Ilocos Norte town stands out for anticancer drive

TARGET MET Mayor Chrislyn Abadilla of Banna, Ilocos Norte, who is a physician by profession, administers an HPV vaccine shot to a 9-year-old school girl on May 10. Banna became the first local government unit in the country to achieve 90-percent vaccination of girls age 9 to 14 in the fight against cervical cancer. —photo from Disease Prevention and Control Section, DOH-CHD ILOCOS

MANILA, Philippines — On May 10, the town of Banna in Ilocos Norte province achieved a medical feat not even the richest cities in the country had done.

With its meager resources, the fourth-class municipality was able to vaccinate almost a thousand of its girls age 9 to 14 with two shots of the human papillomavirus (HPV) vaccine, which protects them from various HPV infections that lead to the fatal cervical cancer.

This made Banna the first and only local government unit (LGU) in the country to immunize 90 percent of its target population with the HPV vaccine. This was among the goals set by the World Health Organization (WHO) to eliminate cervical cancer in the coming decades—which countries around the world, including the Philippines, committed to achieve by 2030.

READ: ‘Cervical Cancer: ‘Di mo DeCerv’: Igniting hope in the fight against cervical cancer

Banna Mayor Mary Chrislyn Abadilla admitted that this milestone was not an easy task, since vaccine hesitancy among parents was still prevalent in the country.

Some even downplayed this feat, since the small town only needed to fully vaccinate less than a thousand girls, compared with the larger towns and cities.

But Abadilla, being a physician, was herself a considerable advantage for her municipality—with her knowledge and expertise in implementing immunization programs.

For the mayor, it was a combination of the assistance of the Department of Health (DOH) and Department of Education, “a little bit of political will, and most importantly, the passion to serve my people” that helped her town achieve its vaccination target.

“We are hoping that [Banna is] not going to be the one municipality in Ilocos Norte that will be able to reach this goal. We are wishing that some municipalities and cities in other provinces will also emulate what we did in our humble town,” Abadilla said last week during a “cervical cancer elimination summit” in Quezon City—the first such forum in the country, timed with Cervical Cancer Awareness Month in May.

Toll on women

Thanks to HPV vaccination and early screening, cervical cancer is one of the most preventable cancers.

And yet it remains the fourth most common neoplasm affecting women worldwide, causing 350,000 deaths in 2022 alone.

In the Philippines, cervical cancer is the second most common cancer among women after breast cancer—with almost 40 million between the ages of 15 and 44 years old at risk of the disease.

It is the fourth leading cause of death among Filipino women, claiming the lives of 4,052 in 2022 alone, or equivalent to 12 mothers, sisters or daughters killed each day.

It was only in 2015 that HPV vaccination was included in the National Immunization Program of the DOH. From being community-based, HPV vaccination became school-based starting in 2017 to better reach the target population of school-age girls 9 to 14.

Low vaccine coverage

The HPV vaccine is available for free. “These life-saving, safe and effective HPV vaccines are being given to us LGUs for free by the DOH. Of course, it is our duty that we are able to give it to our constituents,” Abadilla said.

Yet, the Philippines still ranks last in terms of HPV program coverage among low-to-middle income countries.

According to data from the WHO and the United Nations Children’s Fund (Unicef), only 23 percent of the country’s female population of 30 million as of 2021 were able to get their first dose—and only 5 percent were able to complete the second dose.

Vaccine coverage was even lower, based on the estimate of epidemiologist John Wong, president of EpiMetrics. According to the health research institution, the average HPV vaccination rate over the past eight years was only 4 percent for the first dose and less than 1 percent for the second dose.

Frances Ngo, a professor of the College of Pharmacy of the University of the Philippines in Manila, said most studies show that the Philippines could eliminate cervical cancer between 2071 and 2098, but only if it commits to the WHO’s “90-70-90” targets.

According to that formula, 90 percent of Filipino girls must have been vaccinated against HPV by age 15; 70 percent of women between 35 and 45 must have been screened; and 90 percent of women with cervical diseases should be getting treatment.

“But if we continue with the status quo, … we will not be eliminating cervical cancer within this century,” Ngo said.

‘A little push’

Abadilla said “We need to keep in touch with our people. As local chief executives, we need a little push, for our people to trust us.”

“Our constituents voted for us, and they will trust us even more if we have clearly explained to them how this HPV vaccination will protect their daughters.”

The mayor recalled that when she was elected in 2022, among her first actions was to mobilize the barangay health workers in the town’s 20 villages to find all the 1,088 girls between 9 and 14.

In November that year, Banna started vaccinating the first batch of schoolgirls. But it was only in May this year that the town was able to expand the 90-percent target of vaccine coverage for these girls.

Convincing the parents

Other local officials had asked Abadilla how she was able to persuade the parents of these girls, who are minors, to have them vaccinated.

These officials said it was difficult to convince the parents after 14 schoolchildren died in 2016 following the vaccination campaign on the antidengue jab Dengvaxia.

Abadilla said she had talked to the school heads in the town, who in turn organized parents-teachers meetings, where she was able to personally discuss with the parents the benefits of HPV vaccination for their daughters.

The mayor also said she had her only daughter vaccinated against HPV.

“This [HPV vaccine] is one of the best gifts that you can give to your daughters. As they get older, you can sleep soundly at night knowing that your daughter will not get cervical cancer because they had been protected years ago, because you let them get protected,” Abadilla remembered telling the parents.Banna’s HPV vaccination coverage reached 91.16 percent by the middle of May, she said.

“Our town is small, but it has a resounding effect in Ilocos Norte, with several LGUs in the provinces also pledging to continue the feat we have started,” Abadilla said.