HPV school-based vaccine campaign

Integrated School Health Programme Manager, National Department of Health, Feni Motshwane, details the success of the HPV school-based vaccine campaign thus far.

When did the HPV school-based vaccine campaign start?

The human papillomavirus (HPV) vaccination campaign was introduced in SA, in March 2014, in the public health sector. 

This school-based vaccination campaign was launched by the Minister of Health, Dr Aaron Motswaledi, and Deputy Minister, Dr Gwen Ramokgopa, in Bloemfontein, Free State.

Why was it started?

The intended long-term strategic goal of the HPV school-based vaccine campaign is to reduce the risk of cervical cancer in future women, which is a high national priority. 

Each year over 5 743 women are diagnosed with cervical cancer. Of these, 3 027 are associated deaths and 99% are associated with HPV and related complications. The incidence rate of cervical cancer in SA is reported between 22,8 and 27 per 100 000 women, compared to the global average of 15,8.

What is the goal of the campaign?

This annual campaign is now in the eighth year of implementation. The aim is to reach all eligible Grade 5 learners, aged 9 years and older, in public schools and girls aged 10-12 years in special schools (as special schools aren’t graded), to be fully vaccinated, with the two HPV vaccine doses, at least five to six months apart, and to contribute to the cervical cancer reduction in future women.

The fundamental principle to a successful campaign relies on the number of signed informed consent forms by parents/guardians/caregivers of eligible Grade 5 girl learners. 

Since Feb/March 2020, the grade shifted from Grade 4 to 5 as approved by both Ministers of Health and Basic Education. This was due to a high number of Grade 4 girls who were still under 9 years and were missed as the campaign is grade-based. 

What does the campaign entail?

It entails procurement of HPV vaccines, cold chain management (vaccine fridges, freeze tags, thermometers, cold boxes and ice packs) to keep the vaccines potent. Furthermore, hiring and compensation of employees (contract nurses and data capturers), data management (daily registers, IEC material). Other consumables, such as syringes, needles, cotton wool balls and waste management, are also bought with the allocated budget for the successful delivery of the HPV vaccination campaign to Grade 5 girls.

Most importantly, the campaign entails advocacy, communication and social mobilisation to parents/caregivers and guardians about the importance and benefits of the vaccination campaign and to sign consent forms. No child/learner will be vaccinated if there is no consent form.

What HPV vaccine is used and why was this vaccine chosen?

Cervarix, the bivalent vaccine is used. This vaccine provides primary protection by preventing persistent infection with HPV types that cause about 70% of cervical cancer.

Explain the process of the campaign 

The Department of Basic Education (DBE) has sought approval, through their legal department, for the Integrated School Health Programme (ISHP) consent form to be valid for the calendar year.

It’s the responsibility of DBE through the schools and educators to distribute the consent forms at the beginning of each calendar year, then followed-up by each class teacher to be returned to schools. 

This is a comprehensive consent form, covering routine school health services provided in schools, including but not limited to HPV vaccination for Grade 5 girls, Tetanus and diphtheria (Td) vaccination for six-year-olds and Grade 5 boys and girls. 

The school health nurses and HPV vaccination teams will then visit the schools to set appointments to visit each school. A schedule is then developed with the campaign dates and times of the planned visit. 

It’s during this visit that the number of learners in a grade is verified against the class register, availability or return of consent forms is verified and then dates are confirmed with the school.

The consent forms are supposed to be in place, to confirm informed consent by the parents/caregivers/guardians for the learners to benefit from the school-based programmes.

What schools are included?

The campaign takes place in public primary and special schools (government). Independent and private schools are not included in the campaign. However, parents/caregivers/guardians are encouraged to take their children to their family doctors for further engagements and recommendations.

How many girls have been vaccinated so far?

Since 2014, over three million girls have been vaccinated through the HPV school-based vaccine campaign. However, some didn’t receive the second dose due to several reasons.

The total number of girls in Grade 5 from the previous year are used as learner estimates and used to plan for the first round of each annual campaign. Furthermore, the DBE provides learner numbers to the Department of Health as the school health programme is implemented jointly according to the 2012 Integrated School Health Policy.

What is the success rate of the second round vaccine vs the first round? 

When data is analysed, the first doses of learner coverage are often higher than the second dose. It’s noted with concern, the reasonable number of signed consent form withdrawal by parents/caregivers/guardians, among learners who received their first doses without any reason/s provided. Continuous advocacy and social mobilisation are done.

Furthermore, a small number of learners experience minor adverse events following immunisation (AEFIs) which are reported and investigated. Depending on the classification of the AEFI committee, it’s highly recommended that such a learner receives the second dose to be fully protected. However, if the parent objects, such learners are excluded from receiving the second dose. Absenteeism and previously vaccinated learners due to repeating grades are some of the reasons.

With the COVID-19 pandemic, the campaign was postponed in 2020 Sept/Oct due to school closure and unavailability of learners. However, in Feb/March 2021, a provision was made to offer all learners who received their first vaccine doses to get the second dose, so that they are fully protected.

What happens if a learner gets the consent form signed but then on the day of the vaccine she is absent? 

There is a follow-up on these girl learners. This is also known as the mop-up campaign and is planned for absent learners with consent forms to ensure that all eligible girls receive their doses and that they are fully vaccinated.

What education is given to the girls on why the vaccine is needed?

Young girls, age 9-12 years, are given information and educated that the vaccine aims to provide protection against cervical cancer in future.

Do the girls understand this message?

Most young girls might not fully understand the message. However, we have learnt that this is built-up information and education to them. As they progress in their school grades and grow older, they motivate Grade 5 girls to also take the vaccine and become young advocates for the programme in their families, schools and communities, including their parents/caregivers/guardians and their educators.

When do the first round and second round vaccines take place? 

The campaign takes place twice a year over a period of four to six weeks in Feb/Mar and Sept/Oct in each calendar year. The timing is based on the six months interval between the doses.

When are the consent forms given out? 

The consent form is valid for the calendar year. It’s therefore, the responsibility of DBE through the schools and educators to distribute the consent forms at the beginning of each calendar year, then followed-up by each class teacher, so that when the school health teams and HPV vaccination teams visit the schools, these forms are already in place for the learners to benefit from the programme.

Will boys be included in the campaign?

Cervarix is used only in females, girls and young women aged between 9-25 years, to prevent cervical cancer caused by HPV types 16 and 18.

Plea to parents

Parents/caregivers/guardians are urged to sign the consent form for their children to be vaccinated and benefit from the programme and therefore reduce the mortality and fatality of cervical cancer in SA.

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