At just 21, Jessie Mzemba is a foot soldier in Malawi’s battle against vaccine hesitancy and cervical cancer. Every day, she knocks on the doors of girls aged nine to 18 living in the rural, hard-to-reach areas outside Malawi’s capital, Lilongwe. Her goal is to promote the human papillomavirus (HPV) vaccine and offer reliable health information.
“I wish there was someone like me when I was their age. Someone I could ask questions and talk to about my health,” she says. “When I was diagnosed with HIV at 15, I went into complete denial. I had no one to talk to, as my parents died long ago.”
Cervical cancer is six times more likely to affect women living with HIV, and though many parents are eager for their children to receive the HPV vaccine, they do not have the transport to make the journey to a health clinic. Others are reluctant, having heard that the vaccine is dangerous and designed to cause infertility. It is Mzemba’s job to answer their questions and address their concerns.
Mzemba tries to visit at least five households a day. “Most of the time, if you provide parents with information, they change their mind,” she says. “I am local to the area, they know who I am. They trust me.”
Mzemba works with mothers2mothers, an international NGO that promotes family health and works with HIV-positive women. It rolled out its HPV peer-mentoring scheme in Malawi last year when the government extended eligibility for the vaccine to all girls aged nine to 18, in an effort to combat the plummeting coverage rate.
Malawi has among the world’s highest HIV rates, with the prevalence rate considerably higher among women than men, and has the second-highest rate of cervical cancer mortality after Eswatini. While the global cervical cancer mortality rate is seven per 100,000 women, more than 51 women die due to the disease per 100,000 in Malawi.
More than 95% of cervical cancer cases are caused by HPV, which is sexually transmitted. In a UK study, the HPV vaccine was shown to prevent up to 87% of cervical cancer cases in women in their 20s who were offered it at ages 12-13. The World Health Organization (WHO) recommends that the vaccine is given to girls aged 9-14 before they become sexually active.
While the HPV vaccine has been available for free in Malawi since 2019, the coverage rate fell with the onset of the Covid pandemic from 83% to 14%, according to WHO data. School closures and vaccine hesitancy are to blame, say health advocates.
“During Covid we lost a decade of progress in three years in terms of global vaccination rates,” says Corrina Moucheraud, a public health researcher at New York University. “And the HPV vaccine, according to Unicef, has globally been one of the most affected. Things are changing in Malawi but it’s not like we are fully back to normal, you cannot fully undo what happened over the last few years.”
The key barriers to vaccinations are poor transport and misinformation, says Tendai Mayani, the senior programme manager at mothers2mothers.
“Unlike infants, adolescents rarely show up in medical centres. In the areas we work in, they may live over 5km away from a health facility and not have access to transport,” says Mayani. “We work by gathering parental consent for the vaccines for a group of about 20 girls, and then we arrange for a health worker to travel to the village.”
Since launching last year, mothers2mothers’ HPV scheme has reached more than 1,000 girls. “One woman was very suspicious of the vaccine,” says Mzemba. “But when she saw how many girls at her daughter’s school were getting vaccinated she came to see me the next day to get more information and she consented.”
“There are a lot of rumours going around,” adds Moucheraud, who interviewed parents and guardians to understand their experiences with HPV vaccinations. “Many parents said that they would trust a doctor or nurse about the vaccine, but very few have been able to have those conversations. For some hesitant parents, it may be the case of not getting trusted information from the right sources at the right time.”
The results of the HPV vaccine campaign will be used to help the rollout of other newly developed adult vaccines, say experts. Edina Amponsah-Dacosta, a virologist at the University of Cape Town, says: “The HPV vaccine is a test case. If we get it right, we can establish an adult vaccination platform that can be expanded to more vaccines.”
“I want my daughter and my family to be proud of me,” says Mzemba, who has a one-year-old daughter and is working towards a public health degree. “I’m championing my local community, but I want to be everywhere. I want to bring change to my community, my family and my country.”
