The National Primary Health Care Development Agency (NPHCDA), is responsible for the enactment and management of health policies at the primary level in the country. It undertakes key policy issues around immunisation, maternal and child deaths, strengthening primary health care towards achieving Universal Health Coverage.
It intervenes to prevent diseases by
ensuring that communities have access to health facilities, services and basic health insurance.l which are delivered through Primary Health Care guidelines, norms and enabling Acts for States and LGAS.
In this interview with NewsNGR, the Director of Disease Control and Immunization of the NPHCDA, Dr Bassey Bassey Ikposen, spoke on the difficulties the country is facing to get vaccines for cervical cancer, deaths from the disease and how the agency is deploying various methods against fake news in relations to vaccination and other sundry issues.
There’s The Report You Are Facing Difficulty Accessing Vaccines For Cancer Treatment? What Are The Problems?
The Human Papillomavirus Vaccine was first used in the United States in 2006 and in the UK in 2008.
We in Nigeria have made several attempts to also get the vaccine introduced. The closest we were told to attempt was in 2015 where we sent in a proposal to introduce the vaccine. Of course that proposal did not see the light of the day because the vaccine was not available.
One of the things that worked against us as a nation was that our population was much. The manufacturers and our sponsor would say the vaccine they would give Nigeria can solve so many countries’ problems.
I always know numbers to be a strength but here, it was not that in favour of Nigeria. Because the quantity of vaccine we would need every year to reach out to eligibles was not easy to get.
Why So? Is It Only One Company Manufacturing This?
There are few manufacturers of this vaccine globally. Of course, we know the most effective of this vaccine is the Gardasil group. 95 percent of vaccines in the U.S. for HPV vaccine is Gardasil and 60 per cent in the UK Gardasil manufactured and some Asian countries too.
Of course in Nigeria, we want the best for our girl child that is why we also go for Gardasil.
What’s The Actual Figure And Facts of HPV in Nigeria?
When you look at it annually about 73,417 cases of cancer are diagnosed in Nigeria of these 3075, are cervical cancer which is 16.4 percent of all cancers.
And 8,969 of these women die and we know from documentation that 95 percent of cervical cancer in Nigeria is caused by HPV infection exposure.
These are deaths that could have been prevented if these women were vaccinated.
If you look at what other countries are doing and what we are doing based on the limited vaccines we have available and the lessons we have learned from other 11 African countries, the first was Rwanda in 2011.
What’s This HPV Infection? Who Are Those That Can Easily Get Them?
It is a fact that 85 to 95 percent of every adult and young adolescent has been exposed to HPV infection at one point or the other in the person’s lifetime. What that means is, that every human being that is an adult has been exposed,
because most times it does not cause any sign for you to know it is a problem but when it starts showing itself, it is usually showing late.
It is also on record that HPV is the most common sexually transmitted infection whether in developed or developing countries in the world is being documented.
What statistics have shown is that, 80 percent of women who report at the facility with signs of cancer get there late, and because of that 80 percent of them end up dying.
Another fact that we know is that women in Nigeria are dying every year from cervical cancer, we don’t need a soothsayer to tell us people are dying from cervical cancer or other related cancers in Nigeria.
Also, HPV is real and the vaccine is very effective in protecting against the virus.
At What Age Does One Need To Get Screened?
Theoretically and clinically, the advice is that, after 26 years, go to your physician, do cervical cancer screening where they will take the PAP smear into the lab and to be sure there are no pre-cancerous cells or being already exposed when all these have been settling, the doctor can now advice the patient to go and take the vaccine because the HPV is not just one strain.
What Are The Various Strains Of The Virus?
We have several strains of the virus that cause infections and serious problems.
We have the 6, 11, 16, 18, 31, 33, 45, 52, and 58. These are the strains that cause most of the problems associated with HPV but the ones mostly associated with the cancer are 16 and 18 even in Nigeria, that is the strain.
But of course, the Gardasil we are going to use can curtail strains including the 16 and 18 which are very effective.
We have demonstrated examples from the post-introduction survey done in the UK and the US which show the effectiveness of the vaccine and currently the ones in the 11 other African countries that have done several degrees of studies and it is already showing a decline in between the HPV related infections and the complications in those countries.
Do You Have The Vaccine Now And How Will It Be Distributed?
Since 2015, there have been proposal submissions and submissions until late last year when we got the approval and early this year we had a confirmation for the first few badges of the vaccines to arrive.
Even with the number of years we had waited, the vaccine we are getting for the first supply will not go around all the states. So what we have to do is a phased approach.
The vaccines we have now will cover the first 16 states and the other 21 states will be in the first quarter of 2024 where we expect we are going to have additional vaccines.
The 16 States are Northeast—Adamawa, Bauchi, Taraba; Northwest—Kano, Kebbi, Jigawa and Northcentral—FCT, Benue and Nasarawa.
South, we have Southwest — Lagos, Ogun and Osun; South-south— Akwa Ibom, Bayelsa and Southeast—Abia, Enugu States for now and the rest is February 2024 to be specific.
That is the first approach of phasing. Now the second approach of phasing is that in the U.S. and UK, they use it for boys and girls child but we have the problem more in women, phasing until we have enough vaccines, we decided to go for the girl child first mainly because of other experiences from other African countries like Rwanda which first introduced it in 2011, Uganda in 2015, Liberia in 2016, Lesotho, Zambia in 2017, and the rest of them, the last was Sierra Leone in 2022.
These are countries that have introduced the HPV vaccine and they are seeing progress ahead. We could not get the vaccine on time.
Why The Focus On The Girl Child?
Why we are focusing more on the girls is that we have more cases of females affecting females than the males.
The reason for the girl child now is because it is gotten via sexual interaction, it is expected that before the age of 14, the girl should be protected, and the boy should be protected, after that period you might not guarantee.
There are some instances where these children are being abused before 14, the majority would be intact before that time, not yet defiled, that is the best period to give them the vaccine so that they are prevented.
Even when they eventually are exposed, they are protected against the infection and the complications of the disease.
The cases of genital, and penile cancers we see in Nigeria are far less compared to what you see in cervical cancer and so on.
Of course, we know from general principles if a woman has 5 children and she comes back home with one loaf of bread, she will, first of all, give her children to eat and go to bed hungry, that is what a wise woman will do.
So if we have those vaccines we will look at who is in the best position to receive this vaccine, it is the girl child at 9-14 years old to get the vaccine before they are exposed.
In another 3 to 5 years from the quotation, we were told we are going to have more vaccines then we will bring in the boy child to be able to vaccinate the boys.
Does The Virus Show Sign For Self-Discovery?
Most people who have HPV don’t know that it is self-limiting, it does not show any signs. The earliest sign that people notice there is a problem is when they have a genital wart around the genital. It is very hard, and sometimes it stays like that without growing and sometimes, it disappears on its own and thereafter, the wart doesn’t grow more than that
That is the earliest people can see and say they have a problem and begin to look for treatment outside that until it stays progressing.
We will now look at HPV at the terminal part, it can cause cervical cancer, vulvar cancer for women, penile cancer for men. It can also cause oropharyngeal cancer at the base of the tongue for both men and women.
It is not something that is limited to just cervical cancer, it is just the most common among these groups of cancers HPV can cause.
How Would You Undertake Vaccination Since There’s Acute Lack Of Awareness About The Virus And Scepticism Generally About Vaccination?
There is a lot of hesitancy by everybody, even both the educated, you will still see people who have opinions about that, it is when people don’t know about something that they will ask. That is why our priority for now is to educate Nigeria on the importance of this vaccine so that they can independently request for it.
Sometimes, it is sad when we hear people say, “They want to control fertility” Where? When will all these rumour-mongers stop all this?
When there are things good for the public and the country goes out to secure them for the indigenous people, people will come up with all sorts of rumours.
People who took the vaccine before are now grandparents, we can place you on call to talk to those who are first-generation vaccine takers.
How many Nigerians now with the economy can walk into a private hospital and pay 65000 for a dose of the HPV vaccine? This will come free to the public and you will hear people saying the vaccine is not safe, don’t take it.
Please, Nigerians don’t listen to such people, this vaccine is safe and effective to prevent cancer.
It is the same misconception we heard during COVID-19, where they said if one takes the vaccine, one will start dancing as a mad person. And no one started dancing like a mad person. Another said the person will die in six months, six months came and pass, they saw people surviving the vaccine and the now said it is 2 years, now it is 3 and a half years
The immediate past President demonstrated leadership when he publicly took the vaccine, it was open to the media. He took it on the 6th of March, 2021, with all foot soldiers taking the vaccine the same day.
It is over 3 years now, where are those saying people will die? Those who took the vaccine are still alive. The mass deaths they were talking about are not there.
If it is so, what happens to the other vaccines given to children when they are born when almost everything that comes into the country is imported?
Please don’t listen to those rumours.
Prevention is better than cure. Let’s avoid the ones we can avoid and the ones we know we cannot, let’s leave it to God to help us.
How Can People Trust The Vaccine?
Most of the new vaccine introduction in Nigeria is supported by GAVI the alliance vaccine and immunizations.
GAVI was established to support medium/ developing countries to introduce some of these new vaccines that are expensive to get and of course, Nigeria is one of the countries that has been supported by GAVI.
The HPV vaccine will not be the first vaccine we have been supported by GAVI to introduce.
We were supported by GAVI to introduce the yellow fever vaccine, meningitis A vaccine, Pentavalent vaccine, and PCV vaccine, and in the last 2 years they supported us in introducing the rotavirus vaccine for children to prevent diarrhoea and now we are being supported by them to introduce this HPV vaccine.
We have also written a proposal for malaria vaccine introduction support, they anchor, speak to the companies that produce these vaccines, and be able to secure them for the countries they are supporting.
If not for anything, Nigerians should know that with this level of support, they are helping us to introduce this new vaccine, they are not shouting, now it is the HPV vaccine for the girl child, people are shouting, what do we really want? Is it because it is the girl child’s turn to be protected?
We advise Nigerians to disregard every rumour and present their children for vaccination once the vaccine is available in their states.
Based On Your Explanation, We Started Late Which Is Not Good For Us regarding The Fight Against The Virus
Yes, I mentioned earlier that the US started in 2006, and a study concluded in April 2022, has shown there has been an 88 per cent reduction in the diseases and complications caused by HPV. This is progress and that means that there is a reduction in the number of genital warts, and cancers that HPV causes.
Yes, indeed, we did not start in time, but we are starting now as a country, it is better late than never
What’s The Good News?
The good news is that as dangerous as that could be HPV is very effective in preventing infections by the virus itself.
Is The NPHDA Going To Deepen Awareness To Dispel Rumours And Fears About The Vaccine?
On the awareness creation, we have engaged and sensitised traditional/religious leaders, academias, professionals, CSOs/NGOs etc.
We are working with the Federal and state ministries of education to reach out to the schools. We are engaging with the schools and LGAs directly working with the states and LGAs.
There are TV and Radio appearances to educate the public.
We are supporting the states and LGAs to conduct community-based sensitization meetings involving the community members and the target age groups and so on.
What Of Accessibility? What Approach Are You Adopting?
From our approach the way it is designed, we are going to use two main approaches – fixed facility vaccination and outreach vaccination.
What fixed facility vaccination means is that in every facility that is currently offering routine vaccination, we will make sure that the vaccines are available so that any girl child 9-14 that walks into those facilities or taken by their caregiver, guidance will freely get the vaccine administered to them.
Now when we look at the outreach approach, we are looking at the school based vaccination where teams will be sent to all schools that will get girl children from 9-14.
We are already working with Federal and State Ministries of Education, the Ministers have been notified.
We also have teams that will go about training the principals of the schools speaking to the girl child, engaging which a lot of that is ongoing now to know the importance of the vaccination before it comes to them and then outside school.
The teams in all the local governments have also identified points that they can get girl child 9-14 like markets, IDP camps, other gatherings that they know will get the girl child so that the team will take this vaccine and the girls will receive it.
So we are targeting girls in school and out of school and also to make sure that the vaccine is available at all health facilities for eligible girls anytime.
We want a situation where the caregiver will call the principal and say I hope my daughter has been given the vaccine, please make sure she receives the vaccine.
If the daughter is at home, a day student, they make sure they take her to get the vaccine…that is the picture we want to see. We want Nigerians to understand the importance of the vaccine and once they do, they won’t allow what anyone tells them to keep them from getting the vaccine.
The Report Is That The Vaccine Is Expensive, How Can People Afford It?
Just to plead with our health workers, please do us a favour, when these vaccines are sent to you, keep them in your facilities and give to these girls, don’t prioritise giving them to private facilities where they will now keep and sell and give you feedback.
The vaccines are very expensive. They are meant to be given to these girls free of charge. Don’t charge any client that will come to your facility for this vaccination.
Let it remain free as it is so that we can get the best out of the introduction and prevent our people from the damage from cancer.