Accelerating Women’s Healthcare in Africa through Scientific and Innovative Approaches

Dakar — Healthcare for women is moving forward, from having their sexual and reproductive rights left out of many countries’ policies to having access to contraceptives and health services previously denied to women.

But science and innovation can accelerate women’s healthcare even more, and experts at the Grand Challenges meeting in Dakar, Senegal, under the theme Science Saves Lives, gathered to reflect on the past and plan for the future.

The Bill & Melinda Gates Foundation launched the Grand Challenges in Global Health initiative in 2003, focusing the initiative on 14 significant scientific challenges, but more challenges were subsequently added.

Helen Rees, Executive Director at the Wits Reproductive Health and HIV Institute, spoke on the progress made in women’s health in the past 80 years, from a focus on contraceptives to looking at child survival, maternal mortality, and sexual and reproductive health. Rees said lack of investment is one of the biggest challenges in women’s health.

And despite available drugs on the market and clinical trials for diseases, Rees said that women are still excluded even though the interventions could be life-serving for them too, sharing an example of how many tests and research exclude pregnant women.

To look for scientific and innovative ways to solve some of these challenges the Bill & Melinda Gates Foundation launched the Grand Challenges in Global Health initiative. When it was launched in 2003, the initiative focused on 14 significant scientific challenges but as years went on more challenges we added.

Focus on cervical cancer

Cervical cancer is mainly caused by the infection of the cervix by the Human Papillomavirus (HPV), which is sexually transmitted. In the region of 70,000 cervical cancer deaths could be avoided on the continent if efforts to eliminate the disease by 2030 are ramped up. According to the World Health Organisation (WHO), there is no treatment for the virus itself, but there are treatments for the health problems that HPV can cause, and the risk of infection and developing cervical cancer is much higher for girls and women living with HIV. The WHO recommends the HPV vaccine for the protection of girls between the ages of 9 to 15 which will protect them from getting cervical cancer later in life.

The HPV vaccine is available for young girls in some African countries but stigma and lack of awareness leave too many girls unvaccinated and not enough women screened. If women are not screened, the chances of the cancer being caught early are few, leaving them vulnerable to the disease at a later stage.

“If you have worked in our settings, such as the gynecological ward where women sit with late-stage cervical cancer … I always say the thing about that ward is that it’s a space of suffering. You smell it before you enter the ward. And when you walk in there, and you listen to the women’s stories on how they come in bleeding, pouring urine and stool, and yet, we know, this is a disease that needs not happen. It’s a completely preventable cancer,” said Dr Nelly Mugo, Principal Senior Clinical Research Officer at the Kenya Medical Research Institute.

Mugo and Dr. Maricianah Onono, Prof. Elizabeth Bukusi, Dr. Betty Njoroge, and Dr. Ruanne Barnabas conducted a randomized controlled trial of 2,275 women in Kenya that showed that a single dose of the HPV vaccine was highly effective.

“We know that the HPV vaccine was registered in 2006 and that it has been implemented in high-income countries for the three doses but this wasn’t happening in low middle-income countries. We didn’t we didn’t have access to the vaccine for many years. And then GAVI made it possible.

But there was good data that started to show up from India, Iraq, and Costa Rica, that the women who ended up getting one dose had stayed protected from infection. So that stimulated this trial, where we randomized women to one dose of the Meningococcal vaccine and we selected women ages 15 to 20, who were not eligible for vaccination we followed them up for incident persistent HPV infection, and the DSMB at month 18 said this data is amazing. And they unblinded us. And we found that we had efficacy levels for single dose equivalent to the market at three dose trial data,” Mugo said.

After their study, Mugo said countries like Australia and the United Kingdom were the first to change their guidelines and use the single-dose HPV vaccine.

“So that was amazing data. But the question people then asked was, is it durable? But then we know that the observational studies had more than 10 years of data showing durability that those women who had been in observation had remained protected.

However, we have continued to follow up with this cohort of women 20 to 75 young women, and we have data that was presented this year at the International Papillomavirus meeting that demonstrated up to 98% efficacy for protection from HPV 16 and 18 that cause 70% of cancers and 97% for the other additional high-risk HPV types in a novella vaccine.

Now this is amazing. We were excited and the world has remained excited many countries are now adopting single doses as the way to deliver HPV vaccine and doing something to move our countries towards the elimination of cervical cancer,” said Mugo.

She said inequity drove this investigation but is happy that their investigation has been beneficial to the world.

“Delivering in one dose is easier. It’s cheaper, and you do better coverage. We can expand the age band of women who are receiving it and we have a higher likelihood of doing gender-neutral vaccination. We don’t have data on boys, but it means we have more vaccines for more people and can move closer to elimination,” she said.

Jeffrey Stringer who is a Professor of Obstetrics and Gynecology, at the University of North Carolina School of Medicine, said there have been many improvements in women’s healthcare. Stringer worked in Lusaka,  Zambia for 11 years between 2001 and 2012, where he established and led the Centre for Infectious Disease Research in Zambia (CIDRZ), and spoke about “two huge” changes.

“One is that the technology of ultrasound has become miniaturized and made much cheaper by production on a large scale in China and other places. The second is that computers can replace some of the things that we do as doctors.

One of those things is recognizing and categorizing images, yes computers can’t do human being type of things, but they can do that, they can make very good diagnoses.

And so it occurred to us fairly recently that maybe we can take advantage of these new technologies and revisit this idea of democratizing ultrasound and getting it into places where it’s traditionally not been available. We can make all manner of diagnoses now, in some cases we can make those better than a trained sonographer,” Stringer said.

He said this is not being used as a way to replace human-based decision-making and care that everyone recognizes as important to delivering good outcomes, but as an important tool that allows researchers and doctors to extend their reach and to essentially democratise the benefits of the technology, and get it into more far-flung places to improve outcomes worldwide.

“Right now what we need for HPV vaccine is scale, urgent, global scale up and coverage, because data has shown that you need at least a coverage of 50% and above to have population impact. But we are battling against this thing called vaccine hesitancy and misinformation,” Mugo said.

Mugo urged everyone present at the meeting to be advocates for HPV vaccination in hopes that they would spread the message and get all young women vaccinated and also called on men to get involved so that the women in their lives are screened.