Cancer: Another vaccine, another controversy

By Abiemwense Moru, News Agency of Nigeria (NAN)

Nigeria is no stranger to vaccine controversy. Some two decades ago, health authorities in the country had to contend with the rejection of the Oral Polio Vaccine (OPV) in many parts of the country.

Rumour mill had it that the Wild Polio Vaccine (WPV) was a creation of the West to depopulate Africa by rendering them impotent from as young age as possible.

So, the vaccine that was meant to save the future generation from the crippling effects of Wild Polio Infection, was roundly rejected.

To overcome the OPV resistance challenge, the Federal Government and its development partners unleashed a battery of counter offensive in the rejection endemic regions, mainly the north. They recruited traditional and religious leaders in the process.

At some point they had to send a fact-finding team to Malaysia, a predominantly Muslim country and source of OPV for Nigeria to convince skeptics that the government had no hidden agenda against its Muslim population.

A similar resistance also greeted the COVID-19 vaccine. Again, conspiracy theorists said it was an instrument designed by the West to depopulate Africa. Many vowed to die of the rampaging COVID-19 than to take the vaccine.

More than two years down the line, those who took the vaccine are still alive.

Vaccine skeptics have every right to be concerned. In 1996 in Kano State, Pfizer, a global pharmaceutical company decided to test the efficacy of its meningitis vaccine on some hundreds of children.

It turned out to be a fatal exercise as 11 of the children died after taking doses of the oral antibiotic Trovan and ceftriaxone trial vaccines. While five kids died from taking Trovan, six were victims of ceftriaxone.

After 15 years of legal battle, Pfizer was found guilty and had to pay 175,000 dollars to each family of the deceased children.

So, as the federal government and its development partners recently rolled out the Human Papillomaviruses (HPV) vaccine for short, for the prevention of cervical cancer, it is no surprise that it is facing similar fate as OPV and COVID-19 vaccines.

Photo credit- WHO Nigeria

So far some parents have refused to make their female children aged between nine and 14 available for the vaccine even as the federal government and its development partners say all scientific efforts have been put in place to ensure the safety and efficacy of the vaccines.

In a video that went viral, a popular Abuja-based talk show presenter was seen warning parents to reject the vaccine alleging that it is dangerous to their wellbeing.

Also, one social media user sarcastically urged those who want to vaccinate other people’s daughters with HPV to first administer it on their daughters.

While some Nigerians question the safety of the vaccine, others who have lost their loved ones said their pain would have been averted if the vaccine was available when the victims were alive.

This is as the federal government and its partners embark on a mass campaign to vaccinate as many young women as possible.

However, there are many Nigerians that have lost close relatives to the disease.

One of them, who lost her mother to cervical cancer, Angela Usi, a business woman, narrated how her mother was in pain for two years before she died of the disease.

She said her mother did not attend her wedding because she couldn’t survive cervical cancer.

Usi appealed to parents to allow their children to be part of the HPV vaccination to protect their lives.

According to the World Health Organisation (WHO), one of the arrow heads of the HPV campaign, there are six licensed HPV vaccines: three bivalent, two quadrivalent, and one nonavalent vaccine.

Experts say Quadrivalent vaccine, are designed to protect against four different types of a disease while HPV nonavalent vaccine protects against infection with low-risk HPV types 6 and 11.

WHO says all vaccines are highly efficacious in preventing infection with virus types 16 and 18, which are together responsible for approximately 70 per cent of cervical cancer cases globally.

It says the vaccines are also highly efficacious in preventing precancerous cervical lesions.

The primary target group in most of the countries recommending HPV vaccination is young adolescent girls, aged 9-14. For all vaccines, the vaccination schedule depends on the age of the vaccine recipient.

Eduardo Celades, Chief of Health, UNICEF Nigeria, says the HPV `is something we have been looking for, for a long time`.

Celades spoke in Abuja during one-on-one interviews with experts and key stakeholders involved in the rollout of the vaccine in Nigeria.

“Having these vaccines is an incredible entry point to start to work with the young girls to really improve their data. So for us, this is the first thing that we would like to do,” he said.

According to him, if vaccination rates have started to decrease or the number of people resistant to vaccines increases it means putting at risk many years of hard work.

”We know it’s approved not only by NAFDAC in Nigeria, it has been approved by the FDA in the U.S. and European medical agencies by the Swiss medical agency,” he said.

Emily Kobayashi, Head of HPV Programme, Gavi, the Vaccine Alliance, said cervical cancer is a deadly disease hence the need for young girls to receive the vaccine.

