Source: The Observer
Eleven-year-old Juliet Akee wore a brave face as she watched the nurse fill the syringe with a vaccine.
She had to be brave to show a good example to Sarah Acheng, 13; Juliet Akello, 12; Edna Ayo and all the other girls, 95 in total, lined up for vaccination against the Human Papiloma Virus (HPV) that causes cervical cancer in women. Nervous as she was, she had to put up a brave show for the hundreds of guests, including the First Lady and minister for Karamoja, Janet Museveni, as well as the minister of Health, Dr Christine Ondoa, who had gathered at Ayeke primary school in Oyam district to witness this landmark moment.
The ministry of Health was, September 6, launching the mass vaccination of 140,000 girls in Uganda to prevent them from acquiring the HPV that causes cervical cancer.
This cancer affects the lower part of the uterus that connects to the vagina. It is caused by the HPV, a sexually transmitted virus -- passed on through sexual contact with an infected man, or a woman, if in a lesbian relationship.
In men, the virus is harboured in the penis and is eventually passed on to a woman. When the virus gets to the cervix, it mutates and, after some years, causes cancer. Condom use can help prevent transmission, although the virus can still be transmitted if one touches the condom after use and then touches the woman's genitals, before washing one's hands.
Back in Oyam, when the nurse reached for Akee's left arm, the girl looked away, shut her eyes and cringed in pain. But it was over in a matter of seconds and thunderous applause filled the school grounds. Records in Oyam's Abor hospital show that cervical cancer accounts for 86 per cent of all cancers suffered by women. Of the 100 women screened last year, eight were found to have it.
To prevent girls from contracting the virus, the ministry of Health is following World Health Organisation (WHO) guidelines that recommend vaccination of young girls between 9-12 years of age before they become sexually active.
"We know that [previously], the [average] age of sexual debut [in Uganda] was 18 years, but it has come down to 11 years. Therefore, the age chosen -- 10 years -- to give the vaccine, is strategic. If the vaccine, which is very expensive, is given to women who are sexually active, it goes to waste," says Dr Anthony Mbonye, commissioner for community health in the ministry.
Dr Mbonye says 50 per cent of men and women have the HPV, and that there are 40 types of the virus, but only about four cause cervical cancer. However, one cannot know which type they have and whether or not it causes cancer. The vaccine was donated by Merck, Sharp and Dohme (MSD), a multinational pharmaceutical company with headquarters in the United States, to help tackle the most common cancer amongst women in Uganda.
"It's important that the vaccine is brought to women who need it most. Many countries launch programmes, but this one is special. As a woman, I believe in a future where women shouldn't die from preventable diseases, no matter where they are, especially when there are preventative methods," says Colleen McGuffin, the MSD representative.
The company donated some 460,000 doses that will be used to vaccinate 140,000 girls in 12 districts over the next two years.
The vaccine, which offers protection against cervical cancer and warts, is safe and has been approved by WHO and the US Food and Drug Authority (FDA). More than 125 countries worldwide have already used it. In Uganda, girls in primary four and those aged 10 years will be given three doses over a six-month period (a dose per month). Success of this pilot will inform roll-out throughout the country in 2014. The ministry of Health hopes that by 2014, it will be able to provide routine vaccination to girls aged one to 13 years, as recommended by WHO.
"We don't immunise males who harbour the HPV. Research has found out that the vaccine does not kill the virus, but enables one to build immunity to fight cancer. HPV causes penile cancer in only 0.3 percent of men, so it's not practical to immunise boys," says Dr Jane Acheng, the director general, Health Services in the ministry.
Killing off women:
An estimate 529,000 new cervical cancer cases are diagnosed every year worldwide and 274,000 deaths occur, most of them in sub-Saharan Africa. Dr Acheng says cervical cancer should be a serious concern in Uganda. The incidence and mortality rates here stand at 45.6 per 100,000 and 25 per 100,000 women, respectively, and vaccines are not widely available in the country to help reduce these numbers.
The Uganda cancer registrar estimates that 3,500 women in Uganda are diagnosed with cancer annually and 2,700 die from it because it is diagnosed too late. According to MSD, HPV will affect 75 per cent to 80 per cent of males and females. Normally, the virus clears on its own, but for those susceptible, cervical, vulva and vaginal cancer can occur in women, and genital warts in both genders.
HPV prevalence among females in eastern Africa is 33 per cent, compared to 11 per cent in the rest of the world. Prevalence in Uganda is quite high, although it is not known.
Dr Acheng says six of the 13 regional referral hospitals in the country and 12 per cent of the lower health centres offer screening and cryotherapy (treatment for HPV. She says equipment and materials for screening and cryotherapy are available at the National Medical Stores, but the ministry plans to roll out the services to more health centres as soon as possible.
The minister, Dr Ondoa, said in Oyam that the ministry of Health, working with the Global Alliance for Vaccination Initiative (GAVI), would roll out HPV vaccination throughout the country. Her advice to girls receiving vaccination was simple and carried a promise: "Stay in school and abstain from sex until marriage. I promise that if you do that, when you invite me to your wedding, I will come."
She counselled further: "Delay having your first baby until you're above 18 years. You need to space your children so that your body has enough time to recover and be ready for the next baby. The government of Uganda is ready to support all health programmes to help you achieve this."
Mrs Museveni urged the girls to abstain from premature sex and, when married, to remain faithful to their partners.
"We should not entrust our destiny to condoms. HIV is going up because we believe we can trust condoms. We have an affordable, cheaper way of building self-control and stamina by abstaining," she said.