- In 2018 Tanzania achieved a historical milestone to roll out a Human Papilloma Virus (HPV) vaccine against cancer of the cervix, the second most common cancer in women worldwide. But how far have we achieved as 2020 comes to an end?
Oliva Nyemba*, 24, a University student who neither knew what a Human Papillomavirus (HPV) was nor did she ever think of contracting a sexually transmitted disease before she became a victim in 2018.
She found out that she had the virus four months after being in a relationship with her fellow University student.
“The virus must have gotten to me for a while before a cluster of genital warts started forming. Honestly, I despised and feared visiting a hospital for testing because I was nervous about what the test results could reveal,” Oliva tells in an interview with Your Health.
“I began to Google the disease by using the signs I was experiencing, hoping it would be an ‘easier’ disease that I could have treated right away but what I found out made me feel uneasy,” says Oliva.
Adding, “My heart dropped when I found out online that what I had was related to cervical cancer. I saw no chance of surviving the virus as the Googled results revealed that the virus can be persistent. This took a toll on me mentally as I worried and freaked out what the actual results would reveal.”
Oliva finally decided to go to the hospital five months after developing genital warts. She was diagnosed positive with the virus and was prescribed a cream that could get rid of the warts.
Oliva contracted HPV from her boyfriend at the University who at first blamed her as they both found out about the virus infection few months after they met before he fully decided to join forces in the treatment journey.
What is HPV?
According to Dr Johnson Katanga who works in the Immunity Department at Ocean Road Cancer Institute (ORCI) in Dar es Salaam, HPV is a sexually transmitted disease, categorised as high-risk and low-risk virus.
He explains that high-risk HPV consists of type 16 and 18, which is related to cervical cancer and it’s the most researched category due to its relation with the deadly cancer.
The low-risk HPV consists of type 6 and 11 whereas 90 per cent of people affected by this type of virus, get genital warts formed in clusters that may last up to 2 years till they disappear, that is if one’s immunity is strong enough.
“80 per cent of the women who have contracted HPV, their body immunity contains the virus before getting rid of it, the other 20 per cent are the ones whose immunity fails to naturally protect itself from the disease and hence get cervical cancer in some cases,” explains Dr Katanga.
High-risk HPV takes 10 to 15 years for the virus to show symptoms of cervical cancer after failure of body immunity to rid the human body of the virus.
“High-risk HPV often results to cervical cancer because the virus type is persistent in nature, and for a person to notice the symptoms of the disease, they must get tested once in a while,” advises Dr Katanga.
HPV virus and men
The expert further says that HPV affects both men and women but the outcome is different because men are the virus carriers.
As Dr Katanga refers to the research carried out by the Catalan Institute of Oncology, which reveals that men are also at risk to be infected by such a cancer but it occasionally happens.
“Men are potential multiple transmitters of the virus but he can also be at risk for several HPV-associated cancers such as anal cancer, penile cancer and throat cancer,” he says.
HPV acts as a risk factor because it influences other diseases to prevail after the failure of the human body’s immunity to act; it is the reason a person with chronic diseases such as HIV can contact the high-risk type easier than other people whose body immunity is still strong.
Until symptoms develop, a person would not directly know they are affected by the virus, until the prevalence of genital warts or through Pap test results (during cervical cancer screening).
“This led to the establishment of measures like vaccination to intervene the virus before diseases like cervical cancer get in between,” says Dr Katanga.
“Due to cost-effectiveness, the vaccine that was first brought in Tanzania in 2018, targeted girls aged 9 to 14 who were assumed to have not started sexual relations to prevent them against HPV type 16 and 18 only,” explains Dr Katanga.
However, Dr Katanga explains that the vaccine was given to individuals for free of charge according to HPV types as the vaccination was divided into quadrivalent and bivalent HPV vaccines.
The first batch of vaccination brought in Tanzania was bivalent vaccine only, which was for the types related to cervical cancer.
