The US can learn from Rwanda on stamping out cervical cancer
A recent study in the journal “Lancet” made a big splash when its authors concluded that cervical cancer could be eliminated worldwide “if sufficient population-level vaccination coverage can be reached.” Rwanda is certainly doing its part. The tiny African country decided a decade ago to prioritize the reduction of cervical cancer, and in 2013 it started offering 11 and 12-year-old girls immunization against the human papillomavirus (HPV), the cause of most cervical cancers. The country now has a 93 percent vaccination rate among young girls. The U.S. needs to be more like Rwanda.
The Lancet study analyzed data on the use of the HPV vaccine in 14 high-income countries. It found that after five to eight years of vaccination, the prevalence of infection with the two most common strains of the cancer-causing viruses decreased by 83 percent among girls 13 to 19 years old and by 66 percent in women 20 to 24 years old.
After five to nine years of vaccination, rates of pre-cancerous uterine lesions dropped by more than 50 percent in screened girls aged 15 to 19 and by 31 percent of women 20 to 24.
These findings suggest that the world’s first eradication of a cancer is within reach — but only if the world follows Rwanda’s lead and actually uses the HPV vaccine.
How did one of the poorest countries in the world achieve what those high-income countries in the Lancet study, particularly the United States, have not? How did such high vaccination coverage happen in a country that suffered a genocide campaign that led to the slaughter of 800,000 of its citizens just 25 years ago?
In a country in which sex — and therefore diseases that are transmitted through it and can cause cancers of the vagina, vulva, penis, anus, and throat — is not openly discussed? In a country in which some suspect that vaccines targeting sexually transmitted diseases are really meant to render girls infertile?
The HPV program began when Rwanda entered an agreement with Merck through which the company provided the vaccine at no cost for three years. That may have helped solve the cost problem, but the government had many other cultural and ethical issues surmount. Considerable community support made the 93 percent vaccination rate possible: Teachers discussed HPV immunization in their classes.
Church leaders told their flocks of the importance of the vaccine. HPV awareness campaigns hit billboards. The country’s tens of thousands of community health workers emphasized that the vaccine prevented cancer, explaining to parents the horrors of cervical cancer along the way. Sterilization plots got debunked. As a Ministry of Health manager said in a recent interview about Rwanda’s HPV immunization program, the “community knows that we do not bring things that are not good for them.”
The U.S. is not even in Rwanda’s league when it comes to stamping out cervical cancer. Eighty million Americans, most of them in their late teens and early 20s, are currently infected with some type of HPV virus. More than 13,000 cases of invasive cervical cancer will be diagnosed this year, and 4,000 women will die from the disease. Yet, just 49 percent of all adolescents 13 to 17 years old have received the full recommended series of HPV shots.
Why can’t we be like Rwanda? We can, if we take that country’s lessons about countering vaccine hesitancy and denial to heart.
Many Americans believe the myth that HPV vaccination increases sexual promiscuity. Our social media is awash in bogus claims about the dangers of getting the HPV vaccine. All of this plays out against a backdrop of deep distrust in both government and Big Pharma, suspicion of which is often cited by anti-HPV vaccination groups.
Fortunately, there are signs that there may be hope for us yet. In May, the Vaccine Awareness Campaign to Champion Immunization Nationally and Enhance Safety (VACCINES) Act of 2019 was introduced in the House and currently has 18 bipartisan cosponsors.
The legislation would authorize funding for the CDC to research vaccine hesitancy and increase public awareness of the benefits of immunization. States are ramping up efforts too: Rhode Island, Virginia, and the District of Columbia require HPV vaccination for secondary school attendance, and a handful of states have passed laws allowing minors to self-consent to HPV immunization even if their parents object.
Our approach to cervical cancer is Pap smear screening and costly, painful surgery. Prevention is much better. Countries such as Australia and Scotland now have plans in place to achieve Rwanda-like HPV vaccine uptake.
The U.S. should join them by requiring every state to have an HPV vaccination mandate for junior high school attendance — for both boys and girls. Congress should pass the VACCINES Act and the president should sign it, thereby empowering the CDC to vigorously counter the persistent misinformation about promiscuity and safety that gives the HPV virus the opportunity to kill younger Americans. With measures like these, we can be like Rwanda.
Lisa Kearns is a senior research associate at and Arthur Caplan is the founding head of the NYU School of Medicine Division of Medical Ethics. Kathleen Bachynski is an assistant professor of public health at Muhlenberg College.