Does Tanzania need a cervical cancer vaccination programme?

Does the prevalence and mortality rate of cervical cancer justify the introduction of a nationwide vaccination programme?

Photo Courtesy of U.S. Air Force/Staff Sgt. Benjamin W. Stratton

Tanzania has become the seventh African country to implement a vaccination programme against the human papilloma virus (HPV), which is linked to cervical cancer, after Botswana, Mauritius, Rwanda, Seychelles, South Africa and Uganda.

Cervical cancer is mainly caused by the human papilloma virus (HPV), a sexually acquired infection that can be prevented using a vaccine.

The first round of the vaccination programme rollout will see 616,734 girls from all over Tanzania receive the vaccine for free, with health minister Ummy Mwalimu noting that the government will receive 3.9 million vaccines in 2019 to vaccinate girls aged between 9 and 14.

Vice President Mama Samia Suluhu launched the national vaccination drive on April 10, noting that according to 2016/17 statistics from the Ocean Road Cancer Institute (ORCI), cervical cancer was the leading type of cancer in the country.

According to health minister Ummy Mwalimu, cervical cancer accounts for one-third of all cancer cases in the country. Speaking at an event marking the 2018 World Cancer Day, Minister Mwalimu further added that only about 13,000 of the approximately 50,000 new cancer cases diagnosed annually in Tanzania visit health facilities for treatment.

The vaccines will be supplied by the Global Alliance for Vaccines and Immunization (GAVI), following the successful conclusion of HPV vaccine demonstration projects in the country.

So the question is, does the prevalence rate of HPV in Tanzania justify the introduction of a nationwide vaccination campaign?

PesaCheck has looked into the claim by Tanzanian health minister Ummy Mwalimu, cervical cancer accounts for one-third of all cancer cases in the country and finds it to be TRUE for the following reasons:

Data shows that cervical cancer is the most common cause of cancer-related deaths in Tanzania, with 50.9 cases diagnosed for every 100,000 women. Due to the limited treatment facilities available, cervical cancer is linked to 37.5 deaths for every 100,000 women in the country.

The vaccination programme is intended to both lower the number of deaths and to protect the girls and women receiving it from developing the illness at an early age.

Treatment of cervical cancer is quite expensive, costing about $2,000 per patient, far beyond the incomes of many Tanzanian households. In comparison, the vaccine costs US$ 13 per dose on average.

There are more than 100 types of HPV, of which at least 13 are cancer-causing. Two particular types of HPV virus are linked to 70% of cervical cancers and precancerous cervical lesions, meaning that preventing infection through vaccination can go a long way towards preventing the occurrence of cervical cancer.

Cervical cancer is the second most common cancer in low-income countries after breast cancer, according to the World Health Organization. Poorer countries often lack the facilities for early screenings for HPV that are more commonplace in wealthier countries which have already introduced the HPV vaccine.

According to the HPV center, cervical cancer is the most frequently diagnosed cancer among women in Tanzania, particularly those in the 15-44 age group. About 3.3% of women in the general population are estimated to be infected with the cervical HPV at a given time, and 68.0% of invasive cervical cancers are attributed to HPV.

Additionally, 7,000 women are diagnosed with cervical cancer in Tanzania annually, with 4,000 dying from the disease every year.

In Tanzania, 2012 medical research shows that cervical cancer is responsible for 325 deaths out of 1 million women, meaning that Tanzania has one of the highest cervical cancer rates in the world, with the third highest mortality rate from cervical cancer among countries eligible to get GAVI support for vaccination programmes.

WHO 2014 statistics show that Tanzania cervical cancer mortality across 10 age groups stands 32 per 100 000, placing it seventh in sub-Sahara Africa.

The latest statistics indicate that cervical cancer is indeed on the rise in Tanzania, and while this rise could be the result of better diagnosis mechanisms and more testing as was noted in a previous PesaCheck post, one potential cause could be late screening for cervical cancer.

Therefore, the claim by health minister Ummy Mwalimu that cervical cancer accounts for one-third of all cancer cases in Tanzania is TRUE.

Data on the illness shows that Tanzania has a worryingly high prevalence of cervical cancer, and the vaccination programme will go a long way towards reducing overall mortality.

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This report was written by PesaCheck Fellow Belinda Japhet, a data journalist and online editor based in Tanzania, and edited by PesaCheck managing editor Eric Mugendi. The infographics are by Eunice Magwambo, a Kenyan graphic designer, visual artist and digital content producer.

PesaCheck, co-founded by Catherine Gicheru and Justin Arenstein, is East Africa’s first fact-checking initiative. It seeks to help the public separate fact from fiction in public pronouncements about the numbers that shape our world, with a special emphasis on pronouncements about public finances and how governments are delivering on public services related to the Sustainable Development Goals (SDGs) such as healthcare, rural development and access to water and sanitation. PesaCheck also tests the accuracy of media reportage. 
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PesaCheck is a joint initiative of Code for Africa, through its local Code for Tanzania chapter, and the Data Zetu initiative to give Tanzanian citizens actionable data, in partnership with a coalition of local media organisations, with additional support from the International Center for Journalists(ICFJ).

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