The jab that protects SA girls from cervical cancer
HEALTH Minister Aaron Motsoaledi remembers the moment he committed himself to trying to change the future of South African girls. A medical doctor working in the public health system, he was having to admit mothers, wives, sisters and daughters to hospital to die of cervical cancer.
He saw the debilitating effect their condition had on them, their families – and on doctors like him, and the nurses and medical students working around him.
“Maybe that’s why I had so much passion about it,” Motsoaledi says. “I don’t remember ever entering these wards where these women were, and not coming out feeling depressed. It’s terrible to say it, but some women were being eaten from below, alive, in agony.
“I still remember when I was a GP, a woman who was my neighbour whose kidneys had by then also closed down, and she felt all she needed was for me to be able to do something. Yet, I couldn’t do anything. She was terminal, looking at me, begging me. It was very, very sad. In that moment, I became determined.
“That’s what cervical cancer is. Even the wards where these patients go to die, smell of pain. You’re having to say to husbands, okay, your wife is going to pass on. You’re preparing him that this is terminal, and people are angry. They can’t accept. It’s very difficult. I and lots of other health-care workers have had to live through that.
“So this was an opportunity I was given to make a huge difference and I grabbed it with both hands.”
The minister, who has headed the Health Department since 2009, is talking about the roll out of the human papillomavirus (HPV) vaccine, which prevents cervical and other cancers affecting sexually active people. But he’s also talking about something much bigger – the prospect of a cervical cancer-free life for generations of women.
Professor Michael Herbst of the Cancer Association of South Africa (Cansa), who was involved in an advisory aspect on the roll out, says he believes the campaign could see results within 10 to 15 years, when the numbers of those affected will have dropped dramatically.
He says it is possible that the next generation of young women who have received the vaccine, will live without fear of this devastating diagnosis.
“When one looks at the high cost, not only of lives but also what it actually costs to treat a woman with cervical cancer, an incurable cancer, this campaign becomes very important. These children who get the vaccine, without having to pay for it, are being given a gift and I think it’s a real legacy for the minister.
“We believe that, in 15 years’ time, when these girls are about 24, we’ll start seeing the current figure of about 6 000-plus new patients with cervical cancer, dropping. We can start breaking the chain. I’m just sorry that I will not be alive to enjoy seeing that happen.”
Herbst – who at 70 is Cansa’s head of health and an activist – says he doesn’t believe the government will be able to deviate from the programme, even after Motsoaledi has left office.
“But we need as much awareness created as possible. We need people to understand and see the benefits.”
Last year’s HPV vaccine campaign, in which more than 400 000 Grade 4 girls around the country received the required two doses of Gardasil, was regarded as a significant success by the department and stakeholders like Cansa. There was apparently only one reported case of a shot given in error and the minister says he “deeply regrets” that.
“We believe a young girl slipped back into the queue to be given the vaccine, even though her parents had not signed the consent form. Remember, these are children. But we should have been more vigilant on that. We will not allow it to happen again.”
Parents are required to give their permission for the vaccine, which costs between R700 and R1 000 a dose in the private sector. Girls in private education are not covered by the department’s roll-out, which concentrates solely on public schools.
As the second campaign begins today, set to run until March 20, the minister is hopeful that about half a million girls, aged mostly 9 but up to 12, will be reached.
“It is incredible,” he says. “But we can pass policies, and if you haven’t got the people willing to get it done on the ground, you’ll have much more than hiccups. Last year, nurses had to leave their patients to help us change the lives of our girls. It was something that was out of this world.”
Portia Serote, women’s sector representative on the Treatment Action Campaign’s (TAC) national council, says they’re going to continue actively lobbying the minister to expand the programme.
“We are supportive of the HPV vaccination, and we even wrote letters to pharmaceutical companies about reducing the costs of the vaccine to make it more accessible. Otherwise, the minister was not going to be able to campaign for all the children. He was not going to make it.
“We support it because more and more women are dying of cervical cancer, and it is expensive to treat. So, we believe prevention is better than cure. If these children are provided with it, when they grow, the chance of them getting this cancer will be very little. However, we believe that, before the first roll-out, the minister said lots of things in a short space of time and it was confusing for people on the ground level.”
Serote worries that mythologies played out for many parents who were not properly educated. “Honestly, some parents even thought the vaccine wouldmake their children sexually active, because it was launched by the department at the same time as they launched the subdermal implant (a threeyear pregnancy-prevention device inserted below the skin of the arm). So lots of parents didn’t sign consent because they didn’t understand or see the importance.”
Serote says the TAC is also worried about the limitations of the age range, children who are left out of the campaign due to vulnerable socio-economic circumstances and the fact that boys are not being vaccinated.
The minister is open to further discussions but he’s clear on why only 9 to 12-yearold girls are part of the current campaign. “We have to get them immunised before they are sexually active. That was very important.”
The hope is that the government will be able to stretch its R400 million campaign to vaccinate both boys and girls
Serote insists, though, that boys must still receive education around HPV during this campaign. “When we speak about men, we know they try to distance themselves from these kinds of issues. They say it is all about women, but actually it is also all about them. They are the transporters.
“So, if we are fighting for a cancer-free country, the minister must do education, education, education – TV, radio, everywhere. It’s not about something you can get off a toilet seat, like some people believe. It is about all of us,” Serote says.
WE BELIEVE THAT, IN 15 YEARS’ TIME… WE’LL START SEEING THE CURRENT FIGURE OF ABOUT 6 000-PLUS NEW PATIENTS WITH CERVICAL CANCER, DROPPING