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- - - WHAT'S NEW THIS FRIDAY: UGANDA LAUNCHEDS HPV VACCINATION PROGRAMME TO FIGHT ITS COMMONEST CANCER

Thursday, 28th of March 2013

 

• UGANDA LAUNCHES HPV VACCINATION PROGRAMME TO FIGHT ITS COMMONEST CANCER

http://www.bmj.com/content/345/bmj.e6055

BMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e6055 (Published 10 September 2012)

Experts on cervical cancer have welcomed the launch of a vaccination programme in Uganda but have called for investment in screening to run in parallel.

The incidence of cervical cancer in Uganda is three times the global average, and the cancer is the most frequently diagnosed in women.

The vaccine programme, a collaboration between the Ugandan ministry of health and the drug company Merck Sharpe & Dohme (MSD, known as Merck & Co in north America), will see 140 000 girls aged 9-12 years given injections of the quadrivalent vaccine Gardasil, which protects girls against the human papillomavirus (HPV), known to cause cervical cancer. Gardasil protects against types 6, 11, 16, and 18 of HPV, of which the last two types are known to cause 70% of cervical cancers.

The programme will cover just 12 districts, of more than 100 in the country, but the government hopes that it will be the first stage of a national roll-out of the vaccine.

Ian Jacobs, dean of the faculty of medical and human sciences at Manchester University and chairman of the Uganda Women’s Health Initiative, which runs a cervical cancer screening programme in the country, said that the launch of the vaccine was “fantastic news” and that it would save lives.

“The place where the vaccine needs to be used is in Africa and the rest of the developing world,” he said. “In the UK we have an effective screening programme which largely prevents cervical cancer, but in Africa there is no large scale population based screening.

“However, it doesn’t change the need for a screening programme. Women who are above the age of nine to 13 will develop cervical cancer, and a screening programme should be running in parallel,” he said.

Daniel Murokora, medical director of the Uganda Women’s Health Initiative, said that screening programmes for cervical cancer currently reached only about 10% of the eligible population in Uganda and that the effect of the vaccine will not be seen for 15-20 years. “Vaccination is welcome, but we need to look at all interventions and move them forward,” he said.

He added that screening was not something that donors invested in because it was not “marketed” well. He added, “Women die from this condition, which is easy to screen and prevent for less than £10 per person.”

World Health Organization data published in 2010 show that cervical cancer is diagnosed in around 3600 women in Uganda every year, 2500 of whom will die from the disease.1 By 2025 it is projected that number of diagnoses will rise to 6400. A third of women in Uganda are estimated to have the HPV infection.

Speaking at a press conference to mark the launch of the vaccine, Uganda’s health minister, Christine Ondoa, said that she hoped the programme would be expanded to include the whole of the country by 2014. “With half of our population under the age of 15, the health of young people is one of our priorities, and we must continue to ensure that we have the proper prevention and control programmes in place,” she said.

Uganda is joining other African countries in setting up an HPV vaccine programme, including Rwanda, whose programme, launched in April 2011, has over 90% coverage, said Jules Millogo, medical director for international organisations at MSD.

He added that the Ugandan government was serious about the long term future of a vaccination programme. “The government has already made plans to continue beyond the Merck donation using other partners,” he said.

He added that HPV vaccine programmes were important to women in developing countries. “Those who cannot access health facilities and those who don’t have the money will be protected against the disease,” he said.

Notes

Cite this as: BMJ 2012;345:e6055

References

↵ World Health Organization. Human papillomavirus and related cancers: summary report update. WHO, 2010. http://bit.ly/Ot2n7B.