Cervical cancer is the second most common cancer affecting women in Nigeria [1]. There are a estimated 12 000 new cases and 8 000 deaths from cervical cancer in Nigeria, every year [2]. About 70 percent of cervical cancer cases in Nigeria are attributed to Human Papilloma Virus (HPV) 16 and 18 [2]. In October 2023, the Nigerian Government, through the National Primary Health Care Development Agency (NPHCDA), and with support from Gavi, the Vaccine Alliance and other key partners, launched the introduction of HPV vaccination into routine immuniation, to reduce the burden of cervical cancer and other HPV-related cancers in the country [3].
The introduction was in two phases, and the first phase included fifteen states and the Federal Capital Territory. Ogun State was one of the Phase I states. Ogun State is located in southwestern Nigeria and has a population of about 6 million people. The predominant ethnicity is the Yoruba tribe. The HPV vaccine introduction programme included planning and co-ordination activities, advocacy and awareness creation, training of vaccination teams, deployment of vaccines, maintenance of the cold chain, and vaccination of girls aged 9 – 14 years with a single dose of the HPV vaccine. The Ogun State Primary Health Care board, led the HPV vaccine introduction programme in Ogun State, with support from partners.
Several months prior to the vaccination activities, awareness creation began, which included meetings with school heads, teachers and parents’ organisations, traditional and religious leaders, and trade groups. Educational materials such as banners, posters, and handbills were distributed in communities, schools and public places. Information was also disseminated via radio, local television and using e-fliers on WhatsApp. Town announcers took the message on HPV vaccination to the streets and marketplaces, especially in rural areas and local communities. Market edutainment was done, involving singing and drumming in the markets while passing across important information about the vaccine introduction.
The vaccination activities began on the 24th of October 2023 with an official flag-off ceremony by the Honorable Commissioner of Health, Dr Tomi Coker. This flag-off ceremony kicked off a 5-day campaign to bring the HPV vaccine to the doorstep of every eligible girl. The campaign included vaccination teams carrying out outreaches to schools, communities and public places. A vaccination team comprised of a community mobiliser, a vaccinator, a recorder, a supervisor and for schools, it included a teacher. HPV vaccination was also provided at public health facilities.
The HPV vaccination campaign had some setbacks which include delay in arrival of handbills, posters and banners, inadequate funding affecting some aspects of logistics, and widespread rumors that the HPV vaccine causes death and infertility. The spread of such rumors led to community hostility towards some vaccination teams and led to some vaccine rejection.
Rumors were countered by holding shows on television and radio to provide accurate information about the HPV vaccine and allay fears. Educative WhatsApp voice notes were also made by renown religious leaders to counter rumors. During the campaign activities, the vaccination teams took the bull by the horn, by taking up roles as health educators, educating people in the community and schools on the safety and effectiveness of the HPV vaccine. As the vaccination activities continued, parents were becoming more re-assured to vaccinate their daughters as they could see that vaccinated girls were not collapsing and dying as reported by a viral WhatsApp voice note.
The vaccination programme recorded successes. Despite the misconceptions, many parents were convinced of the need to vaccinate their adolescent daughters. As part of the monitoring and evaluation of the programme, our research on HPV vaccine knowledge, attitude and satisfaction with the vaccine introduction programme, was conducted among parents and caregivers of vaccinated girls [4]. At various vaccination sites, we asked parents questions regarding their knowledge on the benefit of the vaccine, who should receive the vaccine, and the number of doses that should be received. We also examined parents’ perception of the vaccine’s safety and effectiveness, as well as their satisfaction with awareness creation activities. We also asked about parents' confidence in the competence of vaccinators and their satisfaction with the cleanliness of the vaccination procedures [4].
Our study revealed that most parents had good knowledge of the vaccine, all had positive attitude and majority were satisfied with the HPV vaccine introduction programme. Most parents heard of the vaccine for the first time, during the introduction programme and many got their information from town announcers and via social media [4]. Many parents chose to vaccinate their daughters because there was a campaign ongoing. This shows that vaccination outreach activities as well as awareness creation can play a huge role in improving vaccination rates.
After the 5-day campaign, which was followed by a 3 day mop up exercise to reach girls possibly missed during the campaign, the HPV vaccine is now available at health facilities for all eligible girls. At the end of the campaign and mop up activities, 280,489 girls were vaccinated out of a target population of 400,452 girls meant to be vaccinated during that period. This gives a 70% vaccination coverage rate. The introduction programme was largely successful despite the challenges encountered, due to the deployment of resources, dedication shown by the State Primary Health Care Board and Local Government staff, the efforts of the Technical Working Group, and very importantly, support by the NPHCDA, and partners like WHO, UNICEF, CHAI-HAPPI and SYDANI.
Ogun State, alongside other states in Nigeria have definitely joined in the fight against cervical cancer and with dedication and armed with the necessary resources, Nigeria is on track to reducing the global burden of cervical cancer.
References
- Jedy-Agba E, Curado MP, Ogunbiyi O, Oga E, Fabowale T, Igbinoba F et al. Cancer incidence in Nigeria: a report from population-based cancer registries. Cancer Epidemiol. 2012 Oct;36(5):e271-8.
- ICO/IARC Information Centre on HPV and Cancer. Nigeria Human Papillomavirus and Related Cancers, Fact Sheet 2023. Available from: https://hpvcentre.net/statistics/reports/NGA_FS.pdf (Accessed 06/02/2025)
- WHO Nigeria. Nigeria to vaccinate 7.7 million girls against leading cause of cervical cancer. 2023. Available from https://www.afro.who.int/countries/nigeria/news/nigeria-vaccinate-77-million-girls-against-leading-cause-cervical-cancer (Accessed 06/02/2025)
- Olubodun T, Ogunsola EA, Coker MO, Olayinka SA, Elegbede WÀ, Ojediran JO, et al. HPV vaccine knowledge, attitude, and programme satisfaction among parents and caregivers of vaccine recipients in Ogun state Nigeria. Reprod Health. 2024 Dec 4;21(1):179. doi: 10.1186/s12978-024-01913-y.