3.5 million girls in Kenya to get HPV vaccine in 2018

By Gatonye Gathura

The stalled free cervical cancer vaccine project for girls will kickoff next year targeting about 3.5 million 10 to 14 year-olds countrywide.
“We are now ready to roll out the programme nationally from 2018 targeting about 3.5 million girls in and out of school in the first year,” says Dr Collins Tabu, the head of the National Vaccines and Immunization Programme.

The free cervical cancer vaccine (HPV vaccine) programme was first piloted among 42,000 girls in Kitui four years ago with the promise it would be rolled out nationally soon after.

“After the current piloting, the project will be evaluated before a national rollout either in 2014 or 2015,” project coordinator Dr Agnes Nakato of the Ministry of Health had told the Standard during the launch.

To date, and with almost 1.5 million girls gone past Class Four, the recommended age for vaccination, the initiative is still stuck at piloting.
The ministries of health and education have since proposed a further two years of piloting in the same county with national rollout scheduled for 2018.

However insider information says the donor, GAVI Alliance has said no to more piloting. Documents show it is yet to approve Kenya’s proposal for extended piloting.

The ministries of health and education based on the Kitui findings the vaccine is too expensive; can’t pay and won’t pay for a national roll out.
If the national rollout had taken off as promised in 2014, millions of girls would have been reached by now.

Today however, neither these girls, nor their parents or even teachers know why they missed a lifetime opportunity at a time 4,802 cervical cancer cases are diagnosed in the country with 2,451 deaths annually.

From the onset the Kitui County pilot was based on false data, largely explaining why the project is still struggling with infancy.
Initially the Ministry of Health had applied for funding and planned to vaccinate about 8,500 eligible girls.

But when they went to the ground, explains Dr Nakato in a document to GAVI Alliance, the number of eligible girls turned to be 21,000, a difference of about 13,000.

“The 8,500 number had been reached at in Nairobi but when the team came out here it was established that eligible girls were actually 21, 000,” says Henry Muinde, the project point man in Kitui County.

This miscalculation, the project team says presented serious challenges in implementation. “This led to a number of challenges including shortage of vaccines,” says a report to the donor. It also required longer implementation time than previously envisaged.

The Government had to step in to meet the unexpected cost of the 13,000 additional girls.

In 2014 the ministries of health and education had evaluated the project. It was found to have successfully reached more than 86 per cent of the targeted girls but at an unsustainable cost.

The compounded cost of delivering the vaccine through schools to each girl was put at Sh 4,600 ($44.77) but described as too much to sustain in a national programme.

“This was deemed as not sustainable if rolled out as a national programme,” the project team wrote to GAVI.

Hence the two ministries proposed further piloting but this time instead of going for girls at schools the little ones would be directed to health facilities for vaccination.

This approach has been tried in various African countries and closer home in Eldoret and its outcomes are well documented being lower cost but poor coverage.

For example, a hospital based pilot was carried out between 2012 and 2013 at the Moi Referral and Teaching Hospital in Eldoret.

Published report of the study, which has greatly informed the Kitui pilot showed high acceptance among parents but very few eventually taking their daughters for vaccination.

“While acceptance among mothers was very high at 88 per cent, only 31 per cent had eventually vaccinated their daughters,” says lead investigator Heleen Vermandere of Ghent University, Belgium.

“That is the crux of the matter. Do Kenyans and their institutions regard HPV highly enough to invest accordingly.” The answer, says a top official within the project but on strict anonymity is negative especially at county governments.

County governments the official said, now responsible for funding immunization, are hardly interested in HPV vaccines.

At Sh 4,600 per girl it will require huge amounts of money to cover the targeted 3.5 million girls in the first year. “The government, GAVI Alliance and other partners have committed to finance the programme,” explained Dr Tabu.

An April 2016 GAVI funding update for Kenya shows the agency projects only a paltry Sh185 million toward HPV vaccine financing for the period 2018 to 2021.

But it is understandable why GAVI may be cautious in funding Kenya at a time it is demanding the country refund previously stolen funds and account for lost vaccines.

A memorandum of understanding between the Ministry of Health and GAVI Alliance published in May says the former will refund Sh160 million and explain the loss of 730,000 doses of vaccines.

The theft had subsequently prompted the rejection of the country’s Sh3.4 billion vaccines appeal, putting the lives of new-born babies at risk.
“The fact that we have to repay this money is a painful experience,” Cabinet Secretary for health Dr Cleaopa Mailu had told a Senate Health Committee in October. “I don’t have details of who was paid but we are looking at the matter.”
Apart from lose of funds the ministry was also accused of neglect and unsafe storage of sensitive vaccines.
“Funding through government systems will not recommence until Gavi is satisfied financial systems are sufficiently robust to ensure resources will be managed as required,” says Iryna Mazur a senior communications manager with GAVI.

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