Kenya: Country Launches Ambitious HPV Vaccination Project

By George Okore

KITUI--Kenya has taken a giant leap by becoming the first country to launch universal distribution of Human Papilloma Virus (HPV) vaccine, to immunize girls against cervical cancer.

Tuesday’s trail launch in Kitui County will eventually immunize all Kenyans against the third most common type of cancer among women. High-risk HPV types 16 and 18 cause about 75 percent of cervical cancers, 70 percent of vaginal cancers, 40 to 50 percent of vulvar cancers and 80 percent of anal cancers. Cervical cancer kills an estimated 275,000 women every year and 500,000 new cases are reported worldwide.  This entirely preventable disease is the second largest cancer killer of women especially in Africa, with most victims dying in their prime life.

Last week, UNICEF awarded pharmaceutical giant Merck a four year contract to supply Gardasil (Types 6, 11, 16, and 18) vaccine to Global Alliance Vaccine Initiative (GAVI)- eligible countries mainly from Africa to solve  high demands for vaccine.  Additional awards by UNICEF are anticipated as vaccine demand increases. GAVI is expected to support introduction of HPV vaccination in 28 countries by the end of 2017. The Kenyan HPV will be replicated this year in seven countries including Ghana, Lao PDR, Madagascar, Malawi, Niger, Sierra Leone and Tanzania.

“This is an important moment for Kenyan women, as cervical cancer kills more Kenyan women than any other cancer. Working closely with partners WHO and UNICEF, GAVI’s support for HPV vaccines is bridging the gap between rich and poor countries, enabling HPV vaccines to reach girls no matter where they live,” says GAVI Alliance CEO Dr Seth Berkley.

High enrollment rates among Kenyan girls mean that most will receive the vaccines through schools. The project in Kitui County will also deliver HPV vaccines with the support of community health workers to out-of-school girls, who may be at higher risk, through local clinics and outreach campaigns.  The vaccine administration schedule will be synchronized with the school calendar to ensure that girls receive all doses. The first dose will be given this month, at the beginning of the second term. In July 2013, the second dose will be delivered before the end of the second term, and the third dose will be given in November 2013.

Globally, a woman dies from cervical cancer every two minutes. Of 275,000 women dying from cervical cancer annually, more than 85% live in developing countries where access to screening and treatment is often limited.  The process-intensive screening is done with pap tests in developed countries but is rare in developing countries. This is due to many reasons including inadequate access to health care leading to high cervical cancer mortality in developing countries.

Kenya’s initiative to provide universal HPV immunization follows last year’s decision by United States allowing vaccination against Human Papilloma Virus (HPV) to protect boys from oral, anal and penile cancers. The U.S. Center for Disease Control and Prevention also recommended that girls under the same age group should be vaccinated to protect them cervical cancer. The committee unanimously recommended routine use of Gardasil in11- and 12-year-old boys to fight the sexually transmitted virus.

Previously, CDC had recommended to doctors to use the vaccine in boys but had stopped short of recommending routine vaccination. Boys aged 13-21 who have not been vaccinated should be given a catch-up dose of the vaccine, which is given in a three-dose series. Men aged 22 through 26 may be vaccinated but the vaccine is not recommended for routine use, the panel said.

Also called Genital Human Papillomavirus, HPV is the most common Sexually Transmitted Infections (STI). There are more than 40 HPV types that can infect genital areas of males and females. These HPV types can also infect the mouth and throat. Most people who become infected with HPV do not even know they have it. However, HPV is not the same as herpes or HIV (the virus that causes AIDS). These are all viruses that can be passed on during sex, but they cause different symptoms and health problems.

Despite proven link between HPV and cervical cancer, HPV vaccines are not yet widely available and screening rates remain low worldwide. Lack of awareness and deep seated stigma associated with the disease pose significant barriers to access. It is envisaged that by 2030, almost half a million women will die of cervical cancer, with over 98 per cent of these deaths expected to occur in low and middle income countries.

In 2009, World Health Organization (WHO) recommended that routine HPV vaccination be included in national immunization programs to help prevent cervical cancer and other HPV-related diseases.  It is estimated that approximately 500,000 women develop cervical cancer annually around the world, with about 85 percent of cases occurring in developing countries. 

WHO estimates that annually in Kenya, more than half of the 2,500 women diagnosed with the disease. The disease is preventable through vaccination and effective screening. Unless efforts are made to prevent and control the disease, the number of women dying from cervical cancer is estimated to double by 2025.

Therefore in Kenya, nearly 20,000 girls in primary schools will be given HPV vaccination. Both girls and boys will also be provided with health education on HPV and cervical cancer as well as on hygiene and hand washing. In the second year of the demonstration project, other services may be integrated, including de-worming and iron supplementation, targeting both girls and boys.