 Welcome to another edition of Cancer with Dr. Denise Ejo, the CEO of Conwood Cancer Foundation, in partnership with Plus TV Africa. Happy New Year to you all and welcome to another year. We are all blessed and privileged to be standing and being able to talk about cancer in 2023. So we want to welcome you and we want to thank you for staying with us in 2022 and joining us again in 2023. Today in the house, I've got a childhood friend of mine, but the first lady of Kebis State. Her Excellency, Dr. Zainab Shinkafi Bagut. Hello. Hello, Dr. Denise, how are you? How are you? Good to see you. Happy New Year and I hope we're all doing fine. Dr. Zainab is currently the first lady of Kebis State in Nigeria and she's the founder and CEO of Medicaid Cancer Foundation. She's also the MD and CEO of Medicaid and Radiodynamics and Clinics. She's a board member of the Union of International Cancer Controls and the chairperson for First Ladies Against Cancer Black. Dr. Zainab works as a consultant pediatrician and advocates for improved women's health with a particular focus on cancer. She founded Medicaid Cancer Foundation in 2009 to increase awareness, build human resources, capacity, fund diagnosis and treatment of cancer in Nigeria. Through this and many other platforms, Dr. Zainab works passionately to build partnerships, policies and policies that increase access to quality care management and research in sub-Sahara Africa. So Dr. Zainab brings a wealth of experience and knowledge in building partnerships for improving health outcomes as well as our public health realities in sub-Sahara Africa with a focus on Nigeria and low and middle income countries. So Dr. Zainab, I've put you on a very big pedal to do this afternoon. So let's look at what we know about cervical cancer because January is the month for cervical cancer and one of the biggest drives globally is the elimination of cervical cancer, am I correct? Yes, yeah. And that we need to know. HPV is not included in the National Vaccination Program. Data that we have based on 2019, right? Let me just put it. So screening in the last five years, so by 11%. Ever screened people only 14% of the population of Nigeria where we have over 200 people. So we're really not doing very well, we have to admit. We're making progress in the private sector from what I can see, but Dr. Zainab will educate us. So let's understand the call for action globally. Whose targets to achieve by 2020, who, World Health Organization, towards cervical cancer elimination by 2023. It's, the medics call it 90, 30, 90. So I'm going to explain that so that when we get there, you all understand where we're coming from. 90% of women screened for HPV. 70% of women with HPV positive test received the vaccine and 90% of identified cervical cancer positive cases are treated, that is their goal. So, Dr. Zainab, am I correct with everything I have shared? Yes, you are, you're very factual. No, firstly, explain this HPV. Let's even start from there, explain the HPV. Thank you again for having me on this program and a happy new year to everybody. I wish us all a very prosperous peaceful and certainly healthy year 2023. It's also an election year for us in Nigeria. And I would start by calling on everybody to take a good look at the health manifestos and what our candidates promise us. I'm not talking about just the president or the parties from top to bottom. It's very relevant to this conversation that we're having. And also the time when we have election years, health professionals and policy makers and people advocates generally use the opportunity to demand. And so we are going to be demanding a lot this election year from our leaders. Having laid the scene of my political side, I will now wear the cap of a doctor and go back to your question. HPV stands for the human papillomavirus. It is a sexually transmitted virus and there are many, many different serotypes. The ones that are concerned conversation today are about four serotypes that cause cervical cancer. There has been found that there is a very high correlation between the infection by HPV earlier on in life during sexual activity and the development of cervical cancer later on. Cervical cancer tends to occur from the ages of 35 and above in our environment. But the infection with the virus is caused early, it's a relatively harmless infection and most people carry it without knowing. It doesn't do any harm at that acute stage but later on it causes at least eight different types of cancers are known. Penile cancer, cancer of the mouth and so on. So these cancers are related to HPV and there has been very strong research and evidence to show that vaccination against human papillomavirus can totally, along with the other measures that you mentioned, can lead us to a cervical cancer free world. Like we've seen with polio and smallpox and so many other vaccine-eliminatable diseases. This is the bane of the WHO calls action and elimination agenda. It's based upon vaccination of 90% of eligible girls for HPV vaccination. So that in a nutshell is what HPV is about. There are screening tests available for it. We have molecular tests that you can use to test for it. So a woman is able to work into most facilities in any country, really in Nigeria, anywhere you are to screen for HPV. Unfortunately, most of the time they would have to pay for it's out of pockets. The same thing with the vaccine. It's not readily available and it has to be paid for. However, the vaccine has been