Tanzania’s 5-million-girls HPV vaccination campaign a “success”

This April, Lisa Peter, an 11-year-old student at Kambange Primary School in Dar Es Salaam, was sprawled on the living room couch after school, scrolling through television channels, when an advert by the Ministry of Health on national television grabbed her attention.

It showed a family doting on a young girl, getting her ready for school. But overlaid on the familiar scene was a message about a huge vaccination campaign against cervical cancer – a disease that kills over 7,000 women each year in Tanzania. The advert cut to smiling girls playing at school. Lisa felt jolted, recognising herself in the advert’s message.

“The teacher told me – this little pinch means a huge difference! Now I’m protected against cervical cancer.”

– Lisa Peter, age 11, student at Kambange Primary School in Dar Es Salaam

“I told my mother I also wanted protection from cancer,” Lisa says.

Lisa is one of the 5 million Tanzanian girls aged 9-14 years who were targeted in a recent vaccination campaign against the human papillomavirus (HPV), the virus that causes the vast majority of cervical cancers, widely known in Tanzania as ‘saratani ya shingo ya kizazi’.

Kicking off in the third week of April as countries around the world observed World Immunization Week, the campaign was notable not just for its scale, but for its approach. Fuelled by research from Tanzania’s own scientists, who had been investigating the effectiveness of a single-dose HPV vaccine, the campaign inaugurated a shift from the two-dose regimen used previously.

For the country’s health services, that meant lowered logistical barriers, financial savings, the loosening of supply constraints. For kids like Lisa, it meant lifelong protection would come at the cost of just a single poke.

Unlike parents swayed by vaccine rumours that can hold back the vaccination efforts, Lisa got instant reassurance from her mother who – like many parents in her area – had been sensitised by a community health worker (CHW) in the city’s Kinondoni Municipality about the vaccine’s safety and health benefits.

Soon, at school, it was Lisa’s turn to get immunised. “It hurt my shoulder a bit,” Lisa told VaccinesWork shortly afterwards. “The teacher told me – this little pinch means a huge difference! Now I’m protected against cervical cancer,” she said.

Marygoreth Temba, Lisa’s schoolteacher and the person responsible for health at Kambange Primary School, says she collaborated with health workers deployed by the Ministry of Health at schools, and helped in dispelling fears and breaking down myths surrounding vaccines.

“As an educator, I made sure pupils got accurate messages. This seems to have trickled down to parents as well. I’ve seen many parents change their attitudes and accept the vaccines.”

– Marygoreth Temba, schoolteacher

“As an educator, I made sure pupils got accurate messages. This seems to have trickled down to parents as well. I’ve seen many parents change their attitudes and accept the vaccines,” said Temba, echoing the voices of those who were on the frontline across Tanzania, advocating and providing vaccination during the campaign from 22 to 26 April, with support from Gavi, the Vaccine Alliance, UNICEF, and the World Health Organization (WHO).

While many countries have implemented HPV vaccination programmes over the past decade, Tanzania’s approach has been unique. Launched in 2019, the vaccine was immediately offered as part of the routine immunisation schedule for 14-year-olds . At that time, Tanzania had the fourth highest incidence of cervical cancer globally, with 59 cases per 100,000 women, underscoring the urgency of the vaccine’s roll-out. The incidence is higher in countries like Tanzania due to high HIV/AIDS rates, which places women at a higher risk of getting cervical cancer.

With the increase of global supply, the vaccine can now be offered to a larger target group, spanning the ages nine to 14, in a nationwide campaign.

“Vaccinating young girls before they are exposed to HPV is crucial,” says Dr Norman Jonas, a tutor in Internal Medicine at the Kilimanjaro Christian Medical College (KCM College). Jonas has participated in public awareness campaigns about HPV vaccines as part of the health promotion support team appointed by the Ministry of Health. He says, “The earlier we protect them, the lower their risk of developing cervical cancer later in life.” This is particularly vital in contexts like Tanzania’s, where cervical cancer screening services are still limited in availability.

Routine vaccination was disrupted by the COVID-19 pandemic. Schools – the main site for HPV vaccination – closed, and opportunities to protect girls were missed.

April’s multi-age cohort (MAC) campaign – which comes five years after the vaccine’s launch in Tanzania – allowed the country’s immunisation system an opportunity to reach all girls aged 9–14 years, an age-range calculated to optimise the vaccine’s impact with a single dose of the cancer-blocking vaccine

Clinical trials on the effectiveness of a single dose had been ongoing in the country, spearheaded by the National Institute for Medical Research (NIMR).

John Changalucha, is a Senior Research Scientist at NIMR who is part of the clinical trials whose findings were presented to WHO and the Ministry of Health, leading to a switch to single-dose vaccine. He says the shift to a single dose was further spurred by past experience with “logistical challenges, and the higher costs associated with offering multiple doses” .

97% reached in just one week

“The campaign response was positive and successful,” said Dr Florian Tinuga, Program Manager of the Immunization and Vaccination (IVD) Program of the Ministry of Health.

“Vaccinating young girls before they are exposed to HPV is crucial. The earlier we protect them, the lower their risk of developing cervical cancer later in life.”

– Dr Norman Jonas, Kilimanjaro Christian Medical College

According to field activity reports from the Ministry of Health, the campaign reached an impressive 97% of the targeted 5 million girls by the end of the week of the campaign in April. Over 87% were from schools, with the remaining girls reached through non-school vaccination centres.

CHWs like Chuma Bakari played a critical role in dispelling myths and encouraging participation in the HPV vaccination campaign. Bakari, who works in Tanzania’s Kinondoni Municipality in Dar es Salaam, explains one of the challenges he encountered: “Some parents expressed concern about the age at which the vaccine was being administered.”

To address these concerns, Bakari intensified his community outreach efforts. “As part of my routine health education activities, I focused specifically on cervical cancer and the HPV vaccine during the campaign,” he says. “I went from door to door to provide accurate information, and I’m happy to say I’ve witnessed a positive shift in attitudes. In fact, some parents even brought their younger daughters, who weren’t yet eligible, hoping to get them vaccinated.”

“I went from door to door to provide accurate information, and I’m happy to say I’ve witnessed a positive shift in attitudes. In fact, some parents even brought their younger daughters, who weren’t yet eligible, hoping to get them vaccinated.”

– Chuma Bakari, community health worker, Kinondoni Municipality

The country is now leveraging the lessons learnt from the campaign as it embarks on a sustainable immunisation plan that runs until December this year, aimed at ensuring all girls aged 9 to 14 receive the vaccine.

The IVD Program Manager, Dr Tinuga, says, “We will revisit hard-to-reach areas where girls might have missed opportunities. All those who missed the vaccine will be reached through routine immunisation programmes and periodic intensification of routine immunisation.”