Plans to prevent one of the deadliest cancers for women in Jamaica have been significantly set back by the Covid pandemic, new figures reveal.
The scheme to vaccinate schoolgirls against cervical cancer in Jamaica – which is the cancer with the second highest death rate in the Americas – began in 2018, but the Pan American Health Organization says inoculation rates fell to just 2.71% in 2021. This represents a drastic drop from the 2019 rate of 32%, and far from the WHO target of 90% by 2030.
The cancer, which is curable if caught early, kills 22 in every 100,000 women in Jamaica. By comparison, in the UK the rate is 2.4 in every 100,000, and in Canada it is 2.
In more than 95% of cases, cervical cancer is caused by the human papillomavirus (HPV), thought to effect nearly all adults, and which can be sexually transmitted. HPV vaccine, approved in 2006, has been shown to prevent up to 70% of cervical cancers. Regular screening is also key.
A national HPV vaccination programme for girls under 15 was launched in Jamaica in 2018 only to be disrupted by classroom closures during lockdown, said Sebastian Oliel from the Pan American Health Organization.
Even the pre-pandemic performance of the vaccination programme was criticised as ineffective due to “poor planning, inadequate communication and public distrust”. In 2019, its most successful year, fewer than a third of those eligible were vaccinated, mostly due to lack of parental consent.
“The HPV programme concerns three topics which are controversial in Jamaica: young girls, sexually transmitted infections and vaccines,” said Dr Samantha Johnson, the director of Margins to Centre, a Kingston-based health advocacy group for women. “In a culture that values pre-marital abstinence, these three things converged to discourage vaccinations. Parents feel that giving children the HPV vaccine is the same as telling them it’s OK to have sex.
“Promotion of the HPV vaccine came out almost at the same time as the vaccines were introduced in schools,” she said. “This was not enough time to inform parents and answer their concerns. If you are trying to promote a new film, you don’t start playing trailers the day it starts screening in theatres.”
Prevention of cervical cancer in Jamaica is also hindered by low rates of cervical screenings. HPV screenings are not provided by Jamaica’s health service but women are entitled to regular smears that test for cancerous cells. But, according to the latest Lifestyle and Health Survey from 2017, fewer than half of Jamaican women reported having had a smear test in the previous three years, although 70% did report at least one test in their lifetime.
“Women are afraid of the screening process and potential pain, but there is also a fear of a cancer diagnosis itself,” said Nicola Skyers of Jamaica’s Ministry of Health. “Some people just prefer not to know. But I also think that healthcare providers don’t offer screenings often enough. If a healthcare provider is really ‘selling’ the pap smear, more often than not the woman will choose to have it.”
Health workers are forced to focus on cures rather than preventions amid staffing shortages and an overburdened healthcare system, said Skyers. “As a doctor, you won’t be encouraging every women you see to do a pap smear if you have 40 patients waiting outside.”
Johnson hopes HPV vaccination rates will rise. “I know that nurses are already going back to school to deliver vaccines,” she said, adding that a robust public health campaign was needed. “The campaigns have to be inclusive, not only of parents but also children. Sometimes you find that the child is the one to convince the parent to give them the vaccine.”
