Mahdi Garba [Lead writer]
When Radeeyah Nasir is not at her job as a registrar in the obstetrics and gynaecology unit of Muhammad Abdullahi Wase Teaching Hospital, Kano, she is part of a team of volunteers raising awareness about the Human Papilloma Virus (HPV), among secondary school students in states across Nigeria’s northwest.
“There are diseases that are preventable, and there are diseases that cannot be cured,” she explained. “Fortunately, cervical cancer is one of the diseases that has a known cause. Cervical cancer is caused by HPV, meaning if we can tackle HPV, we can save women and girls from contracting cervical cancer.”
Nigeria faces a significant threat from cervical cancer, which ranks as the third most common cancer in the country and the second leading cause of cancer-related deaths among women aged 15–44. The statistics are alarming, with 12,000 new cases and 8,000 fatalities reported in 2020 alone. However, in a groundbreaking move, Nigeria launched the first phase of its HPV vaccination program in October 2023 quickly followed by the second phase in May 2024, aiming to protect over seven million girls aged 9 -14 nationwide.
The severity of this cancer is what motivates Radeeyah to take the campaign for the HPV vaccine to secondary schools. “That [the risks] prompted us to engage in awareness on HPV vaccine because if all girls can be vaccinated against HPV, it means that all girls will not have cervical cancer.”
The HPV vaccine campaign has been made possible through the support of Kano’s Global Shapers — a hub of the World Economic Forum (WEF). This diverse group of professionals, comprising of individuals from various professions such as medicine, academics, oil and gas, construction, among others, have come together to drive positive change in their community. Members of the hub usually analyse the most pressing issues within their communities and propose solutions.
According to Khadijah Buhari, the curator of Kano’s Global Shapers, one of the group’s key focus areas is addressing health challenges and implementing programmes that prevent and combat diseases affecting women and children.
Vaccine hesitancy has been a problem in Kano
Although the introduction of the HPV vaccine is a significant breakthrough in preventing the spread of cervical cancer in Nigeria, its potential impact is being hindered by widespread concerns and misconceptions about the vaccine within communities. These concerns are hindering the uptake of the vaccine, rendering many vaccine programmes ineffective.
“You see, now we have access to the vaccine but the uptake of the vaccine here is the problem now,” Radeeyah stated, adding that “people are skeptical about accepting it because there are a lot of conspiracy theories. They say things like ‘do these people want us to have a reduced fertility? why should they give us something for free?’ that has been the mentality.”
The situation in Kano is particularly bleak due to the trauma from the 1996 Pfizer meningitis drug trial debacle. The trial resulted in deadly outcomes, with 11 children losing their lives and many more suffering from severe and lasting injuries, including blindness, paralysis, deafness, and neurological damage. Although Pfizer attributed these outcomes to meningitis rather than their administered drugs, the incident has left a deep mistrust among many communities in Kano, making it even more challenging to implement vaccine programmes and promote public health initiatives.
Other factors contributing to vaccine hesitancy include misconceptions and a general lack of understanding and accurate information about vaccines also plays a significant role in fueling doubt among members of communities. According to Dr. Ephrem Lemango, UNICEF’s Associate Director of Immunisation, people are more likely to hesitate when they lack information about a vaccine’s impact and side effects, and effective communication with healthcare workers can help alleviate concerns and promote vaccine acceptance.
This is where community-based groups like the Kano Global Shapers and other similar foundations come into play.
Catching them young
The HPV vaccine is specifically targeted at girls and adolescents between the ages of 9–14, before they become sexually active, as the virus is primarily transmitted through sexual contact. By vaccinating this age group, the goal is to provide protection against the HPV-related cancer before they are exposed to the risk of infection
Image credit: Kano Global Shapers.
Radeeyah said it is the reason they are targeting primary and secondary school students, “prevention is better than cure,” she says. “So, we target people that have not been [sexually] exposed. You know, most of the people in junior secondary school have not been married, so it is assumed that they do not have any exposure to the virus yet. So, you target these girls that have not been exposed to the virus and give them the vaccine. The vaccine works 100% in this age group and it is a free vaccine where everybody has the fair chance of getting it.”
She pointed to the fact that deaths resulting from cervical cancer are usually a problem in low-middle income countries. Radeeyah explained that the Nigerian government came up with a proposal that every child be vaccinated for cervical cancer, which has been incorporated into the National Policy for Vaccination. However, she stated that more needs to be done about the low uptake of the vaccine across northern Nigeria, due to religious, economic, and other social barriers.
Image credit: Kano Global Shapers.
From Classrooms to Airwaves
To further amplify their message, the group uses radio programs as an additional platform to raise awareness about the HPV vaccine. By visiting local radio stations, they were able to directly engage with parents, emphasising the importance of their consent in the vaccination process. “We had a lot of press conferences. We had a lot of meetings with radio stations. They gave us free airtime, where we go and enlighten the public on the importance of this vaccine,” Radeeyah mentioned.
And because some may have passed the vaccine eligibility, they also encourage parents on the importance of cervical cancer screening. Radeeyah explained that HPV has a long latency period. This means that, it could take 10 to 15 years before it manifests as a full-blown cervical cancer. Therefore, if women are being screened for precancerous lesion, they can be treated early and on the spot before it progresses to cancer. “We are killing two birds with one stone. We are enlightening these kids on HPV, and we are also enlightening them to talk to their parents to get screened for premalignant lesion of the cervix,” Radeeyah noted.
The HPV vaccine project lead, Dr Radeeyah said Northern Nigeria has one of the highest vaccine allocations, but she is glad it has almost finished, which she attributed to their advocacy.
During the launch of the HPV vaccination campaign in Kano last year, the state’s health commissioner announced plans to immunise 1,550,000 girls within the target age group. According to recent data from the Kano State Primary Health Care Management Board, which oversees immunisation efforts, a total of 942,530 girls have been vaccinated, representing significant progress towards achieving the state’s goal.
Systemic marginalisation
Like so many diseases, cervical cancer is an inequitable threat. Studies have shown that rates of diagnosis of cancer, as well as mortality rates from the cancer, are significantly less in higher income homes than in lower income homes.
According to Radeeyah, many private schools across Kano have written to Kano Global Shapers asking them to come to their schools and educate their students about the importance of the HPV vaccine. she, however, stated that on the contrary government-owned schools are not as open to such initiatives because of uncertainty on how the state government will perceive such things. “We want it [the acceptance] to be equal,” she said.
She says that if this disparity continues, it might affect their plan of going to at least 3 schools in each of the 44 Local Government Areas (LGAs) across the state. There are LGAs that do not have private schools and the public schools out of the metropolis are very cautious about granting them access to the schools.
“We wish the government would talk to the school administrators so that they give us more access to their students. We do not want a situation where only children from affluent homes are getting the vaccine while others who [also] need it are being denied [necessary education about the vaccine] because they are not in a private school.”
She further iterated that, “I want to assure everyone that this vaccine is 100% safe. It has no adverse effect and is for the betterment of the people.”