A minister with an HPV mission
Pretoria – Health Minister Aaron Motsoaledi remembers the moment he committed himself to changing the future of girls in South Africa.
A medical doctor working in the public health system, he was having to admit mothers, wives, sisters and daughters to hospital to die of cervical cancer.
He saw the debilitating effect their condition had on them, their families – and also on doctors like him, and the nurses and medical students working around him.
“Maybe that’s why I had so much passion about it,” Motsoaledi says.
“I don’t remember ever entering wards where these women were, and not coming out feeling depressed. It’s terrible to say it, but some women were being eaten from below, alive, in agony.
“I still remember when I was a GP, a woman who was my neighbour whose kidneys had closed down, and she felt all she needed was for me to do something. Yet, I couldn’t do anything. She was terminal, looking at me, begging me. It was very, very sad. In that moment, I became determined.
“That’s what cervical cancer is. Even the wards where these patients go to die, smell of pain. You’re having to say to husbands, okay, your wife is going to pass on. You’re preparing him that this is terminal, and people are angry. They can’t accept. It’s very difficult. I and lots of other health-care workers have had to live through that.
“So this was an opportunity I was given to make a huge difference and I grabbed it with both hands.”
The minister, who has headed the Health Department since 2009, is talking about the roll-out of the human papilloma-virus (HPV) vaccine, which prevents cervical and other cancers affecting sexually-active people.
He’s also talking about something much bigger – the prospect of a cervical cancer-free life for generations of women to come.
Professor Michael Herbst, of the Cancer Association of South Africa (Cansa), who was involved in an advisory aspect on the roll-out, believes the campaign could see results within 10 to 15 years, when the numbers of those affected would have dropped dramatically.
He says it is possible that the next generation of young women who have received the vaccine, will live without fear of this devastating diagnosis.
“When one looks at the high cost, not only of lives but also what it costs to treat a woman with cervical cancer, an incurable cancer, this campaign becomes important. These children who get the vaccine, without having to pay for it, are being given a gift and I think it’s a real legacy for the minister.
“We believe that, in 15 years, when these girls are about 24, we’ll start seeing the figure of about 6 000-plus new patients with cervical cancer, dropping. We can start breaking the chain.”
Herbst – who at 70 is Cansa’s head of health and an activist – doesn’t believe the government will deviate from the programme, even after Motsoaledi has left office.
Last year’s HPV vaccine campaign, in which more than 400 000 Grade 4 girls around the country received the required two doses of Gardasil, was regarded as a significant success.
There was only one reported case of a shot given in error and the minister “deeply regrets” that.
“We believe a young girl slipped back into the queue to be given the vaccine, even though her parents had not signed the consent form. These are children, but we should have been more vigilant. We will not allow it to happen again.”
Parents are required to give their permission for the vaccine, which costs between R700 and R1 000 a dose in the private sector.
Girls in private education are not covered by the department’s roll-out, which concentrates solely on public schools.
But Herbst hopes wealthier parents will take the initiative around their daughters’ health.
The second campaign runs until March 20, and the minister is hopeful that about half a million girls, aged mostly 9 but up to 12, will be reached.
“We can pass policies, and if you haven’t got the people willing to get it done on the ground, you’ll have much more than hiccups. Last year, nurses had to leave their patients to help us change the lives of our girls. It was something out of this world.”
However, not everyone is happy with the way Motsoaledi has approached the use of the vaccine.
Portia Serote, women’s sector representative on the Treatment Action Campaign’s (TAC) national council, says they’re going to continue lobbying the minister to expand the programme.
“We are supportive of the HPV vaccination, and we even wrote to pharmaceutical companies about reducing the costs of the vaccine to make it more accessible. Otherwise, the minister was not going to be able to campaign for all the children. He was not going to make it.
“We support it because more and more women are dying of cervical cancer, and it is expensive to treat. So, we believe prevention is better than cure.”
Serote worries that mythologies played out for many parents who were not properly educated.
“Honestly, some parents even thought the vaccine would make their children sexually active, because it was launched by the department at the same time as it launched the subdermal implant (a three-year pregnancy-prevention device inserted below the skin of the arm). So lots of parents didn’t sign consent because they didn’t understand or see the importance.”
Serote says the TAC is also worried about the limitations of the age range. Children are left out of the campaign due to socio-economic circumstances and boys are not being vaccinated.
“There is no way a woman or a girl will get cervical cancer without having sex with a man or a boy. This is just the truth, so when the boy child is left out, it’s a problem. We don’t see us winning the fight against cervical cancer unless they also get the vaccine.
“But it’s also about the girls 19-plus years who are not at school but at high risk. They can’t afford this vaccine privately, and so we wish to see the programme expanded. The same is true for girl children living with HIV. Surely their age should not matter? They are six times more at risk than an HIV-negative person of getting cervical cancer.
“We worry also about the disabled children vulnerable to rape, who are not in the school system. We need it to move broader in the next round.”
The minister is open to further discussions but he’s clear on why only 9 to 12-year-old girls are part of the current campaign.
“We have to get them immunised before they are sexually active.”
Herbst, too, is focused on the core group at risk, but emphasises that the cost is prohibitive enough to include boys – even though the HPV is pernicious enough to give males cancers of the head, neck and penis.
The hope is that the government will be able to stretch its R400 million campaign to vaccinate both boys and girls
Serote insists, though, that boys must receive education on HPV during this campaign. They must know their responsibilities – even if they cannot yet get the jab.
“Men try to distance themselves from these kinds of issues. They say it is all about women but it is also about them. They are the transporters. So, if we are fighting for a cancer-free country, the minister must do education, education, education – TV, radio, everywhere. It’s not about something you can get off a toilet seat. It is about all of us.”