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Angela Onwuzoo
Findings by PUNCH HealthWise have revealed that major government-owned hospitals in Lagos State do not have the Human Papillomavirus Vaccine that protects women and girls against cervical cancer. Some mothers shared their frustrations about the inability to get their daughters vaccinated as experts blame the government for the scarcity. ANGELA ONWUZOO reports
A Lagos businesswoman, Mrs. Abigail Joseph is unhappy over her inability to get her 14-year-old daughter vaccinated against cervical cancer with the Human Papillomavirus Vaccine that protects against the disease after visiting big hospitals owned by the federal and state governments in the state.
After struggling to raise the sum of N20,000 from her petty trade, getting the vaccine for her daughter has remained elusive since August 2022 as major government hospitals in the state do not have the vaccine.
“What I hear from the nurses each time I take my daughter to the hospital for her to be given the HPV vaccine is, “madam, the vaccine is not available. And we don’t know when it is going to be available,” the mother of four said.
Mrs. Joseph told our correspondent that one of her friends died of cervical cancer and therefore, added that she would do everything within her reach to protect her daughter from the killer disease since it could be prevented with the HPV vaccine.
The Delta State indigene who said she got to know about the HPV vaccine and its importance in the prevention of cervical cancer during the burial of her friend, noted that besides the high cost of the vaccine, the hurdles in getting it could discourage parents from vaccinating their adolescent girls.
According to the World Health Organisation, nearly all cases of cervical cancer can be attributed to HPV infection.
It notes that a large majority of cervical cancer (more than 95 per cent) is due to HPV infection.
“Vaccination against HPV and screening and treatment of pre-cancer lesions is a cost-effective way to prevent cervical cancer.
“HPV vaccines work best if administered before exposure to HPV. Therefore, to prevent cervical cancer WHO recommends vaccinating girls aged 9 to 14 years, when most have not started sexual activity,” it added.
Experts say the HPV vaccine is 97 per cent effective in preventing cervical cancer and cell changes that could lead to cancer but regretted that the vaccine was not available to women in the country.
They noted that the vaccine is extremely effective at preventing HPV infection, especially when boys and girls are vaccinated before they become sexually active.
Mrs. Joseph told PUNCH HealthWise that her daughter who was initially excited that she was going to receive the vaccine is however saddened by the scarcity.
“I took my daughter to General Hospital Gbagada in August 2022 for her to get the vaccine but we were told that they don’t have it. One of the nurses that we met at the maternity ward told us to go to the Lagos University Teaching Hospital, Idi-Araba, or the Lagos State University Teaching Hospital, Ikeja.
“So, my daughter suggested that we go to LUTH since it was closer to where we are living, Yaba, to be precise.
“When we got there, the nurses that we met at their immunisation ward told us that they don’t have the HPV vaccine.
“They told us that the HPV vaccine is scarce in the country. When we enquired to know when they are likely to have it, they said it depends on the supplier.
“But one of them advised us to try any of the big private hospitals in the state but that it will be very expensive. She told us that we could get it up to N35,000 in those big private hospitals if they have it while the cost is N15,000 at LUTH,” the trader said.
The vegetable seller said she and her daughter did not bother considering any of the big private hospitals in the state suggested to them by the nurses as a result of the cost.
Not available in LUTH, LASUTH
The depressed mother said, “Because of the high cost of the HPV vaccine in private hospitals, we didn’t bother approaching any of them and my daughter needs two shots of the vaccine to be fully protected against cervical cancer. I can’t afford it.
“A poor man cannot access healthcare out of pocket in a big private hospital in Lagos. You too know what I am talking about.
“So, later in November last year, my daughter said we should try LASUTH. When we got there, the story was the same. The nurses that we met told us that they don’t have the HPV vaccine.”
Continuing, Mrs. Joseph noted, “When I expressed my anger over the scarcity, they told me that I was not the only one looking for the vaccine.
Blame govt for scarcity, nurses tell mothers
“One of the nurses said to me, “Madam let me tell you, all these lamentations here will not change anything. A lot of mothers have brought their daughters here to be given the HPV vaccine and we told them the same thing we just told you and they left and you are here complaining and shouting.
