Unraveling Myths surrounding HPV vaccination

By Nightengale Ben-Onyeukwu and Nneoma Ahukanna

Mrs. Madumere Maria-Gorretti, Immunisation Officer for Mbaitoli LGA

Imo Governor’s wife Barr. Mrs Chioma Uzodimma about two months ago, flagged off the Human papilloma virus (HPV) vaccination for girl children ages between nine and fourteen years. Represented by Lady Chinyere Ihuoma Ekomaru, PhD. She passionately advocated for compliance with the need to vaccinate girls against cervical cancer, which she noted was the fourth most common cancer globally and second most common cancer affecting women in Nigeria. She added that the human papilloma virus is the most common viral infection of the reproductive tract and causes 85 percent of cervical cancer cases.

Earlier, when a delegation of IMO primary health care development agency came on advocacy visit to seek for partnership with the Ministry for women affairs and social welfare on addressing and ending cervical cancer among women in Imo, Mrs Uzodimma represented by Mrs Nkechinyere Ugwu the Women Affairs Commissioner, assured the Dr. Emeka Okere -led delegation of effective collaboration and pinned down 27th May as flag off date for the campaign.

She also assured that the ministry would create wider awareness and publicity using social media handles, news talks,s well as  involve churches, hospitals, schools and communities to ensure understanding and  acceptance of the campaign.This is to help clear the air on the myths, and conspiracy theories about the HPV vaccine one of which is that it is a huge plot to reduce the population of Africa by causing infertility among young girls.

The Human papillomavirus (HPV) is the most common sexually transmitted infection worldwide and a leading cause of cervical cancer. To combat this, the HPV vaccine has been developed as a safe and effective means of prevention. Despite its proven benefits, concerns and misconceptions continue to hinder its acceptance, particularly in Nigeria, where cervical cancer remains a significant health threat.

There are different versions of the HPV vaccine: Gardasil, Gardasil 9, and Cervarix. Gardasil protects against four types of HPV—types 6 and 11, which cause genital warts, and types 16 and 18, which are associated with cervical cancer. Gardasil 9 extends this protection to nine types of HPV, adding types 31, 33, 45, 52, and 58. Cervarix focuses on types 16 and 18, the most common high-risk types linked to cervical cancer.

In Nigeria, cervical cancer ranks as the third most common cancer and the second leading cause of cancer-related deaths among women aged 15 to 44. Data from 2020 indicated that Nigeria recorded 12,000 new cases and 8,000 deaths from cervical cancer. Research shows that the HPV vaccine is most effective when administered to girls aged 9-14 years, before they become sexually active.

A prevailing concern among parents is the fear that the HPV vaccine may render their daughters infertile. This misconception, fuelled by historical incidents and misinformation, has sparked hesitancy, despite medical assurances that there is no link between the HPV vaccine and infertility. Addressing these concerns is crucial for dispelling myths and ensuring informed decisions about HPV vaccination.

However, questions remain: How reliable is this vaccine? Many people have known about the vaccine for years and are surprised it was only recently introduced in Nigeria. If the vaccine has existed for a long time, could the version brought to Nigeria have been tampered with? Is it really safe for girls to receive this vaccine? What will be the fate of these girls who receive the vaccine in the next ten years?

Research indicates that men are carriers of the virus and can transmit it to women, who may then pass it on to others. For this reason, men are also advised to get vaccinated to help prevent the spread of the disease. While most people do not oppose taking the vaccine—after all, no one wants to die young—the primary concern lies in the perceived reliability and safety of the vaccine itself.

Mrs. Madumere Maria-Gorretti, Immunisation Officer for Mbaitoli LGA, emphasized the importance of the vaccine in an interview, ‘Many people are very ignorant about diseases. Most of them might not know that cancer kills so many people. Cancer, for instance, claimed the life of the late Dora Akunyili. It also claimed the life of Miriam Babangida, a former first lady who died of cervical cancer. I know many people who have succumbed to cervical cancer. By the time cervical cancer is detected, it’s often too late, making it one of the deadliest cancers. It’s crucial to realize that such incidents can be prevented, for example, with the HPV vaccine. Administering this vaccine to children aims to prevent cervical cancer in the future. That’s why we vaccinate them at a young age, before they are exposed to sexual activity. Children aged 9-14 are not yet exposed to sexual immorality, and by immunizing them now, we protect them against cervical cancer for life.’

