Millions of girls in developing countries to be protected against cervical cancer, but …

…countries will need to develop the infrastructure to deliver the HPV vaccine to those that need it! This is precisely where we struggle the most in our Nigeria.

Most people working in the public health community were excited at the recent announcement by GAVI that it had negotiated a new price of $4 for the vaccine against Human Papilloma Virus (HPV), which causes cervical cancer. The same vaccines can cost more than $100 in developed countries and the previous lowest public sector price was $13 per dose (see more at here). The following eight African countries will initially benefit from GAVI’s support to introduce the vaccine; Kenya, Ghana, Madagascar, Malawi, Niger, Sierra Leone, Tanzania and Rwanda. No sooner had GAVI made the announcement, when the Rwandan Minister of Health (who you must follow on Twitter! @agnesbinagwaho) clarified the situation with this tweet.

Amazingly – Rwanda was the first country in Africa to introduce the HPV vaccine into its immunization schedule in 2011, when it negotiated a price with Merck, and subsequently attaining 93% coverage for the first three-dose course of vaccination in the target population. Now – show me a better example of public health leadership. By showing the light, they have not only saved thousands of Rwandan lives, but they have influenced a global reduction in the cost of the vaccine on the continent, potentially saving millions more!

Cervical cancer is the third most common cancer in women, and the first for which we have the opportunity to prevent by vaccination at a population level. The HPV vaccine is one of the major public health breakthroughs of our time. It had here thereto also held the unflattering title of being the most expensive childhood immunisation in the world, initially costing US$360 for the required three doses. As THE LANCET noted in its editorial, “as GAVI scales up the use of the vaccine, the price is expected to come down further“. It also notes that; …”The challenge now is to make sure that countries have strong enough health systems for national roll-out.

This, ladies and gentlemen is the challenge facing our dear country, with its much quoted 7% growth! We have not developed the institutions – across all sectors, to make economic growth benefit the Nigerian people. The above is just a “small” example from the health sector, there are many more. Tell me dear friends, of what use is economic growth if it is nothing more than a number quoted at the World Economic Forum?

So – are you surprised that despite having the largest burden (by factor of our population) of cervical cancer in Africa, GAVI has chosen to ignore Nigeria in its immediate plans? I am not, sadly.

Never doubt that a small group of thoughtful committed people can change the world; indeed it is the only thing that ever has…Margaret Mead

Chikwe Ihekweazu is an epidemiologist and consultant public health physician. He is the Editor of Nigeria Health Watch, and the Managing Partner of EpiAfric (, which provides expertise in public health research and advisory services, health communication and professional development. He previously held leadership roles at the South African National Institute for Communicable Diseases and the UK's Health Protection Agency. Chikwe has undertaken several short term consultancies for the World Health Organisation, mainly in response to major outbreaks. He is a TED Fellow and co-curator of TEDxEuston.

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