HPV vaccine: preventing cervical cancer for the next generation

Cervical cancer kills more Ethiopian women than any other cancer — over 4,000 deaths every year. Almost all of it is caused by a virus called HPV (human papillomavirus). Two doses of the HPV vaccine at ages 9-14 prevent it.

The vaccine is free. Ethiopia offers it in government schools and at health centres. If your daughter, sister, or niece is 9-14, this is one of the most important protections you can give her.

On this page

• What is HPV?
• Who should get the vaccine
• What the vaccine visit is like
• Common concerns
• What HPV does not prevent — screening still matters
• If you missed the vaccine as a teenager

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What is HPV

HPV is a virus spread through skin-to-skin sexual contact. It is so common that most people who have sex will catch it at some point. Usually the body clears it in 1-2 years.

But some HPV types stay in the body and slowly change cells in the cervix, vulva, vagina, mouth, throat, or anus into cancer over 15-25 years. Cervical cancer is the most common of these in Ethiopia.

The vaccine protects against the HPV types that cause about 90% of cervical cancers.

Who should get the vaccine

Best age: 9-14 years, before any sexual activity. The vaccine works best when given before exposure to HPV.

Ethiopia’s programme (2018 onwards):

• Girls aged 9-14 — two doses, 6 months apart. First dose usually in Grade 4 or at age 9-10 through school-based campaigns.
• Catch-up — girls aged 15-19 who missed the school programme can get vaccinated at any health centre. Three doses needed at older ages.

Free at government schools and health centres.

Boys — WHO now recommends vaccinating boys too (they can spread HPV and can develop HPV-related throat, anal, and penile cancers). Ethiopia’s programme has focused on girls first because of the cervical cancer burden, but discussion of boys’ inclusion is ongoing. Boys can be vaccinated privately.

What the vaccine visit is like

Two doses, six months apart. That’s it.

At the visit:

• The nurse checks that the girl is not currently sick with a high fever
• Injection in the upper arm — takes seconds
• Some soreness at the injection site for a day
• Occasional mild fever, headache, or dizziness afterward (usually settles in 24 hours)
• Fainting can happen right after (from the needle, not the vaccine) — the girl should sit for 15 minutes after

The second dose (6 months later) is critical — one dose is being studied but for now we rely on two.

Common concerns

::: factBox

The vaccine does not encourage early sexual activity

Studies from many countries show girls who get HPV vaccine start sex at the same age as girls who don’t. What it does change: fewer cancers in 20-30 years. :::

“My daughter is only 9 — she doesn’t need this yet.” The vaccine works best given BEFORE any sexual contact. Waiting until she’s older reduces effectiveness. Also — some girls face sexual assault they didn’t plan for; the vaccine protects them regardless of when they choose to be active.

“Is it safe?” Yes. Over 500 million doses given worldwide. Safety data from over 15 years. The most common side effects are sore arm, mild fever, headache — all short-lived. Very serious side effects are rarer than being struck by lightning.

“What if she has an autoimmune condition?” Not a reason to skip. The inactive-protein HPV vaccine is safe in autoimmune conditions. Discuss with the health worker.

“What about religious concerns?” Talk to your religious leader. Many faith leaders in Ethiopia and elsewhere have endorsed the vaccine as consistent with protecting women’s lives.

“My daughter fainted at her last injection — should we skip?” No. Fainting is a reaction to needles, not to any specific vaccine. Ask the nurse to have her lie down for the injection and rest 15 minutes after.

What HPV vaccine does NOT prevent

• Other STIs — HIV, syphilis, gonorrhoea, chlamydia. Use condoms and get tested (see HIV testing).
• Pregnancy — not a contraceptive.
• The 10% of cervical cancers caused by other HPV types.

That’s why cervical cancer screening is still important even for vaccinated women.

Screening — for women 30+ who never had the vaccine (or in addition)

Ethiopia recommends visual inspection with acetic acid (VIA) screening at least once between age 30-49 for all women — vaccinated or not. Free at government health centres.

The test:

• A nurse looks at the cervix with a speculum
• Applies vinegar solution
• Precancerous changes turn white and are visible immediately
• If found, treatment (freezing or LEEP) is often done in the same visit

Takes 10 minutes. No lab needed. Available at most primary health centres.

If VIA is positive → the health centre refers you to a district hospital for further treatment. Free.

If you missed the vaccine as a teenager

• Age 15-26: 3 doses at any health centre. Effectiveness slightly reduced (still worthwhile — most people haven’t been exposed to all high-risk HPV types yet)
• Age 27-45: WHO now says the vaccine is safe and effective, but public programmes may not cover it. Private clinics charge for it. Personal decision — the older you are, the more likely you’ve already been exposed.
• Screening (VIA every 5 years) is more important than late vaccination in this age group

When to see a health worker urgently

::: urgentAdvice severity=“urgent”

See a health worker if you have:

• Bleeding between periods
• Bleeding after sex
• Bleeding after menopause
• Watery, foul-smelling vaginal discharge
• Pelvic pain that doesn’t go away

These are not always cancer, but they need to be checked. Early cervical cancer is highly treatable. :::

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Reviewed by Dr. Hanna Alemayehu, MD, MPH — Family medicine, Addis Ababa

Sources: WHO HPV fact sheet 2024; Ethiopian MoH National Cancer Control Plan 2016-2020; WHO position paper on HPV vaccines 2022.

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Draft notes: ~1080 words · grade 7 · Ethiopian context: HPV in EPI since 2018, VIA screening at primary health centres, addresses common cultural + religious concerns respectfully, no shaming about sexual activity · Cross-references HIV testing.