Saving girls from cervical cancer: HPV vaccine set to tame scourge

Sally Kwenda will be turning 50 this month. She begins by thanking God after surviving a series of misfortunes in her life.

Kwenda, a three-time survivor of cancer, has been through depression, a suicide attempt, a toxic marriage and losing her two children as well as her husband.

But, as the country finally rolls out HPV vaccine today, she is hopeful that other girls can be spared the surgical nightmare she underwent to survive cervical cancer. 

“Cervical cancer is something that can be prevented. As women, we should agree with the government that the vaccine be given to our girls to reduce rates of cervical cancer in the country,” Kwenda says.

Her medical woes started in 1999, when she was found to be HIV positive, which she says was tougher to manage at the time. She miscarried at seven months and lost her second child when he was two months old.

By then, she was staying in Mombasa with her husband. “My husband did not understand what was going on and our marriage broke down. I was depressed,” Kwenda said in an interview.

“I decided to take my own life. I threw myself from the ferry, thinking I would die and put an end to all that because I could see those with HIV were buried in a not-so-befitting manner,” she said.

She said did not want to wait to go through that. Because of her status, she would go through other series of tests and in 2007, she did a pap smear test and was found to be having stage two cervical cancer.

Kwenda said the doctor advised that because she was HIV positive, she was to go through total hysterectomy.

Hysterectomy is the surgical removal of the uterus. It may also involve removal of the cervix, ovaries, fallopian tubes and other surrounding structures. Kwenda needed it to prevent the spread of the disease to the organs.

She was being monitored closely. Because she had HIV, she could not go through chemotherapy or radiotherapy. 

It was a difficult decision, but she saw if that was the only way to make her live, then so be it.

“We were back together with my hubby, and he was not happy because he was young and had interest in getting more kids,” she said.

Unfortunately, he died in 2012 because he had resisted being put on ARVs.

ELUSIVE SOLUTIONS

In 2012, the cancer recurred, in the colon this time. The part was cut off but it continued spreading.

After one year, it went to the rectum, and the rectum was removed.

“People were wondering how I would still eat and go to the toilet, yet all those organs had been removed,” she said.

The doctors handling her were experts and hence made a new way of passing waste: the colostomy bags.

“However,  the bags are not readily found here in Kenya, and if you are lucky to get it, it goes for between Sh800-1,000 per piece,” she said.

In a day, you would require maybe one or two, depending on an individual.

Kwenda's experience has made her a cancer advocate.

More than 800,000 10-year-old girls are set to receive two free doses of the Human Papilloma Virus vaccine from this month.

Health CS Sicily Kariuki said the vaccine will be rolled out in Mombasa today. It will be introduced into the routine immunisation schedule. 

The rollout was to be done since early last year but has been postponed several times. The country has 1.3 million doses of the vaccine in stock, acquired at a cost of Sh800 million. 

African countries have been slow to roll out the HPV vaccine to their populations, despite the continent having a high incidence of cervical cancer, which the vaccine helps to prevent.

Currently, 10 African governments offer the HPV vaccine in their national immunisation packages, according to the WHO and Gavi, the vaccine's alliance. These are Botswana, Ethiopia, Rwanda, Seychelles, Uganda, Tanzania, Senegal, Malawi, Zambia and Zimbabwe.

Head of Vaccines and Immunisation Programme in the country Collins Tabu has attributed this to global supply issues rather than local challenges.

WHY LAUNCH WAS DELAYED

The rollout was scheduled after two successful pilot projects in Kitui county schools in four years demonstrated acceptability and effectiveness.

The objective of the pilot was to identify the best approaches for HPV vaccination in the context of the national immunisation programme.

“It was not by design that we had to keep shifting. One of the considerations before you start introducing a vaccine as a country and as a rule into the immunisation schedule, you must be assured of the continuous uninterrupted availability of that particular vaccine across all levels all through,” Tabu said.

