BACKGROUND TO THE INTRODUCTION OF THE HUMAN PAPILLOMAVIRUS TO JAMAICA

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1 BACKGROUND TO THE INTRODUCTION OF THE HUMAN PAPILLOMAVIRUS TO JAMAICA In response to the increase in the number of cases of cervical cancer in Jamaica the Ministry of Health (MOH) has embarked on an initiative to help prevent cervical cancer through the introduction of the Human Papillomavirus (HPV) Vaccine. It is however important that we look at the global reality of cervical cancer which has propelled the need for an intervention such as this. GLOBAL BACKGROUND Globally, cervical cancer is the second most common type of cancer in women with over 85% occurring in developing countries. Every year 528,000 new cases are diagnosed and there are approximately 270,000 deaths. By 2050, without any intervention, cases diagnosed with cervical cancer will increase to one million per year with approximately 90% of the deaths will be in developing countries. The Human Papillomavirus (HPV) is a group of approximately 200 viruses that infect epithelia (skin) tissue. At least 14 types of the HPV have been found to cause cancer of the cervix, penis, anus and oro-pharynx (throat). Types 16 and 18 are responsible for 70% of cancers of the cervix. The virus can be transmitted through skin-to-skin contact, from mother to child at birth and through contaminated surfaces. The World Health Organization (WHO) recommends that HPV vaccines be included in national immunization programmes as a core strategy for primary prevention against cervical cancer. WHO states that HPV vaccination for girls ages 9 to 14 years is the most cost effective public health measure against cervical cancer. More than 70 countries around the world, including more than 20 countries in Latin America and the Caribbean, have already introduced the vaccine, and many studies have proven that HPV vaccination works extremely well, decreasing the number HPV infections and related pre-cancers. 1 P a g e

2 CERVICAL CANCER IN JAMAICA Cervical cancer is the second leading cause of cancer-related mortality in Jamaica and remains a significant public health concern. Current estimates indicate that every year 392 women are diagnosed with cervical cancer, 185 die from the disease with the majority of deaths occurring in women between 40 and 64 years of age. It should also be noted that age-specific deaths in Jamaica exceeds the average rates in the Caribbean and the world. HPV prevalence studies conducted here in 2010, revealed that: 1) the overall prevalence of any HPV infection was 54%, 2) the cancer causing HPV types were detected in 34.9% of the women and 3) HPV types 16 and 18 were found in 10.5% of the general population and in 71% of women with abnormal Pap smears. HPV types 16 and 18, are responsible for most HPVcaused cancers. VACCINE SAFETY HPV vaccines are safe. More than 200 million doses have been given around the world with no major side effects due to the vaccine. The most common side effects of the vaccine include redness, swelling and tenderness to the injection sight. Other less common effects include fever, nausea and upset stomach. The HPV vaccine was included in the national schedules of France (2007), the United Kingdom (2008) and the Netherlands (2009), Canada ( ), Mexico (2012), Panama (2008), USA and Puerto Rico (2006), Bermuda (2008), St. Maarten and Trinidad and Tobago (2013), and Barbados (2015) to name a few. The Global Advisory Committee on Vaccine Safety (GACVS) has carefully monitored the safety of the HPV vaccine and thoroughly investigated reported cases of adverse effects supposedly attributed to the HPV vaccine. The WHO Committee on Vaccine Safety has confirmed that none of the conditions investigated were due to the HPV vaccine and in December 2015 issued the following statement, To Date, GACVS Has Not Found Any Safety Issue That Would Alter Its Recommendations for the Use of the Vaccine." 2 P a g e

