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Colombia was a leader in the human papillomavirus (HPV) vaccination program, which causes several cancers in women and men. The cervical cancer prevention campaign launched in 2012 reached approximately 90% of girls aged 9 to 14 years. After Australia, Colombia was the second country to vaccinate the largest number of adolescents compared to the population. But in 2014, the percentage of girls who received the second dose was reduced to 27% and none of them went to receive the third dose. In 2016, the numbers dropped dramatically. Since then, the percentage has risen shyly, but it still does not reach 20%. (Read: opioid drugs: in Colombia, there are even inequalities to treat pain)
"If we had maintained coverage in 2012 and 2013, we would avoid 4,300 cases of cervical cancer and 1,900 deaths per year among women under 75," he said. The spectator the medical epidemiologist Cali Nubia Muñoz. "On the other hand, with a coverage of 5%, we will avoid only 220 cases of cervical cancer," he continued. In the early 1990s, someone who is a global authority has managed to demonstrate that HPV was the direct cause of cervical cancer or cervical cancer. Over time, this virus has also been associated with cancers of the vulva, vagina, penis, anus and oropharynx (palate and throat), extending its consequences also to men. (Read: The gray zone of drugs in Colombia)
In Colombia, after breast cancer, cervical cancer is the deadliest. Although there are fewer and fewer women dying from this cause, "it is urgent to really reactivate the immunization program," Muñoz said.
With this goal, experts from several countries have met in Bogotá in recent days to prevent and control HPV and the cancers it generates, based on the successes and problems it has had to face in some parts of the planet. .
The situation in some Colombian regions
In Carmen de Bolívar, the situation has not been easy since media episodes in 2014, when dozens of girls arrived at Nuestra Señora del Carmen Hospital with symptoms such as fainting, headaches and chest pain, numbness. in the arms and legs after receiving the vaccine. A study conducted by the National Institute of Health (INS) did not reveal any cause-and-effect relationship. The current Secretary of Health, Javier Luna, is convinced of the need to vaccinate girls to prevent future cases of cancer, but it was not possible to launch vaccination campaigns under his administration: neither his wife nor his boss, the mayor, they are convinced of the safety of the vaccine.
This situation has favored several studies, particularly on the social aspects of the vaccine. In Manizales, Gloria Sánchez, of the University of Antioquia, is conducting research to identify barriers and arguments in favor of HPV vaccine acceptance during its implementation between 2012 and 2014. Preliminary results show that between 60 and 90 percent of vaccinated girls said they were informed about the benefits of applying the vaccine.
In Arauca, with the help of the mayor, oncology specialist Carlos Castro of the Colombian Cancer League reported on the development of a campaign to increase confidence in the vaccine through a communication strategy and education. seeks to increase vaccination rates from 7 to 60% by the end of 2019.
A case of success is located in the south of the country: in early 2018, the first national day of vaccination took place in Pasto, in the state of Nariño, because it is the exemplary department of the country in HPV vaccination, according to 2017 figures. Dr. Diana Paola Rosero, Health Secretary of the Municipality of Pasto, confirmed it: in October 2018, the program for early detection of cervical cancer , with its cytology and vaccination components, already had 93% compliance. He explained that the strategy used was based on awareness, education and communication. His best ally was the mayor himself.
And at the global level … what happened?
Every year, approximately 83,000 women are diagnosed with cervical cancer in the Americas and more than 35,000 die, most of them under the age of 60. They could be more numerous without the prevention programs implemented in the region since the 1970s and including diagnosis and treatment, as well as the existing vaccine in the national programs of more than 20 countries in the region. since 2006. In Colombia, according to reports from the National Cancer Institute, the incidence and mortality of cervical cancer have declined over the last four decades ", thanks to the decrease in parity and improvement medical care. "
There are cases in the world where vaccine resistance has also led to the collapse of coverage figures, as in Peru, Denmark, Brazil, and Ireland, while it is important to note that there is no such thing as coverage. is one of the few cancers whose cause is well established and has the means to prevent it. During the event, representatives from these countries shared how they had survived the crises presented.
In 2011, Peru initiated HPV vaccination with 280,000 girls, while "anti-vaccine groups were attacked," said Marcela Lazo Escalante, a researcher at the School of Public Health of 39, Peruana Cayetano Heredia University. As a result, the Ministry of Health has stopped vaccination in schools. Figures decreased over the next three years until the launch of a major program jointly with the Ministry of Education. The first strategy was a big contest among the 24 regions of the country to choose the "champion of a new generation of women without cervical cancer". Women members of Congress, journalists and actresses supported the campaign. Lazo explained the training activities and communication materials with information about the virus, the vaccine and the myths. The figures reached a coverage of 98% in 2016. Lazo says that they acted quickly when an episode similar to that of Carmen de Bolívar, in a very poor population of Peru.
