Vaccine hesitancy and disease prevention – It’s not just coronavirus which stands to lose

In this post Rose Brade, International Policy Advisor at Cancer Research UK provides her personal experiences with vaccine hesitancy and the implications for cervical cancer prevention.

“No, you’re not allowed [to get the vaccine] and that’s the end of it.”

That was the decision my mum made when I was offered the HPV (human papillomavirus) vaccine aged 12.

But that wasn’t the end of it. This, in fact, marked the start of my journey into international health policy, and what I have come to recognise as the point at which many girls around the world may experience one of many barriers to HPV vaccine access─ the instrumental bullet in preventing cervical cancer. My story happens to be a classic case of vaccine hesitancy─ the reluctance or refusal to allow a minor to be vaccinated, despite the availability of vaccination services. Cervical cancer and coronavirus are both caused by infectious agents and (at least for cervical cancer) preventable by vaccination, yet there is so much uncertainty regarding uptake of protective vaccines – and COVID-19 does not appear to have quelled this trend. As we initiate our efforts to achieve cervical cancer elimination during a global pandemic, how can public health experts leverage this moment to change the vaccine narrative and close the gap of marginalised communities being left behind? I’ve set about trying to answer this in my 2-part blog series.

The World Health Organization’s (WHO’s) strategy to eliminate cervical cancer as a public health problem, formally agreed by countries around the world this week (20/07/2020), marks the first time in history where the global community has pledged to eliminate a cancer type. The significance of a vaccine in making this possible cannot be understated. The strategy is ambitious, with clear 90:70:90 % targets to be met by 2030 across three strands: driving uptake of the HPV vaccine, increasing ‘screen and treat’ coverage, and ensuring timely treatment for invasive cervical cancer. However, this will only be possible if the majority of girls actually get the vaccine and eligible women attend screenings.

Fighting health inequalities

As a black British female, in many ways, my mum’s decision was not surprising. It reflects some typical beliefs often held in the black community. In 2008 I was part of the first cohort of girls to be offered the HPV vaccine, but my mum objected on the grounds that it was ‘somehow a trial’ and ‘her child should not be a guinea pig’ (this, of course, was not the case; HPV vaccine had been approved as safe and effective). Or perhaps more controversially, it’s ‘not something her daughter would need as she wouldn’t be having sex before marriage’ (HPV is spread through sexual contact & classed as an STI).

I’m now 23 and working full time as a female advocate at Cancer Research UK to raise awareness of the opportunity to eliminate cervical cancer across the globe. What I’ve discovered is that I am not an anomaly when it comes to vaccine hesitancy. Globally, the story of cervical cancer is one of ‘gross inequity’  and a painful reminder of challenges in women’s health and diseases which disproportionately affect women of colour and those living in low-and middle-income countries (LMICs). Over 300,000 women a year die from cervical cancer and over 90% of these deaths are in LMICs. Only 15% of women globally have been fully vaccinated. There are many complex reasons, but to put it into perspective ─ according to the WHO─ vaccine hesitancy is one of the top ten threats to global health.

A world view is necessary

Speaking about my experiences with Benda Kithaka, health advocate and co-founder of Women4Cancer, a Kenyan NGO advocating for cervical cancer elimination, I really wanted to understand how vaccine hesitancy looks in Kenya, and what needs to be done to clear the path for all girls to get the HPV vaccine. The HPV vaccine was introduced in Kenya in October 2019, 11 years after introduction in the UK.

Benda said, “It is the most natural thing for mothers to want to protect their children against diseases as well as any perceived threats, no matter what it takes.

“There is a need to make the WHO strategy understood at the grassroots level. Anyone who has sway in influencing the health-seeking behaviour among our women and girls must be equipped with factual information to guarantee that they embrace the interventions, and possibly act as agents of behaviour change. As advocates and public health specialists, it’s our role to make sure messaging is culturally sensitive and relevant, countering concerns as they arise.”

Reflecting on Benda’s insights, it struck me that in a country like the UK where we’re significantly further established in our vaccine programme and successfully hitting the herd immunity target (the minimum number of people to be vaccinated to confer indirect population protection), some may interpret this as ‘job done’. It can often feel like our national conversation on inequalities is muted. The reality is that depending on the behavioural patterns and interactions of women of colour and other marginalised groups, they could end up with little or no protection. We’ll improve outcomes in the UK for everyone if we start working with organisations like Benda’s to better understand the barriers and enablers which could disrupt the trends of non-attendance and non-consenting. Elimination won’t be possible without this mindset shift.

Will coronavirus mark a change?

The irony ─ that I myself have not received the HPV vaccine due to the barriers I’m fighting against ─ is not lost on me. It makes me all too aware that the current increased discourse on vaccines is a challenge as much as it is an opportunity. Against a context of declining vaccine coverage rates in the UK in recent years and worrying levels of mistrust in the safety of vaccines globally, anti-vaxxers have a platform like never before to catalyse the downwards spiral. Anti-vaxxers aren’t always the outspoken personalities you see in the press but can manifest from innocent misinformation and hesitancies. Public health specialists must work with social media platform regulators and communities as we begin on the path to cervical cancer elimination. Clarifying the inevitable debates on both the risks and benefits of vaccines will be key to making sure we address our own and other’s hesitancies. Any decision we make as individuals should be well informed.

Vaccines save lives─ the world is waiting for one after all.

Read more about the challenges of accessing HPV vaccination during COVID19 here.

In my next post I will discuss the work being done at Cancer Research UK and Women4Cancer to respond to the WHO strategy to eliminate cervical cancer.

The views expressed are those of the author. Posting of the blog does not signify that the Cancer Prevention Group endorse those views or opinions.

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