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Why 3.5 million schoolgirls missed crucial cancer jabs

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About 3.5 million schoolgirls who missed the free cervical cancer vaccine may get the crucial jab if the stalled project kicks-off next year.

“We are now ready to roll out the programme nationally from 2018 targeting about 3.5 million girls in and out of school in the first year,” Dr Collins Tabu, the head of the National Vaccines and Immunization Programme told the Standard Friday.

The 3.5 million schoolgirls aged between 10-14 were at risk of missing the vaccine thanks to uncertain funding, corruption and incompetence at the Ministry of Health. The HPV vaccine piloting was launched in Kitui County four years ago, covering 42,000 girls with the promise to be rolled out nationally.

National roll-out

“After the current piloting, the project will be evaluated before a national roll-out either in 2014 or 2015,” project coordinator Dr Agnes Nakato of the Ministry of Health said during the launch.

To date, and with almost 1.5 million girls gone past Class Four, the recommended age for vaccination, the initiative is still stuck at piloting. The Health and Education ministries have since proposed a further two years of piloting in the same county with national roll-out scheduled for 2018.

But insider information says the donor, Gavi Alliance, has said no to more piloting. The government says based on the Kitui findings the vaccine is too expensive and can’t pay and won’t pay for a national roll out. Had the national roll-out taken off as promised in 2014, about 1.5 million girls at the rate of 467,000 annually would be protected against cervical cancer today.

However, neither these girls, nor their parents know why they missed a lifetime opportunity at a time 4,802 cervical cancer cases are diagnosed in Kenya with 2,451 deaths annually. From the onset the Kitui County pilot was based on false data, largely explaining why the project is still struggling with infancy.

Initially, the Ministry of Health had applied for funding and planned to vaccinate about 8,500 eligible girls.

But when they went to the ground, explains Dr Nakato in a document to Gavi Alliance, the number of eligible girls turned to be 21,000, a difference of about 13,000.

This miscalculation presented serious challenges in implementation, including shortage of vaccines, says a report to the donor. It also required longer implementation time than previously envisaged.

The Government had to step in to meet the unexpected cost of the 13,000 additional girls.

In 2014, the ministries of Health and Education had evaluated the project. It was found to have successfully reached more than 86 per cent of the targeted girls but at an unsustainable cost.

The compounded cost of delivering the vaccine through schools to each girl was put at Sh4,600 ($44.77) but described as too much to sustain in a national programme.

“This was deemed as not sustainable,” the project team wrote to Gavi.

Hence the two ministries proposed further piloting, but girls would be directed to health facilities for vaccination this time around. This approach has been tried in Eldoret and its outcomes are well documented being lower cost but poor coverage. A hospital-based pilot was carried out between 2012 and 2013 at the Moi Referral and Teaching Hospital in Eldoret, which has greatly informed the Kitui pilot. “While acceptance among mothers was very high at 88 per cent, only 31 per cent had eventually vaccinated their daughters,” says lead investigator Heleen Vermandere of Ghent University.

Stolen funds

“That is the crux of the matter. Do Kenyans and their institutions regard HPV highly enough to invest accordingly?”

The answer, says a top official within the project but on strict anonymity, is negative especially at county governments. At Sh4,600 per girl it will require about Sh2.2 billion to cover the estimated 467,000 eligible girls annually across the country.

GAVI is demanding that the country refunds previously stolen funds and account for lost vaccines. An MoU between the Health ministry and GAVI published in May says the former will refund Sh160 million and explain the loss of 730,000 doses of vaccines.

The theft had subsequently prompted the rejection of the country’s Sh3.4 billion vaccines appeal, putting the lives of newborns at risk.

“Funding through government systems will not recommence until Gavi is satisfied financial systems are sufficiently robust,” says Iryna Mazur a senior communications manager with GAVI.

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