In Denmark, where 370 women are diagnosed each year with cervical cancer and 100 die of it, the vaccination program was launched in 2008, with coverage ranging between 88 and 93%. They then dropped to 16%, according to Robb Butler, a sociologist at Unicef, because of a reliability crisis in 2013, after some girls, almost all of them sporty, showed effects such as dizziness and tachycardia. The authorities reacted late, after a relative silence that played against vaccination. The communication campaign launched a few months later targeted editors, rather than reporters, "using narrative narratives and not data, using more emotion than information," Butler explained. "When we lose confidence in ourselves, it is extremely difficult to recover." Over the years, the numbers have started to increase again.
In Brazil, cervical cancer is the third leading cause of cancer death among women. They die 5,000 a year. In 2014, of 80 girls aged 11-13 vaccinated in a school, 13 had muscle weakness, temporary leg paralysis and numbness, but neurological examinations were normal. According to Ana Goretti Kalume Maranhao, of the Brazilian Ministry of Health, subsequent studies have shown that the incidence of serious adverse events between 2014 and 2018 was 0.67% out of a total of more than 24 million doses administered.
As a crisis of confidence, the representative of Ireland, Yvonne Morrissey, of the National Bureau of Immunization, described what happened after the first five years of vaccination, from 2010 to 2015, exceeded 80%. That year, he said, two groups of trained parents who, very active, questioned the safety of the vaccine through the media. Then, the government began to identify the population groups they should reach: parents, cancer patients, the education sector and the health sector. They spoke with them and opened a constantly updated web portal containing information on the scientific evidence of vaccine safety in simple, highly interactive language, where questions from parents or health staff are immediately processed. They have formed spokespeople authorized to speak with the media and have launched a campaign each year.
"We know that people who are against vaccines have a personal story," Morrissey said. Laura Brennan, a 25-year-old Irish woman with end-stage cervical cancer, went to the Office and offered to promote the vaccine. Coverage figures have started to increase. "We are overcoming the crisis of confidence," he said. The media changed their speech: after publishing negative stories, they published positive articles on the importance of the vaccine.
In Panama, on the other hand, the vaccination strategy has been implemented in public and private schools through visits, fairs, messages to churches, bus terminals and shopping malls targeting girls and women. the boys. Statistics show the rise in the curve since 2008, reaching 81% coverage. "The cascade training was fundamental to ensure the start of vaccine implementation in all regions of the country," said Itzel de Hewitt, general coordinator of the Expanded Immunization Program of the Panama Ministry of Health.
Lessons learned
Since 2008, the National Institute of Health has a surveillance system called Sivigila, which continuously records, inter alia, the events supposed to be attributed to vaccination or vaccination (ESAVI) in 1 117 municipalities of the country. According to INS Director of Surveillance and Risk Analysis in Public Health, the medical epidemiologist Franklin Prieto, there has been between the years 2012 and 2018 that & # 39; 39, a single serious case related to the tetravalent vaccine against human papillomavirus: urticaria. it was complicated. In 58% of the cases, the vaccinated women had a headache, while hardening and reddening of the skin, local pain and mild urticaria occurred in less than 9% of the vaccinated women. These are symptoms described by manufacturers, as well as by cancer societies. The data reflect that it is a safe vaccine, concluded Prieto.
This data provided some peace of mind to event participants, who asked to make public these statistics on the side effects of the vaccine to compensate for the lack of credibility, while the director of the Oncology Center Javerian, Raul Murillo, has dared to conclude. "It appears from the presentations that the medical community does not seem to play an important role in restoring trust."
The biologist holds a doctorate in public health, Eduardo Franco, current chair of the Department of Oncology of the Faculty of Medicine at McGill University, Canada, said The spectator this science found only a disturbing, but extremely rare, side effect: anaphylactic shock, which occurs in three out of every one million people vaccinated and occurs within the first few minutes after the injection, which is why it is necessary to be accompanied Professional health care staff who react immediately to control the effects.
The group of experts attending the meeting acknowledged the strengths of immunization programs, based on sound scientific evidence on the safety of the vaccine. He encouraged the launch of awareness campaigns targeting population groups including health professionals, the education sector and parents. In the Colombian case, an alliance was suggested between the Ministries of Health and Social Welfare and the Ministry of National Education. "We need the help of doctors, public health staff, the general population and the media to reactivate this vital program of preventing cervical cancer," said Dr. Nubia Muñoz.
The problem is communication, said Dr. Mark Kane, today an international consultant. "When we communicate with people, we can not be very serious or give them data," he said. "It is necessary to use our limbic system, which governs emotions and memories."
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