Creating New Opportunities for HPV Vaccination in Cameroon

The year after the COVID-19 pandemic, Cameroon introduced the human papillomavirus (HPV) vaccine into the country’s immunization program, and Dr. Jeanne Mbengue was hopeful. As District Medical Officer in the Nylon Health District of Cameroon and as an epidemiologist as well as physician, Mbengue knew the data well: cervical cancer is the second-most common cancer for women in the country, and the leading cause of cancer-related death among women. Highly effective at preventing cervical cancer, the HPV vaccine had the potential to be a game-changer in her district of almost 500,000 people. 

“Where I’m working there were, unfortunately, women who got sick and some died from cervical cancer,” she says. “We always say prevention is better than a cure.”  

But a few years later in 2023, and even after adding boys to those eligible for HPV vaccines, “the coverage remained really low in the district where I am working.” When the pandemic hit, “it got a lot worse.” 

When Mbengue heard about the COVID-19 Recovery for Routine Immunization Programs Fellowship offered by Sabin and the World Health Organization last year, she developed a recovery plan for HPV vaccination. Her goal: vaccinating 1,000 adolescents against HPV. Along the way, she hoped to retrain healthcare staff on identifying missed vaccination opportunities and data collection, hold advocacy meetings, conduct educational talks in schools and let people know that the advantages of vaccination extend throughout life, not just early childhood. 

Based on the strength of her proposal, she was selected for the second phase of the Fellowship program, which involved mentorship and a microgrant. She more than doubled her original goal of 1,000 vaccinations: in just a few months, more than 2,600 adolescents were vaccinated.  

“We had almost 27 times more vaccinations than the year before,” she notes happily. “We used the opportunity to catch up the children who missed the vaccination. We targeted anyone from 9 to 13 years old in order to immunize children that were not vaccinated for HPV before.”  

In Cameroon today, HPV vaccination is gender-neutral, meaning it includes boys as well as girls. The goal is to protect males from HPV-associated cancers such as penile, head and neck, and throat cancer, as well as to support efforts to eliminate HPV spread to women. 

Still, the catch-up campaign wasn’t easy. Despite extensive education about the importance of immunization during the pandemic (in support of the COVID-19 vaccine), “Most people still think immunization is only for little children,” she says. “And most of the time, adolescents do not usually come to the hospital unless they are sick.” 

As a result, “At times people do not have the right information. So, we have to tell them again that children can be protected against avoidable diseases. We explained that these cancers are caused by the human papilloma virus and let them know that there is a way to be protected from those diseases.” 

When they understood the situation, she says, “then they were engaged and allowed us to immunize their children.” 

Mbengue also used community health workers already well-known to the constituents to communicate the messages. “Because they are familiar, people feel close to them, and it is easier to render the vaccination. We did not bring in public health personnel. We trained the community health workers to facilitate the discussions with leaders and parents.” 

A critical element, says Mbengue, was to meet directly with parents, which meant setting the stage with key stakeholders in the 16 targeted schools and eight communities where the vaccines would be given. Seeking authorization from education officials and community leaders took some time. “When they were convinced, they even mobilized the communities themselves, their neighbors, and their friends. It was a very good opportunity for us. But we had to get the proper authorizations.” 

Another part of the catch-up campaign included training health personnel to identify what Mbengue calls “MVOs” — missed vaccination opportunities for HPV. MVOs are any contact with health services by an eligible adolescent for vaccination where no vaccination was performed. The data showed only 21 (0.8%) adolescents who came for other reasons were vaccinated. Since MVO identification is not a routine intervention, Mbengue and her team developed data-collection tools and established a data-transmission circuit, which includes reviewing daily and overall summaries to identify potential immunization prospects. “In priority healthcare facilities, we actively sought MVOs for HPV with the help of trained staff.” 

Mbengue hopes the training in MVO identification continues to support higher coverage with the HPV vaccine. “We can seize the opportunity every time that they come for health care to ask them to take the vaccines. We need to look for missed opportunities in the health facilities in all interactions.” 

Challenges going forward, she says, include maintaining momentum for vaccination, continuing to educate parents, and seizing every opportunity to vaccinate for HPV.  

“We should not leave children unvaccinated. We should continue looking for other children to have better and better coverage. This will help us in so many ways. We want everyone to understand the benefits of vaccination throughout life.”