Special envoy to Dakar
In the playground of the Sacoura-Badiane elementary school, in the popular district of the Medina of Dakar, nurses are installed. Four plastic chairs, a cooler, and a box of syringes, that's all they need to vaccinate the hundred or so schoolgirls who line up. In less than three hours, all these young girls will receive their first dose of the human papillomavirus (HPV) vaccine. It will take another six months later for the 9-year-old girls to be effectively protected from these sexually transmitted viruses, responsible for lesions of the cervix that can develop into cancer. While cancer can take years to develop, the virus is usually caught very young, around the time of first sexual intercourse.
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In the ranks, apprehension and fear can be guessed. Some look out of the corner of their eyes at what is happening a few yards in front of them, while the more reckless laugh to see their girlfriend wince or shed a tear when injecting. “It doesn't even hurt. It tingles, that's all, ” says a slender little girl while proudly pressing the piece of cotton against her shoulder. Her face darkens a bit when she learns that a second injection is needed in six months.
More generally, misunderstanding dominates. Few of them really understood what this injection is for. For these little girls, cancer of the cervix is an unknown disease. And at the beginning of March, the arrival of the first cases of Covid-19 in Dakar is causing confusion. “If it's for the coronavirus, my mother doesn't want it,” one of them warns while grinding the tip of her faded pink dress. “But no, it's not for the coronavirus, it's for cervical cancer. It is a disease which affects adult women, and which kills. It's to protect you. I explained it to you yesterday, ” replies teacher Marième Ndiaye. “Parents also don't really understand. Several came to the school to obtain explanations. However, cervical cancer affects all families here in Senegal. But it's not uncommon for doctors not to use the word cancer. And then not all parents speak French. We must therefore explain to them in the national language, Wolof, ”slips Ms. Mendy, her colleague.
The second most common and deadliest cancer
In fact, in Senegal, and more widely on the continent, cervical cancer is omnipresent. It is the second most common and deadliest cancer (after breast cancer). “Women arrive at very advanced stages in hospital, due to the lack of screening and difficult access to care. The cost of treatments, which can climb to 3,500 euros, is also a brake, even if chemotherapy has been free for gynecological cancers for a year, ”comments Pr Mamoudou Diop, director of the Dakar Cancer Institute, the unique care center in the whole country.
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The Ministry of Health decided to introduce it into its vaccination program in October 2018. It is the first country in West Africa to offer it to young girls aged 9 and over thanks to the financial support of the Global Vaccine Alliance (Gavi) which brings together donor countries, foundations such as Bill and Melinda Gates, the World Health Organization (WHO), Unicef, but also the vaccine industry. And the program is ambitious: more than 95,000 young girls must be vaccinated every year.
Some families are wary of vaccines funded, in part, by foreign sources. They think they are of poor quality, poorly stored, or worse, dangerous
Ms. Séné, supervisor of the vaccination program in the southern district of DakarBut at the end of 2018, a strike by health workers for better remuneration complicated everything. To express their dissatisfaction, they boycotted the vaccination sessions. Some have even gone further by spreading false information about the safety of the vaccine. Intoxication straight from France. Health workers, joined by school directors and teachers, have indeed taken up the anti-vaccine comments of French doctors, and in particular those of oncologist Henri Joyeux. “The videos in which he questions the effectiveness of the vaccine and says that it causes serious side effects have circulated a lot on social networks. It created a lot of worries ” , testifies Mansour Niang, secretary general of the Senegalese League against cancer (Lisca) which fought in 2011 so that Senegal offers the vaccine to young girls.
The mistrust of the French population around these vaccines (marketed under the names Gardasil or Cervarix) has also fueled the controversy. In France, vaccination is recommended for all young girls aged 11 to 14, but less than a quarter of those under 16 had done all their injections at the end of 2018. “Parents told us: 'If the French do not vaccinate their children, it's good that there is a problem. Why would I do it? ”” , Relates Ms. Séné, supervisor of the vaccination program in the southern district of Dakar. And to continue: “Some families are wary of vaccines financed, in part, by abroad. They think they are of poor quality, poorly stored, or even worse, dangerous, ”she laments. Drawing on the memory of medical scandals that marked Africa, and the fear of being "the guinea pig" of Westerners, families have therefore refused to have their daughters vaccinated. Fears that we see resurface today in the midst of the Covid-19 storm.
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In Ziguinchor, the largest city of Casamance located more than seven hours from Dakar, two adjoining schools have a different policy regarding this vaccination. Curiously, one welcomes the teams and has already administered the first dose while the other says not to know that it exists. "Nobody came to see me to vaccinate the children, " assures the director of the recalcitrant school. Disguised refusal or true ignorance? Difficult to decide. The majority of mothers crossed at the vegetable market have never heard of this vaccine. Those who have heard of it have a strong opinion: "My daughter will not be vaccinated as long as I have doubts."
To counter the dissemination of these messages which have swept across the country, a group of gynecologists has increased appearances in the media. "All the scientific data show that this vaccine is safe and effective in preventing HPV infections and precancerous lesions of the cervix," Pr Diop tirelessly repeats. The ministries of health and education have also organized seminars to train school principals, a key player in the country's immunization strategy.
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At the same time, Lisca relied on the neighborhood godmothers, a network of volunteer women, playing an essential role in the communities. “These respected figures are responsible for raising women's awareness of issues of health, sexuality and contraception. We have trained them so that they can provide information on cervical cancer and deconstruct the false information relayed by this French doctor, ” explains Dr Fatma Guenoune, specialist in cervico-vaginal pathologies and president of Lisca.
In the field, the vaccination teams ensure that these actions have paid off. Confidence improves, and refusals have become rare. And in fact, in Dakar, all the 9-year-old girls from the Sacoura-Badiane school have been vaccinated. However, ministerial registers reveal a large number of people lost to follow-up: in 2019, less than 69,000 little girls received their second dose out of more than 222,900 first-time vaccinations across the country.
* This report was funded by a grant from the European Center for Journalism (EJC).
