Nigerian girls at risk

•Millions may miss free cervical cancer protection, NPHCDA warns

From** Fred Ezeh, **Abuja

** Despite Nigeria’s progress in vaccinating more than 18 million girls against Human Papillomavirus (HPV), gaps in access and awareness could prevent more eligible girls from benefiting from the vaccine designed to protect them against cervical cancer.**

For Dr. Ahmed Rufai Garba, Director of Disease Control and Immunisation at the National Primary Health Care Development Agency (NPHCDA), the challenge goes beyond making vaccines available. It also involves reaching girls who do not routinely visit health facilities, improving public understanding of vaccination and ensuring that eligible children receive the service without financial barriers.

Garba, who spoke in an interview at the a MSD roundtable on stronger private sector collaboration to scale equitable cancer prevention and care in Nigeria, also highlighted the importance of school-based vaccination, effective vaccine distribution and stronger collaboration between government and private-sector partners.

The roundtable focused on strengthening institutional and private-sector alignment, expanding HPV vaccination and exploring innovative financing solutions.

In this interview, he explains why some girls risk missing vaccination, how the programme can be strengthened and what parents, healthcare providers and private-sector partners must do to improve cervical cancer prevention in Nigeria.

Available data indicated that Nigeria has vaccinated more than 18 million girls against HPV since introducing the vaccine in 2023. How would you assess the progress made so far?

We introduced the HPV vaccine into the routine immunisation programme in October 2023, and we have made significant progress since then. We have crossed 18 million girls vaccinated. That is a major achievement, considering the population we need to reach and the logistics involved in delivering vaccines across the country. Our reported coverage is approximately 76 per cent. This shows that we have made considerable progress, but it also tells us that there is still work to do to ensure that every eligible girl is protected. The introduction of the HPV vaccine was an important step towards preventing cervical cancer in Nigeria. We are not merely administering vaccines; we are investing in the health and future of our girls. However, the work is not finished because making vaccines available does not automatically mean that every eligible girl will receive them. We must continue to identify and address the barriers preventing some girls from accessing the service.

Why is HPV vaccination so important in the fight against cervical cancer?

Human papillomavirus (HPV) is a major cause of cervical cancer. Vaccinating girls before they are exposed to the virus can significantly reduce their risk of developing cervical cancer later in life. Cervical cancer remains a major public health concern in Nigeria. The figures discussed in our engagements indicate that the country records approximately 12,000 new cases annually and close to 8,000 deaths. Those numbers are substantial, and they underline the urgency of investing in prevention. When we discuss cancer, we should not focus only on treating people after they have developed the disease. We must also invest in interventions that prevent the disease from occurring in the first place. HPV vaccination provides that opportunity. It is a preventive intervention intended to protect girls before they become vulnerable to the long-term consequences of HPV infection. Our responsibility is to ensure that the vaccine is accessible; parents understand its benefits and eligible girls are not denied protection because of financial or geographical barriers.

If the vaccine is available free of charge in public health facilities, why are some Nigerian girls still at risk of missing it?

One of the challenges is that not every eligible girl has convenient access to a health facility. Some communities are far from health centres, while some parents may not know where or when vaccination is available. There is also the issue of how people use health facilities. Parents may take their children to hospitals when they are sick, but a healthy nine-year-old girl may not routinely visit a health centre. That creates a gap. The vaccine may be available within the health system, but the child who needs it may not necessarily come to the facility. We must therefore look beyond making vaccines available at health centres. We need delivery strategies that take the service closer to eligible girls. This is why school-based vaccination and adolescent-friendly services are important. If we depend entirely on parents bringing their children to health facilities, we may miss some girls. The challenge is not simply vaccine availability. It is also about how to identify, reach and vaccinate the target population.

Does this mean Nigeria needs to rethink its approach to delivering HPV vaccines?

We need to strengthen our delivery approaches to ensure that the vaccine reaches the girls for whom it is intended. Health facilities remain important because they provide a regular point of access to vaccination. However, we must recognise that facility-based delivery alone may not be sufficient to reach every eligible girl. We should explore complementary approaches that bring vaccination closer to communities and schools. The objective is to make access easier and reduce the number of girls who miss vaccination because they do not visit health facilities. We must also ensure that parents receive accurate information about where the vaccine is available and the age group targeted by the programme. Our efforts should be organised around the needs of the population rather than assuming that people will always find their way to the health system.

How can school-based vaccination help address this challenge?

Schools provide an important opportunity because they bring many children together in one place. Instead of waiting for every parent to bring a child to a health facility, vaccination teams can work with schools to reach eligible girls where they are. School-based vaccination can improve access, particularly for girls whose families may not routinely visit health facilities for preventive services. However, this approach requires proper planning and coordination. Health authorities need to work with education authorities, school administrators, teachers and parents to ensure that vaccination activities are organised appropriately. Parents must understand the purpose of the vaccine, its benefits and why their daughters should receive it. We must also remember that not every eligible girl is in school. Therefore, school-based vaccination should complement, rather than replace, services delivered through health facilities and community-based channels. The objective is to create several opportunities for eligible girls to receive the vaccine, regardless of whether they are reached through a school, a health facility or another appropriate delivery channel.

What role can adolescent-friendly services play in reaching girls who are not routinely brought to health facilities?

Adolescent-friendly services can help address the fact that many healthy children and young people do not regularly visit health facilities. Health facilities should be organised in ways that make it easier for adolescents and their parents to access appropriate services. This includes providing clear information, making preventive interventions accessible and ensuring that healthcare workers can respond to questions and concerns. For HPV vaccination, the focus is on identifying eligible girls and ensuring that opportunities for vaccination are not missed. We must also recognise that reaching adolescents require communication approaches that work for them and their families. Parents need to understand the benefits of vaccination, while healthcare workers must be equipped to answer questions and address misconceptions. The larger goal is to integrate preventive services into the health system in a way that makes them easier to access and more acceptable to communities.