“The vaccination is for young girls to raise their immunities and enable their bodies to fight HPV when they encounter it from a man who may be a carrier,” says Dr Katanga.
The Tanzanian Ministry of Health reached out to education institutes as it was an easier method to reach out to many girls at once.
The decision to vaccinate them was made by the girls’ parents and guardians who were first educated on the importance of the vaccine by the schools’ principals to grant the girls permission to be vaccinated.
Dr Katanga says that some parents at that time disagreed to let their girls be vaccinated and this was one of the biggest challenges faced in maximizing the reach.
“The second batch of the vaccination was repeatedly conducted 6 months after the first time, to boost immunity,” says Dr Katanga.
He reveals that countries like England, started vaccinating boys in 2019 since they are the primary cause of transmission of HPV in the first place.
A report of media seminar organised by Ministry of Health of July 2020, detailed HPV vaccination coverage in Pwani Region districts involving 14-year-old girls from January to May 2020.
It involved two types of vaccination; HPV-1, which was the first HPV vaccine dose and HPV-2 that was the second dose prescribed 6 months after the first dose.
The report details that a higher percentage of girls were vaccinated during the first HPV dosage as compared to the second vaccination.
The report recorded coverage of both HPV vaccination in different Pwani districts including Bagamoyo with 31 per cent for HPV-1 and 18 per cent for HPV-2, the report also showed there was 51 per cent coverage in HPV-1 vaccination and 14 per cent coverage in HPV-2 vaccination in Kibaha district.
The report further shows that there was coverage of 5 per cent for HPV-1 vaccination and 6 per rcent for HPV-2 vaccination coverage in the Rufiji district, while in Chalinze, the coverage was 23 per cent for HPV-1 vaccination and 9 per cent for HPV-2 vaccination.
In Kibiti district, there was 17 per cent HPV-1 vaccination coverage and 19 per cent HPV-2 vaccination coverage, whilst the coverage in Mafia was 75 per cent for HPV-1 vaccination and 46 per cent for HPV-2 vaccination.
The report reads that Kibaha town council had 82 per cent of girls who participated in HPV-1 vaccination and 20 per cent in HPV-2 vaccination.
For Mkuranga district, only 34 per cent of girls participated in HPV-1 vaccination and 28 per cent for HPV-2 vaccination.
However, in Kisarawe district, 51 per cent of girls came for HPV-1 and 56 per cent came for HPV-2 vaccination.
HPV education needs a boost
Dr Katanga reveals that the coverage for HPV education is still very low, and so are the efforts to disseminate HPV information countrywide.
He advises that the local government has to be involved in increasing the rate of awareness by using postcards, seminars, and slogans, as they are the closest authority to the citizens.
“We can restrain HPV in its earliest stages before it causes cancer deaths and barrenness among Tanzanian women. If proper measures to make the public informed will be taken, it will be easier to attract public attention on the HPV education when the public is aware of its presence,” says Dr Katanga.
According to the 2019 HPV information center report by the Institute of Oncology (ICO, in Catalan) in cooperation with the Tanzanian Ministry of Health, the annual number of cervical cancer cases in Tanzania was 9,772 while the annual number of cervical cancer deaths was 6,695.
Lotalis Gadau, National Immunisation Planning Officer from the Ministry of Health, says the ministry is preparing a 2020 HPV report that will reveal the percentage level of all the girls who underwent vaccination whereas the findings will assist the Ministry of Health as a starting point for the next HPV vaccination process.
She says the Covid-19 pandemic affected the health sector because it became difficult to reach out to girls with school closures.
Ms Gadau explains that her ministry targets at emphasising public awareness on HPV generally, as many cancer deaths stem from the virus and the public being uneducated about the virus.
“We aim at reducing cancer cases and deaths among Tanzanian women, in both urban and rural areas,” says Ms Gadau.
She adds that the government intended for the vaccine to reach all Tanzanian women free of charge, it had to cooperate with vaccination sponsors, Global Alliance for Vaccines and Immunisation (GAVI) who covered all the costs.