“If we look around the world we see every year 340,000 women die of cervical cancer and 90 per cent of those actually die in low and middle income countries including countries like Nigeria.

“So, most women in the world are vulnerable to cervical cancer. It tends to affect women in the range of 35 to 55 which is when they’re raising children, where they’re working and contributing to society.

“So losing women at that time is challenging and it is also very challenging to treat cancer.

“It’s very painful to live with, and it can be economically devastating to the patient and to the family. But the good news is, it is almost entirely preventable.

“So 90 per cent of cervical cancer is associated with Human Papillomavirus infection and with the vaccine that we’ve seen reductions of nearly 90 per cent in vaccinated populations”, she said.

Kobayashi said the vaccine is most effective if it’s delivered before sexual initiation which is when somebody could be exposed to the HPV vaccine.

“And so the WHO has recommended nine to 14. That is to target the age range where it’s well before sexual initiation.

On acceptance of the vaccine, she said there was high hope, because the WHO in Nigeria did a rapid survey.

“And what the people said was that even if they weren’t previously aware of HPV, that they were willing to have their daughters vaccinated.

“They’re willing to support vaccination. So what we’re hearing from the community is high rates of excitement and acceptance. So we’re feeling hopeful,” she said.

Dr Chizoba Wonodi, Immunisation the and Convener, Women Advocates for Vaccine Access, said it was important that Civil Society Organisations were involved in efforts to dispel conspiracy theories about HPV and other vaccines.

“CSOs are important because they are the voice of the masses; they decide that they want to work with the communities as regard to passion and desire to see change happen in the communities.

“We train the CSOs about immunisation and give them some support to carry out their activities.’ she said.

“The reason we are training them is to get them to understand about the HPV vaccine, cervical cancer, how to engage the communities in having dialogue and sensitisation with them.

“If you are able to have a dialogue with community members, allow them to ask you questions and you respond to their concerns without judgment then they will be able to make informed decisions,’’ she said.

Mrs Chika Offor, Chairperson Health Sector Reform Coalition and CEO of Vaccine net for Disease Control, said no effort should be spared to mobilise parents to embrace the vaccine.

“How do we get the girls to get vaccinated? Good mobilisation, good planning, good advocacy to the communities are required”, she said. (NANFeatures)

