To close out the year, this month we met with Valerian Mwenda, a Senior Technical Advisor working at ThinkWell. Valerian is an epidemiologist, health economist, and a health policy analyst based in Kenya, working in the human papillomavirus (HPV) vaccination and cervical cancer control space.
What do you think are the key challenges that Kenya’s HPV vaccination program faces?
In Kenya, we have significant subnational disparities in terms of access to healthcare, level of education, the strength of health systems. These differences can be seen when you examine HPV vaccination coverage. Nationally, the first dose coverage was around 58% and second dose 29% in 2022. Yet at the subnational level, some counties have achieved a 90% HPV vaccination rate, while other counties have very low coverage. We have counties in Kenya that have more girls out of school, nomadic populations, and also some vaccine hesitancy. This leads to young girls not being adequately reached with this vaccine. During the National HPV and Cervical Cancer Symposium last month, key stakeholders noted that the HPV vaccination program needs to more effectively reach out to parents.
Last year, you published a study on the cost-effectiveness and budget implications of HPV vaccination in Kenya. Can you provide some background of this study?
The HPV vaccine was introduced in Kenya in October 2019, but its rollout faced significant disruptions due to the COVID-19 pandemic. Also, with Kenya preparing to transition from Gavi support, the country needs to increase domestic funding for vaccines. There was a widespread concern that some vaccines would be deprioritized, so economic evidence on maintaining and scaling up HPV vaccine in Kenya was very much in need.
What were the main methodological issues you ran into in implementing this study?
The biggest issue I ran into was around data availability. We used the UNIVAC model for our study which has specific data requirements, and the data we found was often not in the form we needed it to be in. So, I had to do some data mining and cross-referencing data from a variety of sources.
What were the policy implications of these findings?
Our findings formed part of wider policy thinking on the economic case for Kenya attaining cervical cancer elimination targets. In Kenya, we have a National STOP Cervical Cancer Technical working group bringing together various stakeholders from the county governments, civil society, and academia. It also brings together two government programs – the National Vaccines and Immunizations Program (NVIP) and the National Cancer Control Program (NCCP). We worked with this technical group to refine study questions and disseminate findings as quickly as possible to the Kenya National Immunization Technical Advisory Group (KENITAG) to advise the government to scale up the HPV vaccination program.
You also participated in a research collaboration that modelled the expected impact and cost effectiveness of a single-dose HPV vaccination schedule. What did this study find and how has this evidence been used?
The study found that a switch would generate significant savings that could be reinvested to accelerate cervical cancer elimination. Just as with the previous study, we ensured that our findings were shared with NVIP as soon as they were available. I’m not privy to the ongoing discussions, but the KENITAG is in the process of advising the Ministry of Health on what route to take with regards to adopting a single dose schedule.
You have just started a new project at ThinkWell to advance cervical cancer elimination in Kenya. Can you tell me more about this?
We will develop a costed national cervical cancer elimination action plan that will go hand-in-hand with the cervical cancer elimination strategy, which is part of the National Cancer Control Strategy. We will lay out concrete and costed steps that can move the country forwards to achieve targets and eliminate cervical cancer, capitalizing on the current political momentum. We will develop economic evidence to ensure the action plan prioritizes the most cost-effective interventions, and we will develop an investment case, and an advocacy strategy to disseminate the action plan and ensure its implementation.
You have also supported cervical cancer control efforts through the development of the National Cancer Control Strategy. Can you tell us about the process, and any lessons learned?
I provided technical advisory support for the development of the National Cancer Control Strategy 2023-2027, which was built on the previous National Cancer Control Strategy 2017-2022. The development process brought together national and global stakeholders, under the tripartite United Nations support arrangement for cancer control planning. There is great political will to improve cervical cancer prevention in the country, and Kenya policy making is carried out through a consultive approach, which includes the participation of people with lived experiences. While sometimes this process means decision making takes longer, by moving together you create change.
Can you elaborate on other health economic modelling projects you have worked on related to cervical cancer elimination?
I have been working on another modelling study which compares approaches for scaling up HPV testing, though this is not yet published as I am currently adjusting the model.
And finally, where is your favorite place to travel?
I like Turkey, particularly Istanbul. It is a city of dual personality with its European and Asian sides. It is a cool blend of modern and medieval.
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