By Mary Carol Jennings and Sarah Wanyoike
Dr. Christine Kaseba-Sata, former First Lady of Zambia, an obstetrician-gynecologist by profession, played a pivotal role in introducing human papilloma virus (HPV) vaccination across Zambia in 2013 as part of a national comprehensive cancer prevention initiative. She now serves as the Zambian Ambassador to UNESCO, France, and a number of other countries. Growing concerned about slow progress in expanding HPV vaccine access across the African region, in July of 2022, she agreed to our invitation to step into a role as an Ambassador with the CHIC Project (CHIC is the Coalition to Strengthen the HPV Immunization Community), serving as an advisor to the CHIC HPV Council. CHIC is a global consortium whose secretariat is comprised of the Johns Hopkins University International Vaccine Access Center, Jhpiego, and the University of Antwerp. CHIC is supported by the Bill & Melinda Gates Foundation. The CHIC Council brings together some of the world’s foremost HPV and cervical cancer prevention scientists and leaders in program implementation, united to ensure that the latest science shapes global dialogue and to nurture the community of practice of emerging leaders—particularly those from the Global South—toward a vision of cervical cancer elimination.
We caught up with Dr. Kaseba-Sata in her office in Paris, France at the end of August, and share a lightly-edited transcript of our conversation.
The CHIC Council is honored that you have accepted the invitation to serve as its Ambassador. Your presence and attention are highly sought after on a global scