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Save our girls — Vaccinate them against HPV infection

BY: Dr Dennis Laryea & Charity Binka
Kwaku Agyeman Manu — Minister of Health
Kwaku Agyeman Manu — Minister of Health

The empowerment of women is tied to their health status.

It is only healthy women who can actively engage in the building of a nation.

It is, therefore, necessary to continue to focus on the need to pay attention to   some diseases that continue to claim the lives of women and girls needlessly.

Some of these conditions are cervical cancer, which could be prevented through the Human Papillomavirus vaccination.

 It is appropriate, therefore, to use occasions, such as the International Women’s Day, to focus on the ways in which innovation can remove barriers and accelerate progress for gender equality, encourage investment in gender-responsive social systems and build services and infrastructure that meet the needs of women and girls.

The global campaign theme for the celebration of this year’s International Women’s Day, celebrated on March 8, was “Balance for Better.”

Human Papillomavirus vaccine

The Human Papillomavirus (HPV) is mainly transmitted through sexual contact and most people are infected with HPV shortly after the onset of sexual activity.

 It is the most common viral infection of the reproductive tract.

 There are more than 100 types of HPV, of which at least 13 are cancer-causing.

Types 16 and 18 are known to be responsible for 70-90 per cent of cervical cancer.

There is also increasing evidence linking HPV 16 and 18 with cancers of the anus, vulva, vagina, and penis.

Although these cancers are less frequent than cancer of the cervix, their association with HPV make them potentially preventable using primary prevention strategies as those for cervical cancer.

Case for HPV vaccination

Several countries are instituting national vaccination programmes for HPV, including low and middle income countries.  

As the adage goes, prevention is better than cure.

 While this may be true for most situations in health, if not all, the case for cervical cancer is even stronger compared to most other cancers.

The diagnosis of cervical cancer can be very difficult, particularly in our environment with limited availability of laboratory staff and pathologists for the screening and diagnosis of cervical cancer.

 Currently, pathologists in Ghana are limited to a handful of health facilities mostly in Accra, Kumasi, Cape Coast and Tamale.

This limited availability of pathologists renders a screening programme impractical and at the population level limit the public health significance.

The limited availability also means that a national screening programme will most likely overwhelm the pathologists and other laboratory staff.

 Amid the limited human resource for a screening programme, vaccination remains the most viable alternative.

Secondly, there is evidence of a high prevalence of HPV infections among some sections of the population.

 HPV infections have also been identified as one of the commonest sexually transmitted infections worldwide.

Thus the risk for transmission to uninfected persons remains significantly high in the population.

Condoms, for example, have not been found to adequately protect against infection with HPV.

Providing protection from vaccination remains an important intervention.

Vaccination also provides the opportunity for breaking the transmission of the virus thus reducing the risk of cervical cancer among women in Ghana.

 Once a person is vaccinated, the person is less likely to be infected and hence less likely to infect others, thus reducing the risk.

Ghana’s robust Expanded Programme on Immunisation means the infrastructure and human resource are readily available to implement a national vaccination programme.

Vaccination will not only be a fair public health intervention due to limited and maldistribution of human resources for diagnosing and treatment of cancers, but also a cost-effective intervention.

No national programme for HPV vaccination

Clearly, the benefits of vaccinating girls against HPV is enormous.

 So the question is: Why have we as a country not instituted a national HPV vaccination programme?
 
The first reason is the cost of the HPV vaccine.

 The vaccine is currently available in Ghana, with prices ranging between GH¢250 and GH¢500 per dose and three doses are needed to be fully vaccinated.
 
Currently, Ghana receives significant support for the implementation of the childhood vaccination.

 However, there is no clear source of funding HPV vaccination nationally, although the policy on Non-Communicable Diseases has HPV vaccination as one of the primary prevention strategies to be implemented.

Secondly, the level of knowledge on HPV vaccination in Ghana is low, even among NGOs and some healthcare providers.

The way forward

The Human Papillomavirus vaccine presents a unique opportunity to reduce the burden of HPV infection and cervical cancer in Ghanaian women.

The 2019 International Women’s Day celebration provides an opportunity to call for the establishment of a national programme for HPV vaccination.

 It is essential to call on industry players, individuals and NGOs to come on board in order to make the vaccine affordable.

 Potential sources for funding for a national immunisation programme should be explored.

This may include but not limited to the National Health Insurance Scheme, co-payment by recipients, establishment of a fund for non-communicable diseases, part of which would support HPV vaccination.

 The lives of our girls and women matter.  It is time to take action to save their lives!!!

Dr Dennis Laryea is the Programme Manager for the Non Communicable Diseases of the Ghana Health Service - This email address is being protected from spambots. You need JavaScript enabled to view it..  Dr Charity Binka is a member of the National Cancer Board and Executive Director of Women Media and Change (WOMEC) – This email address is being protected from spambots. You need JavaScript enabled to view it.