Expanding coverage of School-based HPV vaccination among girls aged ≥ 9 years in South Africa— all girls matters!

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Cervical cancer is the first most common cancer in women and the first leading cancer related-deaths among South African women, aged 15-44 years. More that 12,000 women are diagnosed with cervical cancer annually, of which 5,500 die from cancer— age-specific incidence rate (15-44 years) of 41.8 per 100,000 women per year and age-specific mortality rate (15-44 years) of 11,7 per 100,000 women per year. Reasons for such a high mortality rate include, low screening coverage of 19.3%, and late presentation with an advanced stage compounded by the high HIV epidemic. The World Health Organization recommends a 2-dose HPV vaccination among girls of 9-13 years. 

In 2014, the South African National Department of Health introduced a school-based HPV vaccination policy— using 2-dose Cervarix vaccine, as prevention for cervical cancer among girls aged 9 and above in grade 4 attending public schools. The policy aimed to vaccinate 500, 000 young girls from 18,000 public schools before their sexual debut. 

HPV vaccine campaign poster distributed by the Department of Health. Source: Government Communication and Information System

Preliminary data showed that 91% of schools were reached and 87% age eligible grade 4 girls were vaccinated, however there is a high dropout rate in the second dose.  

Although the programme seems a success thus far, there is a need for expanded coverage of the vaccine to include higher grades that could potentially house girls of ages 11-13 years. In addition, the vaccine must be widely available at public health facilities for girls who were missed at school because they changed schools or dropped out. Girls attending private schools are presumed to access HPV vaccine through the private health sector, however the HPV vaccine coverage in the private health sector remains low due to high costs and lack of awareness— which suggest that there is low coverage in private schools. Therefore, the vaccine must be expanded to include private schools. This gap may lead to poor coverage of HPV vaccination and may also increase perceptions or hesitancy against the vaccine because it is not widely available for all girls of targeted age. No girl must be left behind.

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3 Responses to “Expanding coverage of School-based HPV vaccination among girls aged ≥ 9 years in South Africa— all girls matters!”

  1. HPV Vaccine in South Africa – Don’t Forget the Private Schools | Tropical Health Matters Says:

    […] virus in South Africa and in the process prevent cervical cancer. Her blog originally appeared in Social, Cultural & Behavioral Issues in PHC & Global Health. Cervical cancer is the first most common cancer in women and the first leading cancer […]

  2. asaunders1919 Says:

    Thank you for this post! There is so much opportunity for prevention of cervical cancer, with a straightforward intervention and policy. The social and economic cost of missing this opportunity is high, and the risk and cost of expanding the vaccine program is relatively low. I agree that the prevention program should be supported and expanded.

  3. Jayoung Park Says:

    Thank you for your post! I just read on cervical cancer in Malawi and you should also check out the blog post. I’ve attached the link below:
    https://sbfphc.wordpress.com/2019/05/12/cancer-control-planning-in-malawi/#comment-28362
    I see that the South African National Department of Health is leading to prevent cervical cancer in South Africa. As I read along with the blog posts, many advocate the policy should be expanded. This HPV vaccination program also does not cover all. I hope that there could be some studies that will support the government to expand the policy. Also, I definitely agree that perception causes hesitancy to get the HPV vaccination that education is very necessary for this policy to consider about when they amend the policy.
    Again, thank you for sharing!

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