“Once you start vaccinating against a disease, you do not stop unless one of two things happens: unless you have totally eradicated the disease against which you are vaccinating, or Jesus comes, whichever happens first.”

It will be supplemented with school outreaches and community outreaches targeting girls who might be out of school, to ensure no girl misses out on the vaccine.

“Before you start, you must be consciously aware that you have mapped out your needs going forward. Remember Kenya is not introducing this vaccine in a silo. Our needs must be mapped out against the global needs of the other 115 countries,” Tabu said.

The production capacity of the vaccine, assuring its continued global availability, must then be considered.

Once introduced, the caregiver of any 10-year-old girl will be able to walk into any healthcare facility and access the HPV vaccine free of charge.

“The girls will not be screened for any conditions as a prerequisite to getting the vaccine,” Tabu said.

There have been local published reports of bilharzia lowering protection, but Tabu said since this has not been reported elsewhere. The government will be evaluating the information as it goes along with the vaccine introduction.

“But when you realise that if you have a condition that lowers the protection of the vaccine, then this is more the reason you have to ensure that a more potent and effective vaccine has been delivered to these particular girls,” he said.

“And maybe even consider an extra dose, like could be recommended to HIV positive individuals, who are recommended to get an extra dose, like a third dose.”

The vaccine against the cancer-causing HPV will be administered six months apart, at about 9,000 public, private and faith-based facilities countrywide.

The vaccine will be given in form of an injection in the muscle of the upper arm, either left or right, and a card issued to all vaccinated girls, indicating the return date for the second dose.

In Kenya, cancer of the cervix is the second most common kind of cancer in women aged 15-44 years after breast cancer, according to statistics released by the International Agency for Research on Cancer last year.

“It's a bit embarrassing that, globally, at least 115 countries have the HPV vaccine within their routine immunisation schedules, and Kenya is not among them. We are coming in on the lower half. It's a bit embarrassing," Tabu said.

Women 4 Cancer co-founder Benda Kithaka said, “Cervical cancer is not a death sentence. It can be prevented through the vaccine. Way before the girl is introduced to HPV virus, we can help her build her immunity. The vaccine has been proven worthy and effective.”

WHY GIRLS NOT BOYS

Statistics from the ministry show that nine women die every day due to cervical cancer, about 3,000 a year.

In 2018, there were 5,250 cases of cervical cancer and 3,286 deaths in Kenya, according to the Ministry of Health. This equates to nine deaths per day, with the number of cases on the rise.

Globally, it is the fourth most frequent cancer in women. At the same time, 10.3 million women aged 15 years and above are at risk of developing the disease.

The World Health Organisation recommends vaccination of all girls and screening at least once every year for older women to reduce cancer risk, and that the vaccine is most effective when administered between the ages of nine and 14.

The government, as part of the rollout plan, will support the training of school nurses on HPV vaccination and support linkage with the nearest health facility for vaccination.

The HPV vaccine also prevents other types of cancers like anal warts and cancer and vulvar cancer.

But Tabu said boys will wait longer before they can also receive the human papillomavirus vaccine that prevents some cancers.

The Public Health official said it was more effective to target girls because 99 per cent of cancers caused by HPV affect women.

"Remember we are introducing the vaccine to protect our girls from cervical cancer. We do know that the vaccine might be able to protect against other conditions, such as genital warts, anal cancer and even oesophagal cancer," he said.

Like any virus, there is no cure for HPV, but it is preventable through vaccination.

Studies show that because HPV is mostly sexually transmitted, so vaccinating boys and men also helps protect women.

"While it might be looked at from that perspective, we may need to consider that it is probably most cost-effective to target the girls and by extension, if the girls are disease-free, we then have the benefits extended to the boys as well," Tabu told the Star.

The virus is spread sexually and women tend to be infected with it at one time or another in their lives, especially during their sexual debut.

Whereas in most women, the immune system clears away HPV naturally, for a small percentage, the virus persists in the cervix.