Cervical Cancer prevention in Solomon Islands - latest update

National Cervical Cancer prevention program set to launch in Solomon Islands next month.

I am very proud to share with you some news very close to my heart, that in May 2019, Solomon Islands will be launching their national HPV vaccination program as part of their national immunization schedule.

This completes a major milestone in a journey started by my mother Margaret Atkin many decades ago after my dad’s first born sister died in her 30s from cervical cancer in Honiara in the 1980s.

This troubled my mum greatly and her first step was undertaking her Masters thesis in Public health in the early 1990s in Brisbane researching cervical cancer in the Solomons.

She then spent a few years pursuing different approaches to reduce the burden of cervical cancer in Solomons such as travelling on foot across Makira delivering education and training program (in her spare time while working fulltime and supporting her 2 sons as a single mother in Brisbane) before realising that HPV vaccination would be a gamechanger in a developing country with low density population spread across dozens of islands where there was never any likelihood of pap screening reaching more than 1% coverage. Or even if detected, the medical services couldn't successfully treat more than the early stage cases assuming that women could make their way to Honiara for treatment.

However HPV vaccination was still an impossible challenge until she met Joe Tooma, CEO of Australian Cervical Cancer Foundation (ACCF - the organisation setup by HPV vaccination founder Prof Ian Fraser). With Joe's support, they identified a 5 year+ pathway for Solomons to introduce National HPV vaccination supported by international health donor GAVI (largely funded by first world countries and the Bill and Melinda Gates Foundation).

This GAVI pathway involved very strict requirements and the first step was a complex 60 page application for an initial 2 year demonstration program across metro and rural regions that described a blueprint of how the country would run such a program and required approval signatures from the Ministers of Health and Education.

The second step was successfully running the 2 year demonstration program with rigorous evaluation of vaccination coverage and the program.

The third step was a GAVI application to introduce the program nationally based on the success of the demonstration program.

HPV vaccination is a complex public health program to design and run for a few reasons:

1) Delivery model - most immunisation programs in developing countries are for babies. Mothers are well aware that their babies need their needles to protect them and so most will go to their rural clinics when required. In these developing countries where childhood mortality is high and prevalence of life threatening disease is high, this is well understood and supported. However HPV vaccination targets girls between 9 and 14, when girls are in school so the vaccine delivery modality is much different and also needs to account for girls not attending school.

2) Communication of the program is complex. Firstly communities needs to understand the concept of cervical cancer, although once the symptoms are explained, many people are aware. From our own research, we identified that in rural areas many women were dying of cervical cancer-like symptoms without much of this data ever reaching the cancer data team in Honiara. After explaining cervical cancer, the linkages to HPV and the HPV vaccine need to be explained, then why the target group is young girls prior to sexual activity. This is complex messaging especially in a country with many different languages and dialects. There are also myths to dispel such as that the vaccines for girls are part of a western plot to sterilize the country's population.

There were also many other challenges to work through such as the cold chain infrastructure that ensures vaccines are properly transported and stored, and the logistical challenges of reaching the target group across an archipelago with low density population across many different islands - which significantly increased cost of delivery per person.

Mum volunteered her time in 3 month blocks over a couple of years, supported by and operating through ACCF, to progress the program, build local support and capability with the Solomons Ministry of Health, WHO and other stakeholders. Initially this was for stage 1 which was to develop the program blueprint and application for the program for the 2 year demonstration program. She used her decades of experience in the Solomons, her networks and her persistence and passion. Some of the senior medical staff working in the Ministry of Health were trained by her in nursing in the 1970s.

I provided program support over these first couple of years which included volunteering my time for 8-10 days at a time in Honiara. My main focus was providing support in writing the 60 page application.

We were also very fortunate to have the support of the world leading expert of HPV vaccination programs in developing countries – epidemiologist Dr Scott LaMontagne who works primarily through PATH and supports developing countries globally with HPV vaccination.

This support was also combined with strong local leadership of Dr Divi Ogaoga, Director of Reproductive and Child Health at the Solomons Ministry of Health and Medical Services.

My direct involvement ceased after the first 2 years (2013-15) when a couple of key outcomes were achieved – firstly the application for the 2 year demonstration program was approved and funded by GAVI, secondly the local Ministry of Health took ownership of the program and I was confident that they would see the program through to a successful outcome.

Mum continued to support the program as they went into the micro planning stage for the first year of the demonstration program before we felt that she could transition out of direct involvement.

We have stayed connected for the last 4 years monitoring the progress through the demonstration program and then application for national program, a few times when there were major issues mum was ready to jump on a plane and go and help out, but it wasn’t necessary. Mum also continued with some other projects including supporting to initiate a project to support women with low cost and realtime cervical screening and treatment with Family Planning NSW in Solomons using Visual Inspection with Acetic Acid (VIA) and cryotherapy.

Despite some of the current political challenges faced in the Solomons, the people of the Solomons can and should be very proud of their achievements in getting to this stage where they are ready to launch their national HPV vaccination program, which means that in the next 20 years, many, many women across the Solomons will not die early of cervical cancer, nor will families and communities be deprived of their mothers and leaders.

Many thanks again to the wonderful people who supported and continue to support this lifesaving program including my mum Margaret Atkin, Joe Tooma, Dr Scott LaMontagne, Dr Divi Ogaoga, Dr Leanne Panisi, Dr Roger Maraka among many others.

On a footnote, at the end of my last involvement in this program in mid 2015 as I was enjoying a cold drink seaside in Honiara, my cousin came to me and asked me to help our family back home in Makira. This discussion eventually turned to cocoa and a few months later began my next chapter, Makira Gold my cacao/chocolate social enterprise to help Solomon Islands cacao farmers and their families. This is a story still in progress...