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No Controversy Here: Rwanda’s Effort to Beat HPV and Cervical Cancer

HPV CouricDaytime television host Katie Couric courted controversy where it does not exist, yesterday. She featured Emily Tarsell a woman who said the HPV vaccine Gardasil is responsible for her her daughter’s death.

Remaining guests, including medical doctors, discussed their support and opposition to the HPV vaccine. Couric builds ‘controversy’ by rising fear of vaccines based on non or pseudo-scientific claims. The ‘balanced’ style of reporting left viewers with few answers and may have caused more confusion than help enlighten misinformed Americans.

“So we’ve obviously heard two different sides about the HPV vaccine and I think for parents watching, it’s probably still rather confusing when you hear these heartbreaking stories that these parents have endured,” closed Couric.

Viwers are left thinking that there is an actual debate over the HPV vaccine when there isn’t.

There is more agreement in the medical community than Couric’s show lets on. The American College of Obstetricians and Gynecologists recommends women both receive the vaccine and are screened regularly for cancer. It is the same recommendation made by the World Health Organization for countries around the world.

HPV is almost entirely responsible for cases of cervical cancer. The US Center for Disease Control estimates that HPV is the cause of some 25,000 cancers each year. Of that total, 12,000 are cervical cancer in women and 6,000 are oropharyngeal (throat) cancer in men.

However, it is developing countries where cervical cancer is the most deadly. More than 85% of the 274,000 deaths caused by cervical cancer each year occur in developing countries, says the WHO.

The three shots during adolescence provide protection against HPV, significantly reducing the chances women develop cervical cancer when they get older. Advances are underway that both reduce the regime and the price for the vaccine.

Cancer is responsible for 5% of deaths in Rwanda each year. Much lower than the 23% in the US, but a problem that will grow as Rwandans live longer.

The Ministry of Health began implementing a preventative structures to reduce the incidence of cancer in 2012. For women, that means improving access to breast cancer screenings and a national HPV plan.

“We are a government that is evidenced based and result oriented,” asserted Minister of Health Dr. Agnes Bingawaho.

That is why Rwanda implemented one of the first widespread HPV vaccination campaigns for young girls in a low-income country.

For Rwanda’s older population, health clinics will undertake systematic screenings of women between the ages of 35 and 45 years old for cervical cancer. The solutions dominated approach has shaped the Rwandan cervical cancer program and the way that it developed.

“We always go for a policy first – the science in front of everything. We develop a strategy plan, followed by an implementation plan and then fundraise,” said Bingawaho.

Rwanda began working with Pharmaceutical giant Merck as far back as 2009 to develop a partnership that led to the signing of a three year memorandum of understanding in December 2010 to provide the vaccine at no cost. A paper authored by Dr Bingawaho covered the rollout of the vaccines for over 90,000 schoolgirls in April 2011. The researcher report over 90% coverage for all three vaccine rounds.

The authors answered questions regarding the allocation of resources towards the campaign by making a rights-based argument for vaccinating against HPV. They write, “High-level leaders are committed to ensuring the long-term integration of a rights-based cervical cancer prevention, care and treatment programme into the basic package of health services.” Prices will continue to fall, argue the authors, as more countries follow the lead of Rwanda and implement HPV vaccination campaigns.

Merck announced in June of 2011 that it would provide the GAVI Alliance, a global organization dedicated to improving access to vaccines, its HPV vaccine at two-thirds its market price of $15. GAVI followed up in November by officially announcing its intention to support that introduction of HPV vaccines in developing countries with the goal of vaccinating as many as 2 million girls in nine countries by 2015.

“The HPV vaccine in particular is critical to women and girls in poorer countries because they usually do not have access to screening to detect cervical cancer and treatment available in richer nations,” said GAVI CEO Dr Seth Berkley in announcing the organization’s goals.

The Ministry of Health relies heavily upon community health workers to reach its citizens. Dr Bingawaho considers them to be the ‘echo’ of the ministry and an integral connection point to communities. There are three community health workers per village and they are selected by the village members. Doing so, explained Dr Bingawaho, engenders greater trust. That in turn leads to better health outcomes.

“When people are given the opportunity to have better health, they are very responsive,” she said.

Note: Large portions originally appeared in a story I wrote about cancer in Rwanda last year for A View From the Cave. Given the recent events, it seemed timely to revisit this reporting.


About Author

Tom Murphy

Tom Murphy is a New Hampshire-based reporter for Humanosphere. Before joining Humanosphere, Tom founded and edited the aid blog A View From the Cave. His work has appeared in Foreign Policy, the Huffington Post, the Guardian, GlobalPost and Christian Science Monitor. He tweets at @viewfromthecave. Contact him at tmurphy[at]