The Challenges of HPV Vaccination in Low-Income Countries, Highlighted by Tanzania

HPV hits hard almost everywhere in the world, but countries are taking different measures to tackle the potentially fatal virus, which is usually transmitted through sex.

And while rich countries such as the United States have been providing the vaccine to young men and women in adolescence for two decades, poor countries, such as African countries, are still struggling to deliver the vaccine, says a New York Times report.

According to the report, 90 percent of deaths from uterine cancer, of which HIV is one of its causes, occur in low-income countries.

The newspaper highlights the experience of countries such as Tanzania with misinformation, cultural and religious unease, and with supply problems and logistical obstacles that all represent challenges countries face in implementing what is considered a critical health intervention in the region.

And the newspaper says that some girls avoid receiving the vaccine because of rumors related to the safety of the vaccine – which protects almost completely from the virus – while their parents worry that obtaining a vaccine “might make their children feel more comfortable with the idea of ​​having sex.”

And since cancer screening and treatment is limited in Tanzania, the vaccine shot could sharply reduce deaths from cervical cancer, which is the most deadly type of cancer for Tanzanian women, according to the newspaper.

HPV vaccination efforts across Africa have been hampered for years.

In the United States, the HPV vaccine costs about $250.

GAVI, the Vaccine Alliance, which usually negotiates deep discounts from pharmaceutical companies, has aimed to pay $3 to $5 per dose for the large quantities of vaccine it seeks to buy.

But as high-income countries were expanding their vaccine programs as well, the vaccine makers — Merck and GlaxoSmithKline — targeted rich-country markets, leaving little for developing countries.

“We had 22 million girls who countries asked to be vaccinated and we didn’t have supplies for them at the time,” the newspaper quotes Aurelia Nguyen, chief strategy officer at Gavi, as saying. “This was a very painful situation.”

Low-income countries had to decide whether to allocate the limited quantities of vaccine they received.

Tanzania chose to first target 14-year-old girls, who are seen as the oldest and most likely to initiate sexual activity.

Girls also start dropping out of school at this age, according to the newspaper.

Health authorities suffer from another problem, according to the New York Times, as girls must be persuaded to receive the vaccine, and since they have not yet reached the age of majority, parents must also be persuaded. This means frank discussions about sex, which is a sensitive issue in the country.

Because the 14-year-old girls were seen as young enough to marry, rumors quickly spread on social media and messaging apps about what was actually in the vaccine, and whether it was a “hidden campaign for birth control”.

The newspaper quotes health officials as saying, “It was difficult to confront rumors in a society that has limited understanding of research or scientific evidence.”

The Covid pandemic has complicated the HPV vaccine campaign as it has disrupted health systems, forced schools to close and created new levels of reluctance to receive vaccines, according to the newspaper.

Despite all the challenges, Tanzania managed to vaccinate nearly three-quarters of its 14-year-old girls in 2021 with a first dose.

But it was difficult to convince people to come back for a second dose, as only 57 percent received the second dose after six months. A similar gap persisted in most sub-Saharan countries that started HPV vaccination.

Since Tanzania has relied largely on makeshift school clinics to deliver vaccines, some girls miss the second dose because they have left school by the time the health workers return.

Populous countries including Indonesia, Nigeria, India, Ethiopia and Bangladesh plan to introduce or expand use of the vaccine this year, which could prove challenging.