“Go and complain to the government whose duty it is to make the vaccine available and not us. We only administer the vaccine and not procure it.” At that point, my daughter and I left the hospital angrily.”
Not deterred by her last experience, Mrs. Joseph told our correspondent that she still took her daughter to LASUTH on January 19, 2023, to get the vaccine but was told the vaccine was not yet available.
“We went back to LASUTH last week, but still, the story has not changed. They said they don’t have the vaccine. If by the end of March, I am unable to get my daughter vaccinated, I will put back the money that I have set aside for the vaccine into my vegetable business. I am the only one struggling to take care of my four children. My husband is late.
“I don’t even know that there is a vaccine that can prevent cervical cancer. It was the day one of my friends who died of cervical cancer in April 2022 was buried that I got to know about it.
“Someone during the burial ceremony said women should go for cervical cancer screening and ensure their adolescent girls get the HPV vaccine to avoid this type of death,” she recounted.
Never give up
The Lagos resident further said, “The person said with N20,000 or less, one can get a shot of the vaccine in a government hospital. After that, I started saving to get my daughter vaccinated. I have four children, three boys, and a girl.
“But I never knew that getting the HPV vaccine even with your own money was a big challenge in Lagos. I will keep trying. The government should please help us and save our girls from cervical cancer. They should make it available and free so that ordinary Nigerians will have unhindered access to it.”
A Consultant Oncologist, Dr. Abia Nzelu told PUNCH HealthWise that the masses in Nigeria still do not have access to the HPV vaccine.
Nzelu says that cervical cancer is preventable and that when diagnosed early, it is one of the most successfully treatable forms of cancer.
The oncologist urged the Federal Government to strive to make the HPV vaccine available to protect women and girls from HPV-related cancers.
Cost of HPV vaccine prohibitive
Nzelu said, “The HPV vaccine protects both males and females from HPV-related cancers.
“Sadly, the cost of HPV vaccine is prohibitive to those who need it most. A dose costs over N20,000; two doses are required, administered six months apart.”
Nzelu who is the Executive Secretary, GivingTide international, says though cervical cancer is on the increase globally, the situation in Nigeria has assumed a worrisome dimension.
She explained, “Just like COVID-19, Nigeria is also experiencing a second surge of cervical cancer, a disease that has a much higher mortality rate than COVID-19 and which is also caused by another deadly virus, known as HPV.
“In Nigeria, cervical cancer is the 2nd most common cancer in women generally as well as among women between the age of 15 and 44 years. It is also the 2nd most common cause of cancer deaths in females after breast cancer”.
Another Lagos resident and mother of three who simply identified herself as Mrs. Taiwo told our correspondent that she took her 12-year-old daughter to LUTH twice last year to get the HPV vaccine but was told it was not available.
Mrs. Nkiru Ukaegbu and other mothers in the state who spoke with PUNCH HealthWise said their efforts to get their girls vaccinated against cervical cancer in the last four months have been in vain due to scarcity of the HPV vaccine in government hospitals.
Findings by PUNCH HealthWise show that both federal and state government-owned hospitals in the state do not have the HPV vaccine which also confirmed the claims of the distressed mothers.
Our correspondent went around some hospitals in the state and findings revealed that while some mothers are eager to have their adolescent girls vaccinated against cervical cancer, government hospitals did not have the HPV vaccine at all.
At LUTH, a high-ranking health worker who did not want her name to be mentioned disclosed that the tertiary health facility did not have a single dose of the HPV vaccine.
Govt should take ownership
“It is not available. It is scarce in the country. The problem is with the suppliers and not the hospital. A lot of women have been bringing their female children to get the vaccine since last year but we don’t have it. If the government can come in and take ownership of the vaccine and include it in National Routine Immunisation Schedule, I believe it will be readily available and accessible,” the health worker said.
At LASUTH, one of the nurses at the immunisation ward told our correspondent during the visit that the HPV vaccine was not available.
“We don’t have it. I doubt if you will see it in any government hospital. You can try Lagoon Hospital. But it will be expensive,” the health worker said.
Asked when the vaccine will likely be available, she said, “I don’t know. It is our suppliers that will answer that question,” the nurse who does not want her name mentioned in the report said.
Not available at FMC Ebute- Metta
At the Federal Medical Centre, Ebute- Metta, the story was the same when our correspondent visited the tertiary health facility.
Our correspondent who during the visit was directed by a nurse at the family planning and immunisation ward to go to the hospital’s pharmacy to get the vaccine was told by one of the pharmacists that the vaccine was not available.
Also, the HPV vaccine was not available in some of the general hospitals visited.
Be patent, Adewole begs mothers
Experts who spoke with PUNCH HealthWise on the issue blamed the Federal Government for the scarcity of the vaccine while a former Minister of Health, Prof. Isaac Adewole appealed to the women to exercise patience, assuring them that the Federal Government will make the vaccine available before the middle of the year.
Prof. Adewole told PUNCH HealthWise in an exclusive interview that all efforts were on track to get the vaccine into the country this year.
Adewole who is a Professor of Obstetrics and Gynecology at the College of Medicine, University of Ibadan revealed that Nigeria records 12,000 new cervical cancer cases annually out which of 8,000 die.
Cost major problem
The maternal health expert said the vaccine was available but in commercial pharmacies, adding that the problem has to do with the price.
“The challenge has to do with the availability of the vaccine. We had a global shortage of vaccines. But three things have made it easier for us to be able to get the vaccine this year. The production of the vaccine in India and China and the adoption of a single-dose regimen.
“People should just be patient. It is available at commercial prices which may be out of reach of the ordinary Nigerian. So, let them be a bit patient. This vaccine will soon be available in Nigeria. The vaccine is available in commercial pharmacies, but it is the price that is high”, the Prof. said.
The gynaecologist urged women to go for regular cervical cancer screening and avoid late presentation when they are symptoms of the disease.
A consultant Gynaecologist and Obstetrician, Dr. Philips Ekpe said cervical cancer was still a killer disease in this part of the world because “our attitude to prevention is very poor.”
Lack of political will
Ekpe, a former Secretary-General of the Nigerian Medical Association, said the vaccine was scarce in government hospitals because the government lacks the political will to make it available for the masses.
The gynaecologist said, “Why the HPV vaccine is not available has to do with lack of political will on the part of the government to get these things done.
“The vaccine is expensive. Ordinary people cannot afford it and that is why the government needs to take it up.
“When the government takes up the vaccine and it is available in our hospitals and there is an increase in the up uptake of the vaccine up to 60 per cent, the morbidity and mortality from cervical cancer will reduce drastically.”
He further said, “The Federal Government must have the political will to include it in national routine immunisation schedule so that girls from the age of eight years can get vaccinated before they are exposed to sex.
“If this is not done, we are still going to be suffering from the late presentation of cervical cancer leading to higher mortality.
“I have received several calls from those who want to procure the HPV vaccine.”
The HPV vaccine according to the WHO recommendation is given as a series of shots.
“For those aged nine to 14, two shots of vaccine are recommended. The second shot should be given six to 12 months after the first one.
“For those aged 15 through 26, three shots of vaccine are recommended. The second shot should be given one to two months after the first one. The third shot should be given six months after the first shot”, the global health body declared.
The Federal Government had in 2020, promised to introduce the HPV vaccine into the national immunisation schedule.
But three years after, the Federal Government is yet to fulfil its promise.
The Executive Director and Chief Executive Officer of the National Primary Health Care Development Agency, Dr. Faisal Shuaib was yet to respond to a text message sent to him on the issue by our correspondent as of the time of filing this report.
The WHO says worldwide, cervical cancer is the fourth most frequent cancer in women with an estimated 604, 000 new cases in 2020.
“Of the estimated 342, 000 deaths from cervical cancer in 2020, about 90 per cent f these occur in low- and middle-income countries.
“In high-income countries, programmes are in place which enable girls to be vaccinated against HPV and women to get screened regularly and treated adequately. Screening allows pre-cancerous lesions to be identified at stages when they can easily be treated.
“In low-and middle-income countries, there is limited access to these preventative measures, and cervical cancer is often not identified until it has further advanced and symptoms develop,” WHO said.
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