**If used please credit the writer and News Agency of Nigeria.

Myths about HPV vaccine untrue, unfounded — FG

By Folasade Akpan

As the Federal Government gets set to launch the Human Papilloma Virus (HPV) vaccine in Abuja on Oct. 24,
it has debunked myths making the rounds which claims that the vaccine is intended to reduce fertility in girls.
Dr Uche Nwokwu, the acting Director, Clinical Services, National Institute for Cancer Research and Treatment (NICRAT), dismissed such claims
in an interview with the News Agency of Nigeria (NAN) in Abuja on Wednesday.
NAN reports that HPV is a virus that transmits through skin-to-skin contact and can develop in anyone who is sexually active.
HPV is a primary cause of cervical cancer and other cancers, including cancer of the vulva, vagina, penis, or anus, and by protecting young
girls before exposure to the virus, it can reduce incidences of the devastating disease significantly.
The Ministry of Health and Social Welfare, in partnership with Gavi, the Vaccine Alliance, WHO and UNICEF is, therefore,
set to launch the vaccine, followed by a roll-out in some selected 16 states namely; Abia, Adamawa, Akwa Ibom, Bauchi, Bayelsa, Benue,
Enugu, FCT, Jigawa, Kano, Kebbi, Lagos, Nasarawa, Ogun, Osun and Taraba.
The acting NICRAT director, therefore, explained that though the vaccine could have some mild side effects like every medicine, the side effects
would be explained on the leaflets of the vaccine.
Nwokwu said “the myth about the vaccine reducing the fertility of girls is out of place and not true, which are the reasons people are afraid.
“At the point where the inoculation is done, there could be some reaction around the area; it could be pain of injection, someone may
have mild fever, these are side effects of the vaccine but it is not something that should discourage anybody from getting it.
“The benefits of the vaccine are greater than the minor fever reactions at the site of the injection and
does not reduce the person’s fertility.
“Also, there is no known long term effects discovered and for now; there is no evidence that it has any adverse effects.”
Describing the nature of the virus, he said it is responsible for a lot of disease conditions, including cancer of the cervix or the uterine cervix.
He said there are different stereotypes or variants of HPV, but that the one responsible for cancer of the cervix is stereotype 16 and 18, while
the other stereotypes could cause other warts.
He added that the variants 16 and 18 are responsible for almost 70 to 90 per cent of cancer of the cervix.
He said “many people may have the virus and will not come down with cancer of the cervix.
“It results in cancer when the body is not able to clear the virus. The virus is weak so it’s not as potent as other viruses like Hepatitis or HIV.
“Someone can have the virus or get exposed and the person’s immune system will clear the virus.
“However, in some cases where the immune system is not able to clear the virus, it can cause mutation of the cervix and lead to cancer of the uterine cervix.”
He also said that in some cases, it is common in people who have multiple sexual partners because having multiple exposures could increase the virulence of the virus.
He explained that “there is danger if young girls are being exposed to HPV when their cervix is not yet mature, that is when they are still undergoing transformation.
“There is a particular area of the cervix that is called transformation zone. As the young girl is growing, some part of the cervix is pushing out just for maturity purposes.
“When that transformation is on-going, that place is still fragile and immature. So if the girl is exposed to the virus at that time when that place is maturing, the virus has the capacity to take advantage of the situation and cause problem.”
According to Nwokwu, the vaccine is very important as it prevents girls from any risk of contracting the virus in future.
He said “that is why the target of the HPV vaccination is young girls who are not yet sexually exposed and people who were still very young.
“The target now is for girls between nine to 14 years of age. That is when they are getting to that puberty maturation stage and not yet sexually exposed.
“The other reason for targeting those who are not yet sexually exposed is because once someone has that virus, it does not make sense to take the vaccine.”
The NICRAT official recommended that countries that have the capacity should vaccinate both girls and boys “because boys could have warts
on the penis too, even though those warts do not result into cancer.
“So, in some countries, they vaccinate both the girls and the boys, but in our country, our major concern is the girls because even when the boys
have the virus, the problem with them is not as much as when the girls have it.
“By the time the economy improves and we have the vaccine everywhere, we can as well give the boys and girls so the targets for now in our
National Strategic Plan for prevention of Cancer of the Cervix is to immunise girls.
“We are also hopeful that it will be integrated into the Primary Health Care National Programme on immunisation so that it becomes routine.”
He, however, said that for girls who have been sexually exposed, they would need to do HPV DNA test to know their status.
As for the dosage, he said, it depends on the brand of vaccine being used.
“However, what is important is that if someone is able to take the appropriate dose, it confers life immunity.”
He added that the brand of vaccine Nigeria is inaugurating is the one that has potency against four variants of HPV. (NAN)
Edited by Hadiza Mohammed-Aliyu

NEWS ANALYSIS: Why no woman should die from Cervical Cancer

 

A News Analysis by Vivian Ihechu, News Agency of Nigeria (NAN)

Cervical cancer is the second most common cancer affecting women in Nigeria and the fourth most common cancer among women globally, according to World Health Organisation (WHO).

Cervical cancer develops in a woman’s cervix (the entrance to the uterus from the vagina).

Almost all cervical cancer cases (99 per cent) are linked to infection with high-risk human papillomaviruses (HPV), an extremely common virus transmitted through sexual contact.

Current estimates for Nigeria in 2023 by the Human Papillomavirus (HPV) Centre indicate that every year 12,075 women are diagnosed with cervical cancer and 7,968 die from the disease in the country.

About 3.5 per cent of women in the general population are estimated to harbour cervical HPV-16/18 infection at a given time, and 66.9 per cent of invasive cervical cancers are attributed to HPVs 16 or 18.

However, with proven interventions to prevent and manage the disease, experts say that no woman is expected to lose her life to cervical cancer.

Prof. Isaac Adewole, a former Minister of Health, Nigeria and Co-Founder, African Cancer Coalition

Prof. Isaac Adewole, a former Minister of Health, Nigeria andCo-Founder, African Cancer Coalition, told the News Agency of Nigeria (NAN) in Lagos that cervical cancer had become a public health issue.

Nevertheless, Adewole, a professor at the University of Ibadan and Northwestern University, said the disease which was caused almost entirely by a virus, could be tackled.

He said cervical cancer was preventable and treatable, if presented and diagnosed early.

He said part of the strategies to eliminate cervical cancer included, vaccination of about 90 per cent of girls between ages nine and 14 with HPV vaccine to prevent them from having the cancer.

According to him, it takes about an average of 20 to 30 years for cervical cancer to develop, and the HPV vaccination offers a window of opportunity to kick against the cancer.

He said screening of no fewer than 70 per cent of women using a high-performance test by the age of 35, and again by the age of 45, was also a strategy to save women from cervical cancer.

“When we screen women who are asymptomatic, we have no complaints at all.

