Mr. Speaker I felt it necessary to update this Honourable House on the Ministry of Health’s (MOH) initiative to prevent cervical cancer through the introduction of the Human Papillomavirus (HPV) Vaccine. It is however important Mr. Speaker, that we look at the global reality of cervical cancer which has propelled the need for an intervention such as this.
Globally, cervical cancer is the second most common type of cancer in women with over 85% occurring in developing countries. Every year 528,000 new cases are diagnosed and there are approximately 270,000 deaths. By 2050, without any intervention, cases diagnosed with cervical cancer will increase to one million per year with approximately 90% of the deaths will be in developing countries.
The Human Papillomavirus (HPV) is a group of approximately 200 viruses that infect epithelia (skin) tissue. At least 14 types of the HPV have been found to cause cancer of the cervix, penis, anus and oro-pharynx (throat). Types 16 and 18 are responsible for 70% of cancers of the cervix. The virus can be transmitted through skin-to-skin contact, from mother to child at birth and through contaminated surfaces.
The World Health Organization (WHO) recommends that HPV vaccines be included in national immunization programmes as a core strategy for primary prevention against cervical cancer. WHO states that HPV vaccination for girls ages 9 to 14 years is the most cost effective public health measure against cervical cancer. More than 70 countries around the world, including more than 20 countries in Latin America and the Caribbean, have already introduced the vaccine, and many studies have proven that HPV vaccination works extremely well, decreasing the number HPV infections and related pre-cancers.
CERVICAL CANCER IN JAMAICA
Mr. Speaker, cervical cancer is the second leading cause of cancer-related mortality in Jamaica and remains a significant public health concern. Current estimates indicate that every year 392 women are diagnosed with cervical cancer, 185 die from the disease with the majority of deaths occurring in women between 40 and 64 years of age. Mr. Speaker, it should also be noted that age-specific deaths in Jamaica exceeds the average rates in the Caribbean and the world.
HPV prevalence studies conducted here in 2010, revealed that: 1) the overall prevalence of any HPV infection was 54%, 2) the cancer causing HPV types were detected in 34.9% of the women and 3) HPV types 16 and 18 were found in 10.5% of the general population and in 71% of women with abnormal Pap smears. HPV types 16 and 18, are responsible for most HPV-caused cancers.
CANCER BURDEN ON PUBLIC HEALTH
Mr. Speaker, it is important to note that outside of the emotional and physical trauma that cancer causes to those affected, they are a burden financially to treat. Detecting cancer early also greatly reduces cancer’s financial impact, not only is the cost of treatment much less in cancer’s early stages, but people can also continue to work and support their families. In the United States the cost on diagnosis is US$15,868.00, if the patient survives for a year the rises to US$30,910.00. In Canada the cost is C$39,187.00 and 69,142.00 respectively. In Jamaica, the estimated cost is J$274.4M to treat the 392 cases annually. I should point out that this figure is only for radiotherapy and does not include diagnosis and chemotherapy.
Mr. Speaker I would like to highlight that the HPV vaccines are safe. More than 200 million doses have been given around the world with no major side effects due to the vaccine. The most common side effects of the vaccine include redness, swelling and tenderness to the injection sight. Other less common effects include fever, nausea and upset stomach.
The HPV vaccine was included in the national schedules of France (2007), the United Kingdom (2008) and the Netherlands (2009), Canada (2007-2009), Mexico (2012), Panama (2008), USA and Puerto Rico (2006), Bermuda (2008), St. Maarten and Trinidad and Tobago (2013), and Barbados (2015) to name a few.
The Global Advisory Committee on Vaccine Safety (GACVS) has carefully monitored the safety of the HPV vaccine and thoroughly investigated reported cases of adverse effects supposedly attributed to the HPV vaccine. The WHO Committee on Vaccine Safety has confirmed that none of the conditions investigated were due to the HPV vaccine and in December 2015 issued the following statement, “To Date, GACVS Has Not Found Any Safety Issue That Would Alter Its Recommendations for the Use of the Vaccine.”
INITIATIVE UNDERTAKEN BY JAMAICA
Mr. Speaker, the Ministry of Health has identified cervical cancer as a major public health problem in Jamaica as almost 50% of the women who are diagnosed each year will die from this preventable disease. The MOH has therefore introduced the bivalent HPV vaccine to provide 90-100% protection against HPV types 16 and 18 into the routine immunization programme. The bivalent HPV vaccine is being offered to girls in Grade 7 that is, girls ages 9 to 14 years of age, (the majority being 11-13 years old) free of cost. This vaccine is not mandatory.
The HPV vaccine is not new and has been available in the private sector for several years now and is therefore not a new vaccine to our population. The MOH has employed a school-based strategy for implementation to facilitate greater access to the population as parents will not have to miss work or students school in order to benefit.
Prior to immunization education sessions are held with the girls to be vaccinated. A brief medical history is conducted to ascertain the girls’ fitness and eligibility for vaccination. Information is then shared regarding the: 1) cervical cancer and 2) vaccine (side effects to be expected). As is customary, with all outreach and school vaccination programmes safety measures are in place to treat emergencies. Additionally, the surveillance mechanism monitors and investigates all events supposedly attributable to vaccination or immunization.