in existence for over 15 years and it is available widely. Thank you for setting the scene now. We've set the scene on HPV. Now I want to go to the next part. What's the path of Nigeria in achieving that? Because developed countries, I believe, would have put this already into their programs. Nigeria, where are we? And what's the path in achieving this? First of all, the WHO has over 193, almost all the members, all the countries of the world are members of the WHO. Most of these countries, particularly in the high income countries and in fact all of them have HPV included in their routine vaccination systems. In Africa, I believe the number is about 15. Most countries have it in Africa included on the vaccination routine as indeed we do in Nigeria. That is to say you receive a card that gives you the recommendation that you should have this vaccine at that age and that vaccine at that age. So HPV is included in the recommended vaccines. That's to say that the technical working group on vaccines have met and our scientists agree with the fact that surround HPV vaccine. However, the key thing is that it is not available at our medical facilities. It is not available as a free routine vaccination the same way that we have polio vaccine, the same way we have BCG at birth and DPT and all the other measles vaccines for our children. So it is not available. It is recommended to be given at nine years. However, boys and girls are supposed to receive it. But the first target population of course are the girls because they're the ones that develop the cancer that bears the economic burden which is cervical cancer. So where are we with Nigeria? So go back to your question. Like I said, the government and the primary health system, the national primary health care system agrees that it is a vaccine of use and of value. Secondly, there has been a lot of efforts to try to get the vaccine available on the primary healthcare developments recommended or given to our children. So the system has to be strengthened. The primary healthcare systems have to be strengthened. The school system also needs, there's an impact in a country where you have so many million girls, over 60 million girls out of school. How are we going to catch that population? The target population, we can do it. Most countries, it's a school-based system. However, for us, it's going to be tricky. There are some African countries that have done relatively well. Despite having high numbers of out-of-school children. And so I think that this year indeed is going to be very interesting. We're going to be seeing a lot of progress in the HPV vaccine journey. We're going to hopefully see it being delivered to our primary healthcare centers. And most of all, we're going to see the impact that it has on the cervical cancer cases. So that's about the vaccine. Based on what you were saying, you've identified some of the challenges that we would expect in providing this HPV. But our society is receipt of the vaccine. How do you perceive that to be achievable? As an advocate and somebody that has worked actively in health and in the cancer space, I understand the communities and our ways of thinking. And there is a perception that definitely awareness is low about cancers, the forces and what to do to prevent it. And then also the health-seeking behavior is what you mean of our people. Do they easily access vaccines? When you take it, do they agree to have a vaccinate their children? HPV is a bit dicey in that you are targeting girls. You're also targeting pre-reproductive age girls. So there is a perception at some level that you're trying to make them infertile and you don't want them to have children because of this big conspiracy theory of reducing the population of countries like Nigeria. Now, is that the reality on ground? No, I don't find that to be the reality. And we have proven this through a study that we conducted in Kevin. We were able to vaccinate school-age girls in Yauritown with HPV very, very successfully. And this is a published study. And also the reason for that is because, and the reason I say I don't totally agree with that perception is because most people, if you or all the people we found that when you educate them, when you engage the right stakeholders, when you do the right thing, our people are actually quite happy to do the right thing that you show to them. It depends on who is showing it, what you're bringing, and as long as you are mindful of their cultural context and their own beliefs. If you go during, this was in Yaurit for instance, in fact, we did the last dose during COVID and it was so successful that parents brought their girls back to the school to be vaccinated despite the COVID pandemic. So if you do it in the middle of Ramadan, when they're at home and fasting, you will not get that outcome. So you have to be sensitive to the cultural needs of the people. How did we get them to accept it? We engage the right community stakeholders. We engage the Emia of Yauri, the school education board, the parents teachers association, the teachers associations themselves, education board, everybody was involved as well as the students themselves. We run a cancer health club in the school for at least four years. So this was just a natural progression. By the time we were going to vaccinate, we went to the Emia with all the material, all the, and luckily for us, the Emia is a professor of microbiology. So we were able to educate him. He didn't know about