By Thabisani Dube
At Detema Secondary School in Matabeleland North, 11-year-old Kudzai Ndlovu hesitated before entering her classroom, where nurses were preparing to administer human papillomavirus (HPV) vaccines.
“I was scared,” Kudzai said after receiving the injection.
Her experience reflects a challenge facing Zimbabwe’s HPV vaccination programme: protecting girls from a virus that can cause cervical cancer while addressing fears and misinformation that can discourage parents from allowing their children to be vaccinated.
Zimbabwe introduced HPV vaccination nationally in May 2018, initially targeting girls aged 10 to 14 through mainly school-based vaccination. The programme was supported by the Government, Gavi, the Vaccine Alliance, the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO).
HPV is a common sexually transmitted infection, and persistent infection with high-risk HPV types can cause cervical cancer. WHO says cervical cancer is largely preventable through HPV vaccination and screening.
Zimbabwe continues to carry a heavy burden of the disease. The International Agency for Research on Cancer (IARC) estimates that 3,520 women were diagnosed with cervical cancer in 2023 and 2,318 died from the disease.
At Detema, Deputy Head of School Siphilile Mkosana said the school provides information before vaccination days.
“Schools teach pupils about HPV and the significance of the vaccination,” she said.
However, some parents still withdraw their children because of concerns about vaccination, she said.
Nurse Nozihlobo Ncube, who supports school outreach programmes in Tsholotsho District, said health workers engage teachers and parents before administering the vaccine.
“We meet with both teachers and parents prior to administering the vaccine,” she said. “When we educate our community about the vaccine, they can be less resistant to accepting it.”
Evidence from Zimbabwe’s early national programme shows the importance of school-based delivery. A 2019 survey in three districts found on-time first-dose uptake of 88 to 94 per cent and two-dose coverage of 75 to 86 per cent. Nearly all doses in the survey were delivered through schools. However, the researchers cautioned that the survey was not nationally representative.
A separate study of Zimbabwe’s 2018–19 national introduction found that the first campaign achieved 83 per cent administrative coverage for the first dose, while the second campaign recorded 67 per cent coverage for the second dose among the initial multiple cohorts. The study also documented the importance of collaboration between health and education authorities and the use of school-based delivery.
For some parents, however, concerns about possible side effects remain.
In Harare, mother of two Charity Mudavanhu said she stopped her other daughter’s vaccination after she believed the child had begun menstruating earlier than expected following an injection.
“I became afraid and decided not to continue,” she said.
The concern is not supported by evidence that HPV vaccination causes reproductive problems. The World Health Organization’s vaccine-safety review says available evidence does not support a causal relationship between HPV vaccination and infertility or premature ovarian insufficiency.
For Loretta Ncube, a parent in Gweru, information changed her decision.
“I was unsure at first,” she said. “But after the nurses explained, I agreed because it protects her future.”
Kudzai also felt differently after receiving the vaccine.
“It was quick,” she said.
The United Nations Children’s Fund reported that by June 2024, more than 126,000 girls had received a first HPV dose and 68,277 had received a second dose across 11 districts covered by integrated outreach programmes.
The Cancer Association of Zimbabwe (CAZ) says prevention is particularly important in a resource-constrained health system.
Lovemore Makurirofa, CAZ Advocacy and Communications Officer, said:
“In a developing country where resources are very limited, we need to focus more on the prevention.”
He said misinformation remained a challenge, drawing comparisons with concerns experienced during the COVID-19 pandemic.
“The same misinformation we saw during the COVID-19 period is common in our communities,” Makurirofa said, calling for health authorities and civil society organisations to provide accurate information about the vaccine.
The World Health Organization’s cervical-cancer elimination strategy calls for countries to achieve three targets by 2030: 90 per cent of girls fully vaccinated against HPV by age 15, 70 per cent of women screened with a high-performance test by ages 35 and 45, and 90 per cent of women identified with cervical disease receiving appropriate treatment.
The vaccination target cannot be considered in isolation. The World Health Organization stresses that vaccination, screening and treatment must work together if countries are to eliminate cervical cancer as a public-health problem.
For Zimbabwean girls such as Kudzai, the immediate experience is simple: a brief injection and a moment of fear.
The potential benefit is much longer-lasting — protection against HPV-related cervical cancer and a greater chance of reaching adulthood with access to one of the most important tools available for preventing the disease.
For the health system, the challenge is ensuring that protection reaches girls consistently, that parents receive accurate information, and that vaccination is accompanied by the screening and treatment services needed to meet Zimbabwe’s wider cervical-cancer prevention goals.
