The east, central and southern regions of Africa have some of the highest incidence rates of cervical cancer in the world, making the area the epicentre of the disease. It is the most common cancer among sub-Saharan African women. Worldwide three quarters of cervical cancer cases occur in developing nations where programmes for screening and treatment are seriously deficient. Screening and early treatment are crucial in the prevention of the disease. Vaccination programmes are beginning to be implemented in a number of countries, offering hope for the younger generation that this preventable disease can be tackled in a significant way and end the suffering which it causes.
Health systems in developing countries can lack the capacity and infrastructure to provide proper treatment, while screening of patients is often carried out at a late stage. Such issues are compounded by patients not having the capability to access treatment services which do exist. This can be due to a range of factors including affordability and geographic constraints. A recent report from the only public cancer treatment centre in Kenya indicates that almost half the women being treated “disappeared” from their programmes.
Vaccinating girls against the Human Papilloma Virus (HPV) has become a vital intervention in many countries. HPV is the main cause of cervical cancer. It is spread through sexual contact, it is therefore important that girls are vaccinated before they become sexually active.
Responding to the growing level of morbidity associated with cervical cancer, Kenya has initiated a HPV vaccination programme for all girls of primary school age. Demand for the vaccination has exceeded supply and the £30 per dose cost is prohibitive for many families. The Global Alliance for Vaccinations and Immunisation (GAVI) have assisted the Kenyan health service in distribution of the vaccine on a national scale. They argue there is a vital need to reduce costs so the vaccine is available for everybody.
Similar programmes have begun emerge across a variety of developing Commonwealth countries in the region. In Rwanda cervical cancer is the most common cause of cancer among women. In response the small nation became the first low-income African county to achieve nationwide access to the vaccine. Such a programme has been facilitated by the immense progress made by the health sector in Rwanda which has strategically positioned itself to tackle preventable diseases.
In South Africa, where the disease is the second biggest killer of women in the country, the government has announced that all girls in public primary schools will be vaccinated to prevent the disease. Any child who goes through Grade 4 will receive the vaccine, offering hopes for a new generation of women protected from the cancer.
The African Centre of Excellence for Women's Cancer Control reports the incidence rates of cervical cancer in Zambia as the second highest in the world. To address the heavy burden of the cancer in the country the Cervical Cancer Prevention Program in Zambia (CCPPZ) was established. This has aimed to offer girls at selected primary schools the vaccine with a view to expanding the programme nationwide. Further, the CCPPZ also aims to educate families and communities on the potential benefits of the vaccine so more girls can be reached. It also looks to tackle any stigma associated with invasive treatments for those diagnosed with the disease.
Overcoming cultural barriers and reluctance is a major concern for programmes across the continent. In Kenya women have been noted to ignore symptoms and seek traditional medical practitioners. Such actions delay diagnosis and prolong treatment, allowing the cancer to develop and become more difficult to treat.
As with a range of other conditions, vaccinations provide a crucial means with which to combat the burden of preventable diseases on developing nations. It is imperative that struggles in implementing national vaccination programmes are overcome. With continuing investment, global advocacy and assistance the problems which face vaccination programmes, be they due to poverty, remoteness or a failing health system can be challenged. Similarly cervical cancer remains one of the biggest killers of women in the developing world. However, the programmes highlighted in Rwanda, Zambia, Kenya and South Africa offer hopes for an alternative future. Strengthening of health system capacities and continued international support are key to achieving reductions which may one day see the threat of this preventable cancer diminished.
Written by Michael Cavanagh