“When we screen them, we’ll be able to determine and diagnose stages that occur before development of cancer. We call these stages pre-malignant stages.

“We are able to detect them and when we offer appropriate treatment they will be cured,” said Adewole.

Another  way of addressing the cervical cancer menace, according to Adewole, is prompt and appropriate treatment when detected early.

“Even those who develop cervical cancer, when we pick them in the early stages, we can almost uniformly cure them.

“Treatment of women with early presentation as well as invasive cancer management helps.

“When you look at the three factors of prevention,screening, which is secondary prevention; and treatments of early stages, we have a disease on our hands that applying public health principles, we can control,” explained the professor.

Adewole advocated allocation of resources for cancer prevention, detection, treatment and management.

“Cervical cancer disease is common in areas that are not developed or areas where they have not allocated appropriate resources and attention to this disease.

“It is a disease of under development.

“And where you have infrastructure well developed, where you have appropriate policies that are well-resourced, where you have leadership showing interest in this disease, we collectively can eliminate cervical cancer.

“And this has been amply demonstrated through projections scientifically showing that if you do this, then cervical cancer can become something of history,” said Adewole.

According to him, the challenge in Nigeria, just like in Africa and many developing countries, is that a lot of people are largely unaware of the situation with cervical cancer.

Therefore, he said when cases were presented to the hospitals, they were largely in advanced stage, for quite a number of reasons.

The former health minister also noted that the non-availability and affordability of vaccine hindered efforts in the drive to eliminate cervical cancer in Nigeria.

“It is very expensive if you go to the shelf to buy it and then, globally, the developed countries have ‘cornered’ the vaccine for their people because they recognise the value of the vaccine.

“So, we are left at the mercy of Gavi, the Vaccine Alliance (GAVI) and multilateral donors to fund us.

“The prices are coming down gradually but it is still out of reach for most groups.

“But, there is awindow or door of opportunityfor many as countries that were previously giving two or three shots can now give one and that will free some of the supplies,” continued Adewole.

He said by adopting, introducing and implementing the Global Elimination Agenda for Cervical Cancer Controlhttps://www.cervicalcancerdeclaration.org/, eliminatingcervical cancer as a public health issue would be realised.

“Hence, we call for urgent action to make cervical cancer elimination a global priority, with high-level commitment and resources to make it a reality.

“No woman should lose her life to cervical cancer when we have the tools to prevent, and, especially when diagnosed early, to treat it,” he said.

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

Twelve leading health experts from around the world have initiated a call to action in the fight against cervical cancer through The Global Declaration to Eliminate Cervical Cancer.

The Declaration was formally launched at the World Health Assembly in Geneva on May 22, with signatures from more than 1,200 global health leaders and advocates representing no fewer than 100 countries.

Top among them included former Prime Minister of New Zealand, Jacinda Ardern, CEO of Amref Health Africa, Githinji Gitahi; President of the International Federation of Obstetrics and Gynecology (FIGO), Jeanne Conry, and President-elect of the International Pediatric Association, Naveen Thacker.

Adewole and Prof.Margaret Stanley of Cambridge University, UK and Past President of the International Papillomavirus Society (IPVS), are among the experts championing the declaration.

Stanley told NAN that it was worrisome that 90 per cent of women with cervical cancer lived in low and middle income countries.

Prof. Margaret Stanley of Cambridge University, UK and Past President of the International Papillomavirus Society (IPVS)
Prof. Margaret Stanley of Cambridge University, UK and Past President of the International Papillomavirus Society (IPVS)

According to her, in high income countries like U.S., UK, Europe, there are highly organised medical services which women can access easily.

She added that same services should be replicated in low income countries like Nigeria.

Stanley also agreed that no woman should die from cervical cancer as eliminating the disease was achievable with urgent action in three areas – vaccination, screening and treatment.

“Vaccinating girls aged nine to 14 against HPV is the primary way to prevent cervical cancer.

“HPV vaccines are safe, effective, and can prevent up to 90 per cent of cervical cancer cases.

“Cervical cancer can also be prevented through screening and treatment of pre-cancerous lesions,” said Stanley.

She also recommended the ‘new’ one-dose HPV vaccination regime as part of routine programmes for girls.

The British virologist and epithelial biologist also called for provision ofX rays for screening for cervical cancer, while advocating increased access to adequate health facilities and trained health personnel.

According to experts, tools are available to eliminate cervical cancer and everything must be engaged collectively to eliminate the disease and save women from losing their lives to cervical cancer. (NANFeatures)(www.nannews.ng)

**If used please credit the writer and News Agency of Nigeria (NAN)

EDited by Salif Atojoko

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