How important is public awareness in ensuring that more parents take their daughters for HPV vaccination?

Public awareness is very important. Even when a vaccine is available, parents must understand why their children need it and trust the health system delivering it. If parents do not have accurate information, they may delay vaccination or fail to take advantage of the service. We therefore need sustained communication and engagement with communities. Healthcare workers have a major responsibility in this regard. They should be able to explain the benefits of HPV vaccination and respond appropriately to parents’ concerns. The media and other stakeholders also have important roles to play in communicating accurate information.

People should understand that HPV vaccination is a preventive health intervention intended to reduce the risk of cervical cancer. Our approach must be based on evidence, clear communication and engagement with the people we serve. We cannot assume that making the vaccine available automatically means parents know about it or will seek it for their daughter.

** The vaccine is free for eligible girls at public facilities. What is NPHCDA doing about reports of facilities charging parents?**

The HPV vaccine is provided free of charge to eligible nine-year-old girls at public facilities participating in the routine immunisation programme. Parents should not be charged for the vaccine under that programme. We expect facilities to comply with the policy and ensure that intended beneficiaries receive the service without being asked to pay for it. I have personally taken action in a situation where I discovered that a facility was charging for a vaccine that should have been provided free. I stopped that facility from receiving the vaccine. That action demonstrates the importance we attach to accountability. If government provides vaccines for free administration, the people responsible for delivering them must respect that arrangement. We need continuous supervision and monitoring to identify cases of non-compliance. Parents and caregivers should also seek clarification from the relevant health authorities if they are asked to pay for the vaccine at a public facility. The purpose of providing the vaccine free of charge is to remove financial barriers. If eligible girls are charged improperly, that objective is undermined.

** Beyond access and affordability, how important is the vaccine supply chain to the success of the programme?**

Vaccine availability requires a functioning supply chain, proper storage, distribution and coordination among the different levels of the health system. Vaccines must be delivered to the facilities where they are needed and maintained under the appropriate conditions. This is why logistics and cold-chain systems are essential to immunisation. The programme also depends on coordination between national and subnational authorities and the health facilities responsible for administering vaccines. It is not enough to procure vaccines. We must ensure that they reach the intended facilities, remain properly stored and are available when eligible girls come for vaccination. We must also monitor implementation and identify gaps that may prevent communities from receiving the service. These efforts are important not only for HPV vaccination but also for routine immunisation more broadly. A strong immunisation system helps ensure that vaccines reach the populations for whom they are intended.

How can private-sector collaboration help Nigeria reach more girls with HPV vaccination?

Collaboration is important because government cannot address every challenge in the health sector in isolation. We need different stakeholders to contribute their expertise, resources and reach. Private-sector partners can support awareness creation, community engagement, service delivery and other interventions that strengthen prevention. Their involvement can complement government efforts and help address gaps in access. However, collaboration must be coordinated with the institutions responsible for public health programmes. We need to ensure that partners work towards shared objectives and that interventions support national priorities. The discussion at the MSD roundtable was important because it brought attention to the need for stronger alignment between public institutions and private-sector organisations. Expanding HPV vaccination requires more than the availability of vaccines. We must also reach families, address barriers to access and ensure that the health system can deliver the service effectively. Private-sector support can contribute to these efforts, particularly where it helps extend the reach of accurate information and preventive healthcare.

The roundtable also discussed innovative financing. How can new financing approaches improve equitable access to cancer prevention?

Financing is important because prevention and treatment both require resources. We need resources to support immunisation, awareness, logistics, healthcare personnel and the delivery of services. Innovative financing approaches can help mobilise additional support and complement public funding. The important thing is to ensure that resources are directed towards interventions that improve access and produce meaningful health outcomes. Equity must remain central to these discussions. We should not have a situation in which a girl receives protection simply because she lives in an area with better access to services, while another girl is left behind because of where she lives or her family’s financial circumstances. We need financing arrangements that support services for underserved populations and help reduce barriers to access. The public sector must continue to provide leadership, while private-sector partners can help strengthen the resources and systems needed to deliver services. Through effective coordination, we can make preventive interventions more accessible to the people who need them.

What would you like parents and caregivers to do if their daughters have not received the HPV vaccine?

Parents and caregivers should find out whether their daughters are eligible and take them to a public health facility participating in the routine immunisation programme. The vaccine is available free of charge for eligible nine-year-old girls through the public programme. Parents should not wait until their children become ill before seeking preventive healthcare. They should also obtain information from qualified healthcare workers rather than relying on rumours or unverified claims. Prevention is an important part of protecting children’s health. By ensuring that eligible girls receive the HPV vaccine, families can take a practical step towards reducing the risk of cervical cancer later in life. Health authorities, schools, communities and partners must work together to ensure that more girls are reached. Our progress in vaccinating more than 18 million girls shows what coordinated efforts can achieve. But we must continue to close access gaps, strengthen public confidence and ensure that every eligible girl has an opportunity to benefit from HPV vaccination.

What is your message to stakeholders working to eliminate cervical cancer in Nigeria?

My message is that we must continue working together. Government, private-sector organisations, schools, healthcare workers, communities, parents and the media all have roles to play. We have made progress, but we must not allow that progress to make us complacent. We need to reach girls who have not been vaccinated, improve awareness and strengthen the systems that deliver vaccines. We must also ensure that the service remains accessible to eligible girls, particularly those who face geographical, financial or other barriers. The objective is to protect more girls today and reduce the future burden of cervical cancer in Nigeria. Achieving that requires sustained commitment, effective coordination and a willingness to address the practical challenges that prevent people from accessing preventive healthcare.

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