‘In Mbaitoli, we recorded only two cases of Adverse Events Following Immunisation (AEFI), which were not serious and were resolved with paracetamol. Every individual's body reacts differently, but most children did not experience negative reactions after receiving the vaccine.’

‘Initially, when the vaccine was introduced, serious reactions occurred due to rumours, leading many to initially refuse vaccination for their daughters. However, by the third day of vaccination, some schools began requesting vaccinations. Even a school proprietor arranged for his students to be vaccinated, and subsequently, parents started calling for their children to be vaccinated. Some people now understand that the vaccine is beneficial, contrary to what they had heard.’

‘The LGA immunization team actively sensitized communities and conducted advocacy visits to opinion leaders. Despite mid-term school breaks, schools resumed and began requesting immunization sessions.’

‘I want to thank the government for incorporating the vaccine into routine immunizations. As people become more aware, routine HPV vaccination is increasingly accepted. We plan to vaccinate those who missed out this year, especially children turning 9.’

‘Convincing people to take the vaccine isn't easy, given prevailing misconceptions. Initially, other vaccines like those for polio and measles faced rejection. However, as people saw the significant reduction in measles cases, they began to appreciate the importance of vaccines. Similarly, with time, people will come to appreciate the HPV vaccine. It's important to clarify that the HPV vaccine is not for family planning but for preventing cervical cancer, which primarily affects women. While men can carry the virus, it usually does not manifest as cancer in them, unlike women who are vulnerable due to their cervix.’

‘I strongly advocate for taking the vaccine to prevent cervical cancer. Many women are willing to get vaccinated, but due to limited availability, some seek it in private hospitals where a single-dose vial costs more than sixty thousand naira.’

‘This is why the vaccine is restricted to mature children who have not yet engaged in sexual activity. If it were available to all women, there wouldn't be enough left for the children, as adults would likely take it first.’

Mrs. Madumere Christiana, Cold Chain Officer for Mbaitoli, stated, ‘We are of the opinion that all eligible children should go ahead and take it because it is safe. It is not like what people are saying. Here at our health centre, we have a good cold chain. All our vaccines are kept inside the solar-powered refrigerator.’

Mrs. Iwu Leticia Adaku, the Director of Environment Services in Mbaitoli Local Government Area, highlighted, ‘Girls of that age are exposed to rape, prostitution, and as you know, cervical cancer is mainly contracted through prostitution. Anyone who indulges in prostitution is at risk of developing cervical cancer, so it is important to prevent it. Prevention is better than cure. By now, people in Lagos have already begun receiving the vaccine; it's not only available in Imo state. Taking the vaccine is better to prevent diseases. I advise parents who have not complied yet to do so before it is too late. There is nothing wrong with the vaccine; it is safe. Some states have already completed their vaccination programs. If there were any issues with the vaccine, they would have stopped administering it to girls.’

Before the government distributed the vaccine, they surely tested it and confirmed its safety in the laboratory. They would not distribute a vaccine without testing it first.’

I advise parents to comply and allow their daughters to receive the injection. I am confident the government would not distribute anything harmful to our children.’

Ebere Ukaegbu, a medical practitioner, expressed a different viewpoint, ‘I don’t advise people to take the vaccine because the white men want to use it to reduce our population and cause infertility. But we are Israelites; they can’t reduce our fertility.’

Joy Chinagorom, a nurse working at Eziama Orodo Health Centre, added, ‘This vaccine is very good because before we started giving it to the girls, we first gave it to our children. I have up to four grandchildren (girls) aged 9-14, and I gave all of them the vaccine. Since then, they have been doing fine. Some people around us are now coming to take the vaccine, but it is closed now. They didn’t take it earlier because they wanted to see if those who took it are still alive. Now they are coming after seeing that those who took it are still alive. So, to my understanding, I don’t see anything wrong with that vaccine. It is good for health, and you know that anyone who has that cancer is incurable; that is why we are giving out the vaccine. My advice is for them to take it. I gave it to my own grandchildren… I would not give my own children something that is not good.’

The headmistress of Good Foundation primary school clarified their policy, ‘We do not administer the vaccine to the children. Before we give them any vaccines, we always get consent from their parents.’