vaccines or the fact that they are not godless”.

Other examples of success can be found in Africa, where the authorities are trying to educate people about the safety of vaccines and the fact that they are not ungodly.