“I bled and bled again, until I felt there was no more blood in my body.”
Age 65, Pascasie Nyirahirwa slipped into a coma and was rushed to the nearest hospital in Cyangugu, southwestern Rwanda where she was given three blood transfusions and diagnosed with cervical cancer. Her chances of survival were slim — it’s estimated that every two minutes, a woman dies from cervical cancer around the world.
Nyirahirwa survived but many women are not so lucky. Cervical cancer is the most common cancer affecting women in Rwanda and it kills 829 women each year. In 2022, cervical cancer killed around 350,000 women globally, according to the World Health Organization (WHO) with about 90% of deaths occurring in low- and middle-income countries.
Few diseases reflect global inequity as much as cervical cancer. More than 85% of those affected are young undereducated women living in poverty. The burden is the greatest in Africa where it’s the second most common cancer among women — and the deadliest.
In Rwanda today, Nyirahirwa may not have gotten sick at all thanks to a nationwide vaccination campaign.
Back in 2011, Rwanda became the first African country to implement the HPV vaccine which prevents infection by certain types of human papillomavirus, a virus that ultimately causes more than nine of every 10 cases of cervical cancer.
Rwanda took a landmark step in protecting young girls and women in 2011, when it was the first African country to introduce the human papillomavirus (HPV) vaccine against cervical cancer.
The HPV vaccine dramatically reduces the number of women who will develop cervical cancer. If given to girls before the age of 17, it reduces incidences of cervical cancer by 90% compared with women who are not vaccinated, according to a large-scale study conducted over an 11-year period.
“We know that cervical cancer is a preventable cancer, which is also potentially curable should we be able to diagnose it early enough,” says Dr Princess Nothemba Simelela, assistant director-general for family, women, children, and adolescents at the WHO. “Women continue to die needlessly from this cancer.”
In the first year of the scheme, Rwanda reached nine out of every 10 girls eligible for the vaccine and today continues to demonstrate one of the highest HPV vaccination rates in the world. In fact, officials say Rwanda could be the first country in Africa – possibly the world – to eliminate cervical cancer.
“We are among the frontrunners,” says Dr. Francois Uwinkindi, manager of the non-communicable diseases division at Rwanda Biomedical Centre, part of the Ministry of Health.
Part of the campaign’s success can be attributed to the way Rwanda’s Ministry of Health has worked with village elders, community leaders, churches, and schools to dispel myths around the vaccine and combat misinformation. First-person stories are shared in the magazines that Rwandan girls read and an army of community health workers go door to door in villages across the country to answer questions about the vaccine, raise awareness of the disease, warn of the dangers of cervical cancer, and encourage women to attend screenings.
A student at the Apapec Irebero school in the Gasabo district, Rwanda.
But Rwanda's journey was not without obstacles. A decade ago, HPV vaccination was not the global health priority that it is now.
It wasn’t until 2018 that the WHO’s Director General, Dr. Tedros Adhanom Ghebreyesus, issued a call to action to scale up prevention, detection, and treatment of cervical cancer.
Two years later, in 2020, for the first time in history, the world resolved to eliminate cervical cancer. The WHO adopted the global strategy for cervical cancer elimination by 2030. To eliminate cervical cancer, less than four in every 100,000 women must develop cervical cancer. To achieve the goal, countries must ensure 90% of girls are fully vaccinated with the HPV vaccine by the age of 15.
There were also significant cultural hurdles to overcome.
"Trying to understand the worries from our population was key," says Dr. Hassan Sibomana, who leads Rwanda's vaccination efforts.
"There are still women who think cervical cancer is as a result of witchcraft and visit witch doctors for treatment as opposed to medical doctors," says another cervical cancer survivor, Angeline Usanase, who lives in Rwanda's capital, Kigali. There were also rumors that girls would have their wombs removed or that the vaccine would make girls infertile.
Then, eliminating cervical cancer isn’t cheap, coming in at about $10.23 for every immunized girl.
Simelela believes that costs are so high because cervical cancer affects women, not men: “If this was a cancer that affected men in the way it does women, we would be having a different conversation.”
She adds: “What I see [worldwide] is women get a lot of attention when they’re pregnant, but beyond that nothing exists really in the public health system for women.”
Rwanda seems to be going against the grain here, finding a solution by partnering with a pharmaceutical company that donated two million doses of the vaccine over the first three years of the scheme’s roll-out. Since then, Gavi, the Vaccine Alliance, has covered the cost of vaccines.
“We know that if you empower women, you empower the entire family and society,” says Uwinkindi.
Disclosure: This article is part of a content series that was made possible with funding from the Bill and Melinda Gates Foundation.