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Cancer shot misfires - Dengue, flu cripple HPV vaccination drive; thousands of girls fall through cracks

Published:Sunday | April 21, 2019 | 12:29 AMErica Virtue - Senior Gleaner Writer

The dengue fever and influenza outbreaks have delivered a blow to the Government’s programme administering the human papillomavirus (HPV) vaccine to grade seven girls across Jamaica, resulting in only 400 students of the entire current national cohort being inoculated between February and April 13 this year.

With the summer term of the school year to open on April 29, the ministry will be in a race against time to secure more than 8,000 secondary vaccinations to match numbers for the first dose administered in the Christmas term, especially with the hectic end-of-year examination period looming.

As dengue, the mosquito-borne virus, emerged in late 2018 and peaked this year in mid-February before tapering off in March, and flu rates spiked, state resources were redistributed to mitigate the double dilemma, the Ministry of Health has revealed to The Sunday Gleaner.

The HPV vaccination initiative targets primarily girls in grade seven and more broadly those aged nine to 14. It is key to reducing their vulnerability to diagnoses, in young women, of cervical cancer, one of the most preventable forms of cancer in the world.

The first dose of the vaccine is given in the first term of the academic year, and the second about six months later.

“There was a marked decrease in the administration of the HPV vaccine during the January-March quarter of 2019. The majority of the staff were redeployed to address the dengue outbreak and rise in influenza cases,” Melody Ennis, director of the family health unit in the Ministry of Health, told The Sunday Gleaner on Friday.

But beyond the marginal take-up for the second dose this calendar year, the Ministry of Health is bucking apparent resistance or indifference that has led to just under two-thirds of grade seven girls not being vaccinated.

Data provided by the Ministry of Health reveal that of the 20,647 girls eligible in the current grade seven cohort, 8,515, or 41 per cent, received the first dose in the last quarter of 2018. Dosages were administered at 302 schools.

The 8,515 cohort take-up represents a 10.5 per cent rise on the 2017 first-dose subscription of 7,708 in the inaugural cohort.

The 400 girls vaccinated between February and April 13, 2019 were culled from 10 schools.

But also of concern for the ministry must be the noticeable fall-off in girls who received the second dosage of the vaccination around six months after the first. Only 5,257 girls followed up with a second shot among the 2017-18 cohort, almost a third fewer than those who took the first dosage.

Medical officials say two doses are necessary for the vaccination to be fully effective.

Almost 500 women are estimated to be diagnosed with cervical cancer in Jamaica annually, and more than 350 die from the disease every year. It is the second most prevalent cancer among women in Jamaica and particularly among women aged 15-44.

Ennis said that the ministry was working hard to get full buy-in from education officials and parents, emphasising that more dialogue was needed to convince doubting Thomases and anti-vaxxers.

“I don’t think there has been much resistance from schools. Parents are still sceptical, but we continue to provide credible information,” Ennis told The Sunday Gleaner.

“Public awareness is key. There’s always room for improvement. We continue to reach persons via the media and in one-on-one discussions,” she added.

But The Sunday Gleaner understands that while schools were asked to facilitate meetings with health ministry officials to sensitise parents on the matter, some declined to be party to the collaboration, while others claimed ignorance of the interministry agreement.

However, an October 2017 bulletin from the Ministry of Education and then Minister Ruel Reid, to schools, said: “The health ministry will work with the MOE and other stakeholders to ensure that all stakeholders, including school administrators and parents, have adequate information about the programme.”

Health Minister Dr Christopher Tufton said that his ministry has been dispatching letters to the parents through schools, and that there have been discussions with administrators and education officers to ensure coordination of strategy.

“I think we have improved communicating to key groups and coordinating with schools and parents. We will continue to get the message out, as it’s important for the future health and wellness of our young girls. We have adverts on television, plus greater dialogue at the level of schools,” he said.

But key partners in the leadership of the teaching hierarchy claimed to have little knowledge of the strategy.

Jamaica Teachers’ Association (JTA) President Garth Anderson said his knowledge was confined to what is in the public domain. And his putative successor, Owen Speid, JTA president-elect and principal of Rousseau Primary School, told The Sunday Gleaner that he had no information on the matter.

A January 2019 update from the core curriculum unit/health and family life education (MoE), week ending January 18, 2019, said its role was to “provide support to the MoH to increase awareness in schools of the HPV vaccine”.

Jamaica is seeking, over time, to replicate the success seen in countries that have introduced wide-scale vaccination for young girls, including Australia, the poster nation for a precipitous decline in cervical cancer.

Since implementing three-dose HPV vaccination in 2007 for girls, and later boys, Australia has recorded a 77 per cent decline in cervical cancer diagnoses. Respected medical journal Lancet published in October 2018 that Australia is on track to slashing the incidence to four per 100,000 by 2028 and virtually eliminating the disease totally in two decades.

That’s the message Ennis and other health ministry officials are trying to drive home, including at a mini immunisation fair it will host in Spanish Town on April 27, at which the HPV vaccine will also be available.

She urges parents and school administrators not to interpret their campaign as a backhanded attempt to legitimise teen sex.

“It’s not. It’s preventative. It is the steps we are taking to prevent this horrible disease of cancer. It’s difficult for families, persons involved, and the State,” Ennis said.