How to Improve HPV Vaccination: The View from Cameroon

Rural Doctors joins the Sabin-led Global HPV Consortium. Founder Sangwe Clovis Nchinjoh knows a lot can be done to improve HPV vaccine uptake.

Sangwe Clovis Nchinjoh, MD, MPH, MS, is the founder of Rural Doctors, a non-profit in Cameroon that builds and strengthens sustainable community disease prevention and response in poor rural settings. Cameroon added the Human Papilloma Virus (HPV) vaccine to its immunization schedule in 2020, and Rural Doctors is one of the first organizations to join Sabin’s Global HPV Consortium. As a public health physician and researcher, Dr. Nchinjoh gives his perspective on what works – and what’s needed – to turn HPV vaccines into vaccinations.

How do you build vaccine acceptance in the communities you work with?

We realized one thing: these communities, they know what vaccines are. They would have loved to have vaccines, but they have other issues that serve as a barrier. The most common is where there’s a lot of malaria cases and malnutrition. So that is their priority. Now, when you move into this community, and the first thing you are offering is vaccines, trust gets eroded. So to make this work, we start by setting up what we call a micro facility that offers a basic health package that constitutes what the community considers their priority. Then it becomes easier now for the population to gradually warm up and trust vaccination services.

How is the HPV vaccine different?

The error we make most times is that, because we know the vaccine is very effective, we assume people should just accept it. But for (non-professionals), it’s complicated. Explaining to a family that we’re going to vaccinate just your female child that’s nine years old is complicated because they think, OK, are they sterilizing my child? I think the most difficult part of the HPV vaccine rollout is that most institutions do not invest in the communication part. They are more interested in service delivery and they leave out the communication aspect.

So traditional vaccine campaigns don’t work?

The assumption is that the traditional approach to vaccinating children will just automatically work for HPV. No one really seeks to design an approach or uses tools like behavior and social drivers to see exactly where barriers are and then roll out gradually. If we can invest a little bit more on communication, and also community engagement. How do you get the pastor or the village chief or the imam or religious leaders to support it? If their voice is not properly captured at a national level, if the bishop says no to vaccination, it stays that way no matter what you do.

Does it help to link HPV with cervical cancer?

When it comes to HPV, there are a number of things that must come together. Just vaccinating girl children is a problem. The Minister of Health just announced male children will also be vaccinated, so that solves some of the barriers. The other aspect, which is very important, is being able to look at treatment, screening and treatment for cervical cancer. If I come to vaccinate your child and I’m also coming to screen you, you will be more comfortable with me vaccinating your child. The integrated approach works well. And then you set up a dialog structure that has a feedback loop, which means that if I said I have a problem with HPV vaccine how can I report this in a way that nobody knows that I the one reporting.

Is school-based vaccination a way to assure broader coverage?

This has to start from the top, with the Ministry of Basic Education collaborating with the Ministry of Health, agreeing that this is something that can be done in the school milieu and then moving right down, you know, to operational levels and establishing a clear pathway. We have to determine how we get consent. If we use those approaches and also take into consideration the fact that there are girls that don’t go to school, then we will improve HPV coverage.

How do we address the of out of school girls?

We need qualitative data, because we focus too much on the quantitative data. We need to know not just how many don’t go to school, but understanding what exactly are they doing at home?. First, what are the situations surrounding their being at home? For me that is the first step, and it will give important insights on how to get these children vaccinated. Some of these children belong to a group of girls mentored by elderly women, grandmothers and so on. There will hardly be one approach to solving this issue.

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