The HPV vaccine and eradicating cervical cancer
As you may recall, I highlighted a young lady diagnosed with advanced cervical cancer on July 22, 2023, which had spread to her lungs. We got her admitted to the University Hospital of the West Indies (UHWI) on August 11, 2023, where she stayed until she received her first dose of chemotherapy on Friday, September 1, 2023. It was clearly too late.
She died early in the morning on September 6, 2023. Her name was Jody. She was 41. I sincerely thank the doctors and nurses at the UHWI who did everything they could to help her.
Cervical cancer is the fourth most common cancer among women globally, with an estimated 604,000 new cases and 342,000 deaths in 2020, according to the World Health Organization (WHO).
In Jamaica, it remains the leading gynecological cancer and the second-leading cause of cancer-related deaths among Jamaican women.
This cancer, curable if caught early, kills 22 in every 100,000 women in Jamaica. By comparison, in the United Kingdom, the rate is 2.4 in every 100,000; and in Canada, it is 2.0 in every 100,000.
The Jamaica Health and Lifestyle Survey (2016-2017) says that less than half of our women between the ages of 15 and 54 years reported having had a pap smear done in the last three years.
While it may take up to 20 years for cervical cancer to develop in women with normal immune systems, what many Jamaicans are unaware of is that the majority, or more than 95 per cent of cervical cancer is due to the human papillomavirus (HPV); nearly early all cases of cervical cancer can be directly attributed to HPV infection.
The WHO says HPV is the most common viral infection of the reproductive tract and is mainly transmitted through sexual contact. The data is frightening, as it suggests that sexually active women and men will be infected at some point, and some may be repeatedly infected.
Although most HPV infections clear up on their own and most pre-cancerous lesions resolve spontaneously, there is a risk for all women that HPV infection may become chronic and pre-cancerous lesions progress to invasive cervical cancer. There are two HPV types (16 and 18) that are responsible for nearly 50 per cent of high-grade cervical pre-cancers.
The only way to prevent cervical cancer is to have screening and treatment of pre-cancer lesions to get vaccinated against HPV from an early age as boys and girls.
The World Health Assembly adopted the global strategy to accelerate the elimination of cervical cancer as a public health problem. The definition of elimination of cervical cancer has been set up as a country reaching the threshold of less than four cases per 100,000 women per year.
To reach this threshold by the end of the 21st century, WHO has set up 90-70-90 targets to be achieved by 2030 and to be maintained, which includes having girls fully vaccinated with the HPV vaccine by age 15 and ensuring that 70 per cent of women are screened with high-performance tests by 35, and again by 45 years, etc.
There are some 125 countries that have introduced HPV vaccine programmes offering access to one in three girls aged 9 to 14. Currently, 94 per cent of girls in Uzbekistan, aged 12 to 14, are now covered with a first dose of HPV vaccine, according to their country’s Ministry of Health.
Rwanda seeks to become one of the first countries to eradicate cervical cancer. Last year, through an accelerated expansion of cervical cancer testing and the deployment of thousands of community health workers to raise awareness of the disease, along with a successful HPV vaccination programme for 12-year-old girls, this landlocked African nation surpassed other countries, including the United Kingdom, in terms of vaccine coverage. Now, global health officials accept that Rwanda is on track to achieve its goal.
A national HPV vaccination programme for girls under 15 was launched in Jamaica back in 2018 after a 2010 study conducted by the health ministry revealed that two types of HPV were found to be present in 10.5 per cent of our general population.
However, the Pan American Health Organization says inoculation rates fell to 6.21 per cent in 2022 from 32 per cent in 2019, far from the target of 90 per cent coverage by 2030.
Now, I appreciate that somewhere in our development, many Jamaicans, especially since COVID, have become vaccine-hesitant. But we never used to be this way.
Between 1975 and 1979 Jamaica began its school immunisation programmes with special attention on the rubella vaccination for girls and established a national surveillance system for monitoring vaccine-preventable diseases.
This programme was in conjunction with the WHO Expanded Programme on Immunization (EPI) for the English-speaking Caribbean, with the first group of vaccines for diphtheria, pertussis (whooping cough), tetanus, BCG, and polio. Measles was later introduced in 1980.
Then. on June 3, 1982, Jamaica aggressively rolled out a massive immunisation campaign using an oral polio vaccine targeting all individuals under 30 years, with special priority for children up to 14 years.
The campaign was laser-focused and, by June 30, 1982, 65 per cent of our population received one vaccine dose. Another 641,000 doses were given six weeks later to children aged up to 14 years, a coverage of approximately 70 per cent in this age group (Ashley & Bernal 1985).
The mass campaign was followed by increased efforts through maternal and child health clinics, special outreach activities, and the school health programme to fully immunise children under 10 years old with three doses of oral polio vaccine. During the subsequent 18 months, all newborns received doses, with all three doses of the polio vaccine administered by the age of one year in a continuing programme (Ashley & Bernal 1985).
The Health Ministry ensured this competent immunisation programme of activities and complementary routine follow-ups were integrated into the country’s maternal and child health clinic services. After that, Jamaica enacted legislation in 1985 for the compulsory immunisation of all children.
These pioneering immunisation and courageous public health efforts, along with others, led to the ultimate eradication of polio and measles in the 1990s.
Getting Jamaicans towards compulsory immunisation did not happen overnight, and it took three solid years to change the mindset and behaviour of Jamaicans towards the benefits of the vaccines to their children and themselves.
It’s time we give the same priority to eradicating cervical cancer from Jamaica. In this day and age, no Jamaican woman should have to die from this disease. We can prevent it. Therefore, let us protect our girls with the HPV vaccine. If it is behaviour change through awareness that’s needed, then count me in to help. It is time we approach this vaccine campaign like we did for polio in the early 1980s.
Lisa Hanna is Member of Parliament for St Ann South Eastern, People’s National Party spokesperson on foreign affairs and foreign trade, and a former Cabinet member.