HPV, but we were able to show him all the benefits backed up by research. So by the time we finished the educational stage properly, going through the right steps that you're supposed to go through, it was a walkover. And by the time we finished today, I always say this, I still get calls from Yauri asking when we're going to come and vaccinate the rest of their girls because of the solid foundation that was laid. So that is my experience. And I believe that is the case. Rwanda is almost at 90% vaccination coverage rate now. They've done it very well. There has been a system in place. And so any new vaccine that has been introduced, there has to be a good system. And if it is done properly, then our people will receive it to answer your question. Thank you. Thank you. I see sometimes I like listening to you, Medics, because you translate anxieties in a simple way that makes a lot of sense to people that don't know very much about it. And there is a lot of negative, or I don't know, I just think the information was not shared properly. So it hasn't always allowed for accuracy in selling this type of like the vaccine. So how did you overcome your barriers? Because you must have had barriers. So if there are any other barriers that have missed out or you haven't mentioned, what were they and how did you overcome them? I think the key things we have already mentioned is about awareness. It's about education. It's about the acceptability to the general population. And also the key stakeholders, they're called community gatekeepers. When we're introducing a new vaccine, there is a good process that should be followed. And so how did we overcome them by engaging them, by speaking to them, by giving them the facts that they needed to? We did it in at least, I'd say my team, I went once for sure, each round. And then before the actual vaccination, they must have done four visits to Yowli and they were asked to provide more information. You need to sign good agreements and MOUs. And of course, there must be parental consent as well as consent from the educational authorities. Beyond this, I can't think of any other. There are some vaccines have on-sword effects. We didn't have that during, after. But it was really very well accepted. That is the summary of it. But the key problem is awareness and education and with efforts, the civil societies can play a very big role in overcoming those ones. Thank you. So now funds have to be available. It is not a private partnership type program, this program we're talking about. I want you to speak to not just us, but to the government at this point, for us as a country to be able to get the funding needed, to be able to vaccinate or provide the vaccines for all stakeholders that need it. Because you might correct me. There is for the young children, 11, I think it's 11 to 18, there is the one for adults who missed the vaccination at that earlier on and can still get a boost, I think. Now, money needs to be provided for us to get, move forward. How do we speak to the government to let them know that, excuse me please, lives have to be saved here. And I'm not putting you on the hot seat because of this. No, I think that we have passed that position. I think I know for a fact that the government of Nigeria is keen to start this vaccination. The funds have been appropriated for it, but on our own we cannot do it. It has to be Gavi supported. For us to get the Gavi support, there has been a lot of proposals that have been put together and submitted. There were setbacks with the COVID pandemic and attention moved to as well as funding moved to battling the coronavirus. But we're back on track now and there is funding available for the vaccine. So there is the political world first of all and the funding is available. The parliamentarians are people that we visit and advocate to a lot and they have been very, very helpful as has been the Ministry of Health, the minister, the primary healthcare agency and so on. Everybody is keen to have this vaccine on board. There have been bottlenecks. I mentioned to you initially there was lack of availability. There is a wide inequity in that of the 194 countries that are members of WHO and supposed to be of the world. 107 now have that vaccination available. Now in the last year, in the last one year, I didn't even say in the last one month, I've definitely seen about five more countries come on board, Eritrea and so on in the last one month. So there's been great progress in 2022 regarding countries that are now providing its subsequent to the efforts that is being made to achieve the 2030 targets of elimination. Most of the countries that are left out of that are 197, 107 are from low-middling countries. Now for us to achieve that, there is an estimated at least 10 billion US dollars required dollar requirements. So this has to be a counterpart funding from the countries and also from donor agencies like Gavi and Gavi is a pool for vaccine from different sources, high income countries, even high net worth individuals, our own Elumelu donates to Gavi and is a major funder of Gavi through his foundation. So we do have the ability in terms of the funding, but it's just how quickly can we reach that goal? Right now, even as it is, it's one thing to say this country offers it, but the numbers as shows that of the world's total eligible girls, only 15% have received HPV vaccine. So there is a long, long way to go. And you know why that is Denise? Because the bulk of the