Nine-year-old Ana Sitoe and Isabel Cossa*, learners at Guava Primary School in Marracuene, Maputo, have both received their first vaccine against human papillomavirus (HPV) thanks to an immunization drive targeting young girls.

"I was afraid of the needle, but I knew that the vaccine was good for protecting our health against this disease, so that we can play, study, grow up and fulfil our dreams in the future," Ana says.

The premature mortality rate from cancer in Mozambique is 10.4%, ranking as the eighth highest among more than 184 countries, according to the most recent data available from World Health Organization (WHO). More than 60% of cases occur among women and over a third were related to cervical cancer (34.6%), followed by breast cancer (12.8%).

In 2018, WHO issued a call to action for the global elimination of cervical cancer by 2030. Following this call, in the same year, Mozambique developed its HPV vaccination strategy for girls from the ages of nine to 14 years. Due to disruptions of the COVID-19 pandemic, vaccination only started three years 2021. Since the outset, HPV vaccination has been integrated into the routine immunization schedule.

To catch up on lost time, Mozambique made major efforts to reach as many girls as possible and reach high vaccination coverage. The country's expanded programme on immunization conducted a catch-up campaign in April 2022 when schools opened, to vaccinate eligible girls born in 2012 who had not yet received their first dose of HPV vaccine.

The school-based vaccination programme, in which girls receive two doses in a six-month interval, is complemented by other strategies to reach hard-to-reach girls including using a door-to-door approach, mobile outreach, and vaccination at fixed facilities. Vanessa and Cristina were vaccinated in the first quarter of the year, and like their peers, will receive their second dose during the third quarter.

The country has made good progress over a short period of time. According to administrative data from the Ministry of Health, coverage of the first dose is over 80% and the second dose, 40%.

Aissa Cutane, a public health technician at the Habel Jafar Health Centre in Marracuene, confirms that the school-based vaccination strategy has been very effective. "It is easier to communicate the benefits to the girls, their families, the local community and local health professionals when you take the service to the target group," she says.

Once parents have given consent, the health professionals also deliver sensitization messages to the children before they proceed with vaccination. Fernando Chacatane, Vanessa and Cristina's teacher, considers the coordination between health units and schools to be very advantageous. "Instead of the children and their parents spending a lot of time going to the health units and standing in long queues, the vaccines are delivered quickly and effectively," he says.

"While the start of HPV vaccination experienced delays, the achievements in the last two years show political will and commitment to the global elimination targets," says Dr Severin Ritter Von Xylander, WHO Representative in Mozambique. "WHO will support the country to accelerate its actions so that we can eradicate the scourge of cervical cancer among women."

Both Vanessa and Cristina were counselled to raise awareness of the importance of getting vaccinated against HPV and are now encouraging other unvaccinated girls to do the same.

"We shouldn't be afraid of the sting from the needle. The vaccine is good and prevents HPV, so we'd rather grow up well and healthy," says Isabel.

*Names changed to protect identity

Distributed by APO Group on behalf of World Health Organization (WHO) - Mozambique.