The National Primary Healthcare Development Agency (NPHCDA) has concluded plans to introduce the HPV vaccine into the national Expanded Program on Immunization (EPI). The introduction will be done in two phases. Phase 1 consists of 15 states plus FCT. These states are; Abia, Adamawa, Akwa Ibom, Bauchi, Bayelsa, Benue, Enugu, Jigawa, Kano, Kebbi, Lagos, Nasarawa, Ogun, Osun, Taraba. The remaining 21 states constitute phase 2.
Barring unforeseen circumstances, the phase 1 states should start administering the HPV vaccine to all eligible girls from the 24th of October 2023 while the phase 2 states are planned for the first quarter of 2024. The implication of this development is that cost will no longer be a barrier to accessing the HPV vaccine in Nigeria because NPHCDA will provide it free to all girls between the ages of 9 and 14 years. The cost of the vaccine varies between N15,000 and N210,000 depending on location and type of vaccine.
NPHCDA will introduce Gardasil which primarily protects against 4 variants of the HPV virus (6,11,16 and 18). The cost of Gardasil ranges between N45,000 and N90,000. The other types of HPV vaccine available in Nigeria are Cervarix which primarily protects against 2 variants of the HPV virus (16 and 18) and Gardasil-9 which protects against 9 variants of the HPV virus. Cervarix costs between N15,000 and N50,000 while Gardasil-9 costs about N210,000.
WHO has approved the use of more HPV vaccines such as Walrinvax and Cecolin which are not yet available in the Nigerian market. It is hoped that the cost of the vaccine will be further lowered as the space becomes more competitive with the pre-qualification of more vaccines.
Given the high poverty rate in the country and the high cost of the vaccine, financial barriers are a major hindrance to accessing the vaccine. However, the cost will no longer be a barrier from 24th October this year if NPHCDA successfully introduces the vaccine as planned, but myth, misinformation, misconception and disinformation might be major barriers to these girls accessing the lifesaving vaccine. Annually, about 8,000 women in Nigeria die of cervical cancer which is one of the major cancers that the vaccine protects against. Hence, the vaccine is termed lifesaving because of its proven protection against cervical cancer and other HPV- related cancers such as oral, penile, anal and vulva cancers.
HPV vaccine is a peculiar vaccine in the sense that it is given to adolescent girls to protect them against cervical cancer in the future. This peculiarity makes it an easy target for misinformation. For example, certain unfounded claims have been made about the intention for the HPV vaccination, casting aspersions on the safety and effectiveness of the HPV vaccine. It was alleged that the HPV vaccine poses a potential health risk. These unfounded allegations have raised concerns among stakeholders because such disinformation has the potential to derail efforts towards achieving cervical cancer elimination in Nigeria.
To put the record straight, the HPV vaccine has been proven to be both safe and effective across races. The HPV vaccine was first licensed in the USA for the prevention of cervical cancer by the Food and Drug Administration (FDA), the equivalent of the National Agency for Food and Drug Administration and Control (NAFDAC) in 2006. The close to 2 decades of experience of HPV vaccine administration without any confirmed incident of health risk shows the fallacy in the claim that HPV vaccine poses any health risk. About 100 million doses of the HPV vaccine have been administered since its introduction in both developed and developing countries without a single confirmed case of major health risk.
African countries like Rwanda, Botswana, Malawi and Ethiopia have introduced the HPV vaccine for a variable period spanning over a decade in some instances. There have not been any confirmed health risks from the experience of these African countries confirming the safety of the vaccine amongst black Africans. The allegation that the vaccine causes infertility has been debunked by the experience of African countries that have successfully introduced the vaccine. The experience from Nigeria is therefore not expected to be different from these other African countries.
Cervical Cancer is the second most common cancer affecting women in Nigeria with an estimated annual incidence of 12,768 cases. It was estimated that more than 65 percent of diagnosed cases of cervical cancer die annually in Nigeria. Both incidences and deaths from cervical cancer are reduced significantly in developed countries due to the administration of HPV vaccines and the availability of effective screening services. Currently, diagnosis of cervical cancer in Nigeria is like a death sentence and the HPV vaccine given to girls will protect them from having cervical cancer in adulthood. Nobody will think of doing anything to prevent access to this opportunity of protection against cervical cancer if they understand the pains and troubles of cervical cancer treatment.
It is therefore the collective responsibility of all well-meaning Nigerians not to allow unscrupulous elements to jeopardize the future of our girls through misinformation and disinformation. Consequently, I am proposing the formation of the Nigeria HPV Community to support the government’s efforts towards a successful HPV vaccination program in Nigeria with emphasis on awareness creation, strengthening of public-private collaboration and information crisis management. The Nigeria HPV community should set machinery in motion to respond appropriately to all disinformation with incontrovertible facts including the possibility of legal action. Bar. Mubarak Adekilekun, an Associate Professor of Law, has volunteered to render free legal services if the need arises.
Dr Ishak Lawal, the Executive Director of End Cervical Cancer Nigeria Initiative, wrote via [email protected]
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