Impact of HPV vaccination in Rwanda

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Published: 17 Nov 2017
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Dr Stephen Rulisa - University of Rwanda, Kigali, Rwanda

Dr Rulisa talks to ecancer at AORTIC 2017 about the introduction of the HPV vaccine in Rwanda.

He describes how, through multi-year school-based campaigns and community campaigns, a high rate of vaccination was achieved in Rwanda, the first country in Africa to introduce the human papillomavirus (HPV) vaccine.

Dr Rulisa describes how the campaigns strengthened the health system overall, as other health concerns could be addressed at the same time as vaccination with no long-term burden on the workload of care providers, and looks towards future data on HPV-related cancers being gathered over time.

I was talking about some of my research that I did which was about HPV vaccine in Rwanda, I was evaluating the impact of HPV introduction on the health system in general in Rwanda.

When was the vaccine introduced?

The vaccine was introduced, the HPV vaccine specifically, was introduced in 2011 and it has been going on, three doses every year until now.

How was the vaccine rolled out?

It was rolled out in schools rather than age-based because more than 90% of the girls in that specific age were in school. So it was the decision of the Ministries of Education and Health to base the vaccination in schools which would target the biggest group of that age group. It was rolled out in the schools but some few girls who were not in school at that time then were also targeted in the communities and were vaccinated. So it was done three times a year to make sure the catch-up was optimal.

Did you have any issues during this process?

There were no specific issues but of course we could not reach 100% of the girls. But we think so far, the data we have found in the literature, worldwide we had one of the highest numbers of girls that we could reach – over 93%, in some cases 96% of the girls that we wanted were vaccinated which we think was very impressive. That’s really what started to think what exactly happened and what was the impact on the health system because of the huge programme all over the country.

And what was the impact?

Surprisingly we found that the impacts were positive. The argument we had from other papers was that if you introduce a huge programme like that on an existing health system if the health system is not very strong and then you roll out another campaign it could break up the health system, or at least compromise other health that you’ve got in the system that you’re going on. What we found was the opposite, we found that it actually strengthened the health system. An example was that they grabbed the opportunity during delivery of the vaccine to give other services that we were not giving to the population. For example, they rolled out health campaigns, talked about other issues of reproductive health, they gave deworming tablets to the students in schools and they gave different information that they were not giving. So it was positive to the health system in general.

Do you have any recommendations for other countries?

The recommendation is what I put in my paper that we published, that they should not fear to introduce a new campaign, especially when it is favourable to the country. The other one is that they should take the opportunity to target a specific group to give other information alongside that one. What we found is that we also asked detailed questions about on the days when they delivered this vaccine did they continue giving the routine services in the health facilities which [?? 3:16] planning. Over 70% of the health facilities which were, for example, giving antenatal services on that day, they continued doing it and in parallel did that. So I think other countries could roll out any campaign and it will strengthen the health system. As long as you roll out the package in the existing systems it can only make it stronger.

Will you revisit this with long term research?

That’s what we are planning to do, especially the specific area on the scientific part. We are curious to know now the HPV prevalence in the community, specifically around these girls that we are vaccinating, the long-term impact. We vaccinated young girls who we assume are not yet sexually active and therefore not yet infected with HPV. So what we are curious to do is to see in the future what happens, if there’s a difference.