The target is approximately 22,500 girls, and each girl will need two (2) doses given (6) months apart for full protection. The focus is on cervical cancer protection and therefore boys are not being vaccinated at this time. It must however be noted that once Jamaica achieves >80% coverage with the HPV vaccine our boys will be protected by herd immunity (Herd Immunity (“Community Immunity”) When a critical portion of a community is immunized against a contagious disease, most members of the community are protected against that disease because there is little opportunity for spread of that disease. Vaccines can prevent outbreaks of disease and save lives).
ACTIONS TO DATE
Mr. Speaker, the Ministry of Health has executed several initiatives to ensure the HPV vaccine programme is rolled out in a safe and effective way. Some of the actions taken so far include:
1. Planning and Coordination
- A budget was crafted for approximately JA$100 million for year one (1) of the HPV vaccine introduction which includes: 1) social mobilization and communication, 2) cold chain equipment, 3) training and sensitization and 4) procurement of vaccines and vaccination supplies. The estimated annual cost after introduction is J$73.3M.
- A multi-sectoral oversight committee and a technical working group were convened in April 2017, to oversee the execution of the implementation plan.
- The parishes were engaged, they developed and submitted micro-plans for implementation activities.
- A total of 48,000 doses of bivalent vaccine were ordered for 2017, through the Pan American Health Organization’s (PAHO) EPI Revolving Fund at a cost of US$7.80 per dose. This will ensure that the girls receive the required two doses.
- Vaccine refrigerators are being procured to enhance parish cold chain storage capacity.
- Designs for Information, Education and Communication (IEC) materials(brochures, flyers, posters and stickers) have been completed and printed.
- Distribution is ongoing to schools, churches, community centres, special interest groups etc.
3. Capacity Building
- Training sessions for healthcare workers on the storage, administration, record keeping and risk communication as it relates to the HPV vaccine was completed in September 2017
- All regions have been trained with more than 300 participants in all. Training of school nurses has also been completed.
4. Public Awareness
- Various stakeholder sensitization sessions have been conducted. These include sessions with the:
- MOEYI ( May – September 2017)
- Public sector healthcare workers (January –February 2017; September 2017)
- Paediatric Association of Jamaica (September 2017)
- Private Sector Organization of Jamaica (September 2017)
- National Parenting Support Commission (May 2017)
- Jamaica Council of Churches (June 2017)
- Jamaica Umbrella Group of Churches (September)
- School nurses (July and September 2017)
- Guidance counsellors (September 2017)
- Health and Family Life Education coordinators (May 2017)
- “Dear Parent” letters and accompanying fact sheets were distributed to schools for inclusion in the Grade 7 school packages at the end of the last academic year to sensitize parents / guardians about the planned vaccine introduction.
- The local Health Departments led by the Parish Medical Officers of Health have been and will continue to dialogue with and provide schools with “Dear Parent” letters, HPV fact sheets and an “Opt out” form for girls to take home to their parents. These documents: 1) advise of the date immunization will be done (determined by the school body in collaboration with the Ministry’s team), 2) provide facts regarding the HPV vaccine and 3) offers the “Opt out” form that gives parents the opportunity to refuse the bivalent HPV vaccine. Girls who return the signed “Opt out” forms on the day of immunization will not be vaccinated.
- Six Focus Group discussions with parents and girls were conducted in Kingston, Montego Bay and Clarendon.
- Parent / Student Sensitization were done in Westmoreland, St. James, St Catherine and KSA (met with PTA groups), St Elizabeth, Manchester, Clarendon, Portland and St Ann.
- A Media Sensitization Forum was held 29 September 2017.
- Media Interviews are on-going with:
- Jamaica Information Service
- IRIE FM
- Nationwide 90 FM
- News Talk 93 FM
- RJR Group of Companies
- Print Placement of HPV information is ongoing.
- Radio and Television commercials will be placed.
We are aware that there are lingering concerns in the public and as such members can call the Ministry’s toll free line 1-888-ONE LOVE or 1-888-663-5683 to clarify those concerns. The public can also email us at email@example.com. You can also visit to find additional information on our website – www.moh.gov.jm and our social media channels.
We are ramping up our public education campaign and the media also has a role to play. Our experts from the Ministry have been on the airwaves explaining this vaccination campaign and will continue to facilitate any opportunity to enlighten the public. The MOH through the Regional Health Authorities and the local Health Departments will continue to engage the parents through the Parent Teachers’ Associations (PTAs) and the schools administration to ensure the dissemination of information, education and communication material.
Mr. Speaker, the Ministry is committed to reducing the incidence of cervical cancer in a safe and efficient way. The Ministry of Health will continue to provide credible information on the HPV vaccine by engaging all stakeholders; and conducting public awareness and sensitization sessions islandwide. Mr. Speaker, the Ministry of Health will update the country as we administer the HPV vaccine across the island. We know that this is a new vaccine so we have been monitoring very closely and putting several measures in place out of an abundance of caution in the interest of protecting our nation.