In July 2019, a video of a young woman narrating her ordeal trying to access healthcare for her sister who had been diagnosed with cervical cancer went viral. She said, amidst tears, that they didn’t have Sh1,950 for treatment. Unfortunately, her sister died.
Hers is not an isolated case. This is the reality for many women, particularly those from rural areas and informal settlements.
Cervical cancer is the leading cause of cancer death among Kenyan women aged 15 to 44 years. Some 3,286 out of 5,250 (62 per cent) of women diagnosed with cervical cancer die from a disease that is preventable through proper screening and vaccination.
And so, I am weary of the opposition to the HPV vaccine. While screening girls and women for cervical cancer can and should be scaled up to reduce the incidence of cervical cancer, the vaccine offers an unprecedented opportunity to protect future generations of women.
It also addresses the inequities and inequalities that still exist. And right now, it is the best investment by the government, and the most effective way to prevent cervical cancer.
Multiple factors often hinder large-scale cancer screening efforts. Since 2006 when it was launched, the highest recorded screening was only 16.4 per cent, nine years later, in 2015. More typically, around 14 per cent of women were screened, meaning that a full 86 per cent were never screened for cervical cancer.
The low rates can be attributed to a range of health system challenges such as lack of human resources, long hospital queues and weak quality assurance mechanisms in our public laboratories. There were low screening rates among younger women from rural areas, girls who lived in poor households, girls and younger women who had a low education level, as well as those with poor access to health insurance. These factors are also predictive of poor health outcomes from cervical cancer.
Meanwhile, the cervical cancer vaccine has been in existence for more than 10 years; before this newly launched government rollout, its cost was high. This routine immunisation programme offers the vaccine free of charge for all 10-year-old girls, making it accessible irrespective of their socio-economic status.
It is given in two doses, in line with international guidelines by WHO, and guards against future HPV infection by stimulating bodies to produce cells called antibodies that fight the virus. The vaccine targets the HPV subtypes, which are accountable for 70 per cent of cervical cancer. Vaccinating a greater population that is at risk offers herd immunity so that even those who have not been vaccinated can be protected. The vaccine is completely safe.
Vaccinating against HPV also improves and prolongs life for adolescents and young people living with HIV, as cervical cancer is the most common AIDS-related cancer and the sixth most common AIDS-defining illness in women. Vaccination against cervical cancer supports our national and global goals of Universal Health Coverage by reducing the financial costs of treating it later. Girls and women from poor households can access care while also ensuring the quality of care is good enough to improve the health of those receiving it.
Of course, screening remains a critical tool, particularly for women of reproductive age. When detected early, cervical cancer is highly treatable. But screening cannot be the only tool. Therefore, the combination of screening and widespread administering of the HPV vaccine will result in the greatest protection against cervical cancer. Cancer of the cervix is one of the few cancers that are totally preventable. Vaccination is the best way to save lives, and people in positions of authority should support it.
Dr Bosire is an Aspen New Voices Fellow, British Future Leaders Connect Fellow and a human rights activist.