numbers that need it of the 100% of girls that need HPV vaccine, I low middle income countries, I in Africa, I in Nigeria. Nigeria, we can say we've done 10 countries this year. And if you put them together, those 10 countries are not up to the population of Gavi states. So what are we doing until we address major countries with a population like Nigeria, then we're not going to get that jump that we need. It's really quite sad. And that this is where I say we need leaders to understand the unique position of Nigeria. If we can have such an impact on global health, something as massive as that, because of our numbers, it also means that we have the potential to have the positive impact just by our numbers in terms of production and other things that we do. So there has to be focus on Nigeria for us to be able to get to those targets. If we do not address Nigeria, then it's not going to be possible. Like I said, we're about to start. So we'll see maybe at the end of this year, if we talk from 15%, we might get to 30% if Nigerian girls are addressed. 2023 is a year we're going to hopefully be looking at making some small steps in the right direction. However, in the same conversation, the role of all of us stakeholders on the continent needs to also be expanded because I was with you in Geneva and I know what I saw and it was a very big eye opener for me because I then realized the difference between us as low income, low middle income country as against the globe. And the need for the funding. So going forward, governance structures need to be put in place towards eliminating it. You have talked about that going forward 2023. I want us to be able to pick two things that we're going to say at the end of this year, I can come back to you or anybody in this space and say, excuse me, especially all of us in the cancer space, how far have we gotten? Where are we? And even if we interview people in the communities, we will hear positive. Some people will be able to say, yes, I've felt the impact. Governance is very important and there are different levels of government. You have federal states, local government, then you also have civil society, you have the judiciary, all of these have to be carried along. And however, the key responsibility lies on the heads of the federal government. They have to dictate which way the country is going to go. And from then on, it flows easily. If the government provides HPV vaccine this year, then the onus is on all members of civil society to stand up and create the needed awareness and ensure that people are accessing these vaccines. If the government is going to provide adequate vaccination, there is a responsibility on our policy, on our parliamentarians to appropriate the right funding to continue getting this vaccine. So it doesn't just stop at, oh, I've given one dose, oh, we've given funding for this year and what happens in 2024, what happens in 2025, it has to be a continuous and increased process observing the numbers. So for us, we would like to see in place a very solid system from the federal to the local levels of governments. The health ministry of health and the primary healthcare agency have a huge responsibility, which I'm sure that they're quite capable of doing, of carrying people along, of knowing what is going on and of providing it in a safe and correct way at the primary healthcare centers. I was reading a report today, unfortunately about the state of our primary healthcare centers, but that's another conversation. But this is the only portion or the most important part of our healthcare system that needs to be strengthened to provide all the aspects that we need, vaccination, screening and early treatments. The early treatment is a very simple, easy thing and we're doing it in our general hospitals in Kaby now. However, it needs to be provided at the primary healthcare level with ease for the women. I want to say a very, very big thank you to you. Thank you for taking up your time. Thank you, Excellency, for joining in this discussion on the cancer elimination. It is going to be a conversation for the rest of the month because this month is the cancer, cervical cancer awareness month. So we also want to appreciate plus TV for sponsoring this cancer awareness program in Nigeria. And for all of you that follow us, thank you for sharing the videos, not just about from common cancer, but cancer is cancer and it doesn't matter where, we all need to be informed. We all need to know, we all need knowledge. Excellency, Dr. Zena Chinkafipu Baguru, I want to say a very big thank you to you. I don't take your time for granted or our relationship for granted. I really appreciate it. I joined my voice to appreciate Plus TV for giving you this time and I encourage them to continue. There's a huge part of the media, a role that media plays in this. Radio, TV, all forms of media. We must keep educating our people. We must keep educating even our governments and our parliamentarians on what to do with the legislators on what to do and how to do it right. So thank you so much for having me and you can always follow me, you know that. I know. Follow us all on our social media pages at Commode Cancer Foundation. Share, subscribe and click the notification. And you can always find Dr. Zena's NGO, it's there, the Medicaid, which you will see on the bio as we go along. Thank you very much for joining us and we're about to see you again next week. Thank you all. Thank you Dr. Zena, have a nice weekend.