ZAMBIA is facing several challenges in preventing the spread of human papillomavirus (HPV), which puts young women and girls at risk of cervical cancer, one of the top killer diseases in the country.

Some of the challenges facing Zambia’s HPV vaccine roll-out programme include myths and misinformation about how the vaccine works and the impact of the Covid-19 pandemic.Director and national coordinator cancer Control services at the Ministry of Health, Kennedy Lishimpi, said in spite of the country’s HPV vaccine rollout programme introduced in 2013, cervical cancer is on the rise.He said cervical cancer ‘is the commonest cancer we see in Zambia with an incidence rate of 64/100000 women,one of the highest in sub-Saharan Africa.“Case in point, in 2004 only 5,004 new cancer cases were reported. In 2008, 7,600 new cases were reported. In 2012, 10,000 new cases were reported. In 2018, 12,052 new cases were reported, and in 2020,13,800 new cancer cases were reported,’’ he said.These trends clearly show that the number of cancer cases has been increasing over time in our country.He said it is the most common type of cancer, followed by prostate cancer, breast cancer, kaposis sarcoma and esophageal cancer.

“This is really unfortunate because cervical cancer is a highly preventable and highly curable disease,’’ he said. According to the World Health Organisation (WHO) 2020 statistics, cervical cancer affects 6.5 percent of girls and women and it is the fourth
most prevalent cancer among females worldwide. Immunisation against HPV is aimed at preventing girls from getting infected if exposed to the virus. The WHO regards the HPV vaccine as safe and highly effective.Zambia is expected to vaccinate the 331,000 girls within the prescribed age group. Dr Lishimpi said if it is assumed that all the girls within the target group are vaccinated, Zambia would be preventing 99.9 percent of the infection from being established.He said Zambia will have to wait for the cohort of girls to enter adulthood to see by how much the incidence of cervical cancer will have dropped.The country has continued to carry out some screening programmes, increased awareness and diagnosis.

Assistant director of child health and nutrition in the Ministry of Health,Patricia Bobo, said adolescent girls get the first dose in the first year and the final one after one year. She said the COVID-19 period has had a negative impact on the uptake of HPV vaccines. “The myths and misconceptions that have come with the COVID-19 vaccination have somewhat affected the HPV vaccination as parents and guardians were sceptical,’’ Dr Bobo said. She said COVID-19 has disturbed the HPV exercise in terms of routine planning, implementing, monitoring and support.

The records for 2019 indicate that 249,000 girls were reached for dose one and the target was 331,154, representing 75 percent coverage.During the same period in 2020, 180,209 were reached for dose one and the target was 212,509, representing 85 percent coverage.In 2021,163,102 girls were vaccinated for dose one and the target was 420,704,representing 39 percent coverage.For dose two, 69,288 were reached,representing 33 percent coverage while the target was 212,499.“The myths and misconceptions have somewhat affected the HPV vaccination exercise as parents and guardians are sceptical,’’ Dr Bobo said.In Zambia, HPV vaccine has three modes of delivery, and these are health facilities, community and designated places called outreach points, and schools.“One of the most common myths is that the vaccinated girls would be sterilised. This, of course, is not true,” Dr Bobo said.

Mwinilunga district health director Brian Mwachisowa said the area has managed to fully vaccinate 4,786 adolescent girls since the programme was launched there in 2019.“Every year, Mwinilunga district has about 10,000 girls that are eligible to receive the vaccine. 4,786 will translate into 45 percent of the eligible girls vaccinated against cervical cancer,’’ he said.Dr Mwachisowa echoed Dr Bobo’s sentiments on the misconceptions in relation to satanism and wants them to be systematically debunked.

Bertha Kanyambu, 22, of Mwinilunga district, got vaccinated in 2014 and conceived in 2015 despite the myths that
she would not be able to conceive.“I now have two children from the time I got vaccinated,’’ Ms Kanyambu said.Harriet Wafwamashika, 17, also of Mwinilunga, got vaccinated in 2019 and has called on young girls not to be afraid of the HPV vaccine.“Young girls should not be shying away from getting vaccinated because it is for their own good,’’ she said.Christine Kamusaki, 17, got vaccinated in 2019 and has a child.

Swazi Chipawa, 15, and Beauty Chitembo, 16, have healthy children after getting the vaccines.“These are our success stories. As you can see, these girls got the HPV vaccine at different times and have conceived,’’ Dr Mwachisowa said.Nora Zulu, the Mwinilunga district nursing officer who also participates in the HPV vaccination programmes, said the traditional leaders and teachers have been helpful in reaching out to the community.Mwinilunga District Commissioner Harrison Kamuna, who knew nothing about HPV until this interview, said he would not mind having his child vaccinated because that would be in her interest.“When they start the HPV vaccine exercise, I will ask my daughter to get the jab,’’ he said.

Memory Mwale ,17, and Juliet Chanda,16, of Luwingu district, have been vaccinated against HPV and have no concerns.Luwingu district nurse and adolescent health coordinator Bridget Mwewa confirmed that Ms Mwale got vaccinated in 2019 and Ms Chanda in 2020.Melody Mwamba, 16, and Nkandu Chishimba, 16, have not been vaccinated and they have their own reasons.Melody, a Grade 11 pupil at Don Bosco Secondary School, said she is afraid of getting the vaccine because she was told that she would not conceive if she got vaccinated.Nkandu,16, also a Grade 11 pupil at Don Bosco Secondary School, said she was afraid of being initiated into satanism.

Luwingu District Commissioner Chileshe Chomba, who says he has limited knowledge of the vaccine, said he has faith that the HPV vaccine is meant for good.“The fact that it has been approved for use means it is safe,’’Mr Chomba said.Luwingu district health director Jonathan Bwalya said COVID-19 and myths have affected the HPV exercise and that there is need for more sensitisation in the communities so that people are able to accept the vaccine. He has proposed that the Ministry of Health should improve uptake by allowing the teenage girls to access the vaccine at any health facility anytime of the year.Currently, the HPV vaccine is only administered during the Child Health Week, which takes place quarterly.Dr Bwalya said the eligible group for HPV vaccination in Luwingu district in 2021 was 1,368 for dose one and 1,307 for dose two “Last year, the coverage was very low. This is because schools were closed due to COVID-19,’’ he said.

Father Chandalala Kondolo, a clinical officer and Catholic priest, has called on people to allow their girls to get the HPV vaccine and avoid inconveniences and high cost of treating cancer in the future.“Cervical cancer is a killer disease and can only be prevented if people get the HPV vaccine,’’ he said.Dr Nevers Mumba, a renowned clergy- cum-politician in Zambia, said he has never heard about the HPV vaccine and that he would not allow any of hischildren to get it.“I would not allow my daughter to take it until I fully understand its historical use and its efficacy,’’ he said.One of Zambia’s cervical cancer survivors’ Karen Nakawala, a mother of two girls, said cervical cancer is preventable and that early detection will save lives.“It is preventable if you go for regular screening. And young girls can prevent it by getting the HPV vaccine,’’ Ms Nakawala said.Ms Nakawala said she is an advocate of HPV vaccine and will see to it that her last born daughter is jabbed when she becaomes 14.

This report was supported by the International Women’s Media Foundation’s Global Health Reporting Initiative: Vaccines and Immunization in Africa.’’