High cost of HPV vaccines slows vaccination coverage in Ghana

Melody Akwetey, a mother of three, who lives in Ablekuma-Joma, a suburb in the Ga Central Municipality of the Greater Accra region, says her hunt for the Human Papillomavirus (HPV) vaccines in public clinics within her community was fruitless until a friend recommended a private health facility to her where she got inoculated at a high cost.

Last year, the World Health Organization (WHO) said, “Cervical cancer is the fourth most common cancer among women globally, with an estimated 604,000 new cases and 342,000 deaths in 2020. Despite evidence that HPV vaccines can reduce the incidence of cervical cancer by nearly 90 per cent, coverage of the HPV vaccination has declined to only 12 per cent”.

Cervical cancer in Ghana

According to the Catalan Institute of Oncology (ICO) and the International Agency for Research on Cancer (IARC) HPV Information Centre, Ghana has a population of 10.6 million women aged 15 years and older who are at risk of developing cervical cancer. The Centre indicates that current estimates show that every year 2,797 women are diagnosed with cervical cancer and 1,699 die from the disease.

And cervical cancer ranks as the second most frequent cancer among women in Ghana and the second most frequent cancer among women between 15 and 44 years of age.

Cost of HPV vaccines

Presently, the HPV vaccines are not part of the country’s nationwide childhood immunization programme. It is an individualized vaccination for women who prioritize their health and wellbeing. Elsewhere, the vaccination is free for teenagers, and this makes it mandatory for them to get vaccinated; nevertheless, in Ghana, it costs thousands of cedis to be fully vaccinated at designated private health centers. Even though, the numerous public hospitals run a “cash and carry” system for women who want the HPV vaccines, occasionally they are unavailable.

In an interview, an obstetrician-gynecologist at the Peaceland Clinic in the Ashanti Region of Ghana, Dr. Elizabeth Crenstil, bemoaned the neglect of HPV vaccination by policymakers.

“As a country, it is only the childhood immunization that we run. We haven’t started anything rigorous for cervical cancer vaccination, which is purely financial. Even in recent times, with the childhood vaccines, we were out of supply for some time. It all has to do with money and the nation’s priorities”.

“Because of the exchange rate, a single dose of HPV vaccine in some private hospitals costs between GH¢1,000 and GH¢1,200. For an individual to be fully vaccinated, she needs three doses of the vaccines available in Ghana, which cover four of the viruses at a cost of GH¢3,000 or more”.

Accessibility barriers

An entrepreneur in the capital city of Accra, Akpene Kofi, said, “The only time I hear of cervical cancer vaccination is during awareness month, a global healthcare event observed for the entire month of January each year to raise awareness. That is when you will hear the buzz on radio and TV”.

A not-for-profit organization established in 2011 by a group of clergy and social workers in the Ashanti Region, the Global Cervical Charity Foundation (GCCF) is dedicated to reducing the impact of cervical cancer in Ghana through the provision of effective and feasible public awareness interventions aimed at reducing cervical cancer incidence, suffering, and mortality.

Throughout their advocacy journey, the foundation observed that the inaccessibility and high cost of the HPV vaccines contribute to vaccine hesitancy among Ghanaian women.

“The main challenge is that HPV vaccine is not among the routine vaccines provided free by the Ghana Health Service and the Ministry of Health; individuals buy the vaccines themselves. To make matters worse, the government does not import them, so the prices are high. Despite the fact that we are educating the public, people are not keen to go for it because of the cost per dosage,” says Joana Nyame, the Executive Director of the Global Cervical Charity Foundation.

“Besides, the people you advise do not respond because they can’t afford the vaccines. If some donors could donate HPV vaccines, that would be very helpful. Also, public health education on cervical cancer is low, and as a foundation, we have intensified sensitization and education on predisposing factors, causative organisms, prevention, and screening,” she added.

Way forward

Dr. Elizabeth Crenstil wants a national policy that will drastically reduce the cost of HPV vaccines and bridge the accessibility barriers for young girls and women to be fully vaccinated against cervical cancer.

“They (Merck Sharp & Dohme LLC) have developed another vaccine that covers nine of the viruses, but we don’t have them in the country. But even if we are able to do nationwide vaccination of the inoculations we have, which cover four of the Human Papillomaviruses, that would have been good enough”.

As the WHO continues to encourage HPV vaccination, commercial institutions can consider it a Corporate Social Responsibility initiative to provide HPV vaccines for young girls, especially in rural areas, to reduce the risk of premature deaths and make Ghana a cervical cancer-free nation.

Moreover, the media, in partnership with the Ghana Health Service and the various foundations on cervical cancer, could be more deliberate about awareness campaigns and step up efforts on public education in schools, churches, and market hubs.

By Afia Agyapomaa Ofosu

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