3 INITIATIVE UNDERTAKEN BY JAMAICA The Ministry of Health has identified cervical cancer as a major public health problem in Jamaica as almost 50% of the women who are diagnosed each year will die from this preventable disease. The MOH has therefore introduced the bivalent HPV vaccine to provide % protection against HPV types 16 and 18 into the routine immunization programme. The bivalent HPV vaccine is being offered to girls in Grade 7 that is, girls ages 9 to 14 years of age, (the majority being years old) free of cost. This vaccine is not mandatory. The HPV vaccine is not new and has been available in the private sector for several years now and is therefore not a new vaccine to our population. The MOH has employed a school-based strategy for implementation to facilitate greater access to the population as parents will not have to miss work or students school in order to benefit. Prior to immunization education sessions is held with the girls to be vaccinated. A brief medical history is conducted to ascertain the girls fitness and eligibility for vaccination. Information is then shared regarding the: 1) cervical cancer and 2) vaccine (side effects to be expected). As is customary, with all outreach and school vaccination programmes safety measures are in place to treat emergencies. Additionally, the surveillance mechanism monitors and investigates all events supposedly attributable to vaccination or immunization. The target is approximately 22,500 girls, and each girl will need two (2) doses given (6) months apart for full protection. The focus is on cervical cancer protection and therefore boys are not being vaccinated at this time. It must however be noted that once Jamaica achieves >80% coverage with the HPV vaccine our boys will be protected by herd immunity ("Community Immunity") When a critical portion of a community is immunized against a contagious disease, most members of the community are protected against that disease because there is little opportunity for spread of that disease. Vaccines can prevent outbreaks of disease and save lives). 3 P a g e

4 ACTIONS TAKEN TO DATE 1. Capacity Building a. Training sessions for healthcare workers on the storage, administration, record keeping and risk communication as it relates to the HPV vaccine was completed in September 2017 i. All regions have been trained with more than 300 participants in all. Training of school nurses has also been completed 2. Public Awareness a. Various stakeholder sensitization sessions have been conducted. These include sessions with the: i. MOEYI ( May September 2017) ii. Public sector healthcare workers (January February 2017; September 2017) iii. Paediatric Association of Jamaica (September 2017) iv. Private Sector Organization of Jamaica (September 2017) v. National Parenting Support Commission (May 2017) vi. Jamaica Council of Churches (June 2017) vii. Jamaica Umbrella Group of Churches (September) viii. School nurses (July and September 2017) ix. Guidance counsellors (September 2017) x. Health and Family Life Education coordinators (May 2017) b. Dear Parent letters and accompanying fact sheets were distributed to schools for inclusion in the Grade 7 school packages at the end of the last academic year to sensitize parents / guardians about the planned vaccine introduction c. The local Health Departments led by the Parish Medical Officers of Health have been and will continue to dialogue with and provide schools with Dear Parent letters, HPV fact sheets and an Opt out form for girls to take home to their parents. These documents: 1) advise of the date immunization will be done (determined by the school body in collaboration with the Ministry s team), 2) provide facts regarding the HPV vaccine and 3) 4 P a g e

5 offers the Opt out form that gives parents the opportunity to refuse the bivalent HPV vaccine. Girls who return the signed Opt out forms on the day of immunization will not be vaccinated d. Six Focus Group discussions with parents and girls were conducted in Kingston, Montego Bay and Clarendon e. Parent / Student Sensitization were done in Westmoreland, St. James, St Catherine and KSA (met with PTA groups), St Elizabeth, Manchester, Clarendon, Portland and St Ann f. A Media Sensitization Forum was held 29 September 2017 g. Media Interviews are on-going with: i. Jamaica Information Service ii. IRIE FM iii. Nationwide 90 FM iv. News Talk 93 FM v. RJR Group of Companies vi. CVM h. Print Placement of HPV information is ongoing i. Radio and Television commercials will be placed We are aware that there are lingering concerns within our school and the public and as such person are encouraged to call the Ministry of Health s toll free line ONE LOVE or to clarify those concerns. Persons can also the Ministry of Health at hpvinfo@moh.gov.jm or visit to find additional information on the website of the Ministy of Health at and their social media channels. The Ministry of Education, Youth and Information stands ready to provide support to our stakeholders and so we ask that you make contact with your Regional Office to voice any other concerns or queries you might have and we will be sure to make every effort to address them in a timely manner. 5 P a g e