Human Pappilloma Virus is a sexually transmitted infection which may result to Cervical Cancer and kills over 10,000 Nigerian Women annually, in this interview with Ndidi Chukwu of Health Reporters, Dr. Damaris Onwuka, Acting Director Disease Control and Immunisation, National Primary Health Care Development Agency (NPHCDA), said plans are underway for national vaccination against HPV.
We have increasing cases of Cervical Cancers in Nigeria, what is the cause?
Onwuka: Cervical Cancer is caused by Human Pappilloma Virus. Exposure to that virus can affect the cervical cells. Usually exposure to unprotected sex is a cause just like in HIV and other sexually transmitted infections. It is also common among the child bearing aged women. Nigeria has about 47.7 million women who are above 15 years. These are the group that are usually exposed and affected. They have the risk of developing cervical cancer. In Nigeria, every years we diagnose about 14,550 with cervical cancer, and out of this 9, 500 of them die. Cervical cancer is the second most common cancer among women, it comes after breast cancer and it is very common.
You have linked HPV to Cervical Cancer, is HPV curable?
Onwuka: Luckily, cervical cancer is one cancer that can be prevented, and could be cured if discovered early enough just like any other cancer. Among the women we do screening and that is why we encourage every woman of child bearing age to go for Pap smear. We also have other ways of diagnosing changes in the neck of the cervix where we visualised with acetic acids to see changes of the cells, but what is important is that every woman who is of child bearing age should try and go to the clinic for screening, this is called the secondary prevention but the primary prevention is where to plan to encourage young girls to take Human Pappilloma Virus Vaccines which is being developed to prevent the spread of cervical cancer. Cervical cancer at some stage may not be curable, but it is preventable.
Are the vaccines readily available in Nigeria and what is the cost of full vaccination for one woman?
Onwuka: The vaccines are available. HPV has so many serotypes but globally only two serotypes are known to cause cervical cancer that is the serotype 16 and 18. They cause about 70% of cancers worldwide. This virus, about 50% of people who are sexually active have come in contact with it, they live with it in their lives so we have about two different vaccines available and one of it we call ganacell, the other one cervirus and they are usually given to girls before they are exposed to marriage and sexual activities. We give it between 9 to 13 Years. We try to give it to them and in Nigeria it is important we do that because from studies we have found out that girls are exposed to marriage around the age of 15 and we are aware that early marriage in some parts of the country is also an issue. So it is important for us to make these HPV vaccines available to the early enough before they are exposed to marriage and sexual activities. With regard to the cost, compared to other vaccines, I must confess to you that HPV vaccine is costly but when we introduce it to Nigeria, the government will subsidise or supply the vaccines and so our partners will support us. It is also good for all hands to be on deck, there are some members of the community in our country Nigeria that could also afford to support the procurement by giving us some funds. Here we have our girls, mothers, sisters and wives to protect and what is disturbing about this is that when women develop this disease they shy away they hardly come out to seek for help, they hardly speak out and in some cases husbands will even make it difficult for their wives to go to doctors and be examined. We need to let them know that it is important to protect their own lives. When something unusual is happening to you, speak out, look for help, your life is yours to protect. We encourage women to speak out; when they start bleeding abnormally they should go to their doctor and be sure that they are okay. One thing is that if they don’t go to the doctor early enough and this cancer develops it will spread that is what we call metastasis. It will spread to other parts of the body, by then it becomes difficult. They will present very late and there is nothing the doctor could do about it. People don’t even need to wait until they bleed abnormally we have said they should try and go for screening every year.
Has the vaccines been subsidised already, is it accessible to people as we speak or plans are on going?
Onwuka: The government of Nigeria, we are planning the introduction of these vaccines, they are not yet introduced in the immunisation programme yet but we are working on that, we are planning for that because we see how important it is to people. What our partners have advised us to do is Demo Project, which we are working on now and there after we learn from the demo project, we need to know how people will receive it, how affordable it will be and to whom and where and how before we can plan for national introduction and as I told you the only children who are eligible to access it are those between 9 to 13 years and we are looking at those who are about 11 and 12 for the demo project.
Talking of how vaccines are funded in Nigeria, there are partners, and donors who contribute to ensure that immunisation is done and complete, now if the demo project will be implemented, do you have international support, or you are relying on the Nigerian Government?
Onwuka: For now the Global Alliance for Vaccine Initiative (GAVI) is encouraging us to do this demo and they will also support partly because the cost will be huge when you look at the resources both human, finance and logistics, it is going to be huge and the cost of vaccine is also higher compared to the others. GAVI will come in but we also need the government of Nigeria and other partners, we are going to do a lot of advocacy to organisations and individuals to support this project. We are trying to do affirmative reach to see how people react to it, considering the age group, many parents may frown at it, some religious groups may reject it even the girls themselves that is where social mobilisation and advocacy and awareness creation are going to be key. It is better to educate the people on the dangers of not taking this vaccine because we see women dying no one know why they are dying. If we can prevent women from dying of cervical cancer we have prevented and reduced the number of women dying in Nigeria by half because it is the second most common cancer that kills our women, from the statistics we all should be worried because most of these women are dying in silent.