Zainab Shinkafi Bagudu
In August 2020, for the first time ever, the world resolved to eliminate a cancer: by passing a resolution in the World Health Assembly, 194 countries took a stand against cervical cancer and committed to eliminating it. For Nigeria and other countries in the developing world where the burden of the disease lies, the notion, while an extremely welcome one, is a tall order considering the state of healthcare delivery in these countries and the production rate of vaccines.
Nigeria has one of the highest numbers of cervical cancer worldwide. In 2008, there was an estimated 14,943 new cases and an estimated 10,403 deaths from cervical cancer in Nigeria (Source: GLOBOCAN 2018). Research shows that poor awareness with an underlying weak healthcare system that lacks a screening policy and accurate diagnostic tools are the major contributors that account for the high morbidity and mortality associated with the disease.
As First Ladies of states in Nigeria, working on cancer issues through our individual non-governmental organisations across the six geopolitical parts of the country, we are confronted daily by cancer patients with limited treatment options. The main roles of our coalition, First Ladies Against Cancer (FLAC), is advocacy to increase awareness, access to cancer care, influencing policy changes in Nigeria with the collective aim of reducing the cancer burden in the country. As such, we saw the rationale behind the call by WHO to eliminate cervical cancer and align with it.
For countries to be on the path towards cervical cancer elimination, the new global strategy calls for achieving the following targets by 2030: 90% of girls fully vaccinated with the HPV vaccine by 15 years of age; 70% of women screened twice in their lifetime, using a high-performance test; 90% of women identified with cervical disease receive treatment (90% of women with precancer treated, and 90% of women with invasive cancer managed).
This science of the strategy, while clear and simple enough, presents a number of challenges for us in Nigeria. HPV vaccine is a vital tool in the elimination of cervical cancer as it stops the cancer from developing. By giving the HPV vaccine to all young girls before they reach 15 years of age, it means, in the next 20 to 30 years, there will be no cases of cervical cancer. In order to achieve this, Nigeria needs to incorporate HPV vaccination into the National Immunisation Programme, one of the key advocacies that FLAC has been pushing for. Nigeria has finally committed to the introduction of HPV vaccine into the immunisation programme by the first quarter of 2021 but millions of doses are needed and there is doubt availability will meet global demand. Ironically, high income countries, despite having lower incidence of cervical cancer, have more access to these vaccines, while countries like Nigeria struggle to get the required numbers. Albeit a show of financial strength, there is a lack of prioritization based on disease prevalence by vaccine manufacturers. Thus, the pharmaceutical industry must contribute to efforts towards elimination efforts by not only bringing down the cost, but by considering disease prevalence when selling. Big pharma must join the global effort to eliminate cervical cancer by producing and supplying the required number of doses within a rapid timeline and offer it to low- and middle-income countries at a fair price. This was done with HIV drugs and the race to obtaining a vaccine for COVID-19 is evidence that, with the right commitment, equitable and increased vaccine access can be achieved.
Secondly, to achieve elimination, precancer screening and treatment must also be available and accessible. The WHO strategy calls for using a high-performance test and although women in the developed world have access to these tests, women in Africa are often left to be tested with lower quality methods. In Nigeria, it is common to screen for cancer by applying household vinegar on the woman’s cervix. When done properly by the healthcare worker, this method can help, and FLAC regularly conducts screening exercises using these methods. However, high quality tests known as “HPV tests,” are more reliable. They are important for improving the ability to detect the disease early; but access to these HPV tests remains poor.
The third aspect of the strategy is treatment for cervical cancer. This is probably the biggest challenge we have in Nigeria. With a population of approximately 200 million people, Nigeria needs over 100 more cancer treatment centres to adequately provide quality cancer treatment in the country. In addition to this, the cost of cancer treatment is beyond the reach of the average Nigerian, 70% of whom pay for healthcare out of pocket. We have found that cancer causes catastrophic spending that places severe strain on our patients and their families. Although we have successfully advocated inclusion of most of the continuum of cancer care in our National Health Insurance Scheme (NHIS), majority of our female population still lack health insurance. We are certain that, by fully implementing the universal health coverage, cancer control can be improved.
As a group, we recognize that partnerships work and it is important that agencies multinationals and NGOs working on eradication of cervical cancer enter into viable and sustainable partnerships to ensure the success of all efforts at all levels. Practical strategies include technical assistance, capacity building and sharing of best practices and innovations. At FLAC, we are committed to using our voices and platform to continue our advocacy for sustainable results and we call on the world to join us to win this fight.
Committing to the elimination of cervical cancer will ensure women no longer suffer and die from a preventable and curable disease. It is a choice to restore women’s dignity, to de-stigmatize women’s healthcare, and to confront the injustices reflected in the unequal burden of disease that affects women in the developing world. This may be a long journey, but the time to act is now. By doing so, we can leave behind a great legacy for the next generation, so that they can live in a world free of the unnecessary pain caused by this cancer.
With the world’s recent adoption of the resolution to eliminate cervical cancer, Nigeria faces a choice. If we act now, the country could be among those to finally eliminate an avoidable cancer.
•Dr. Bagudu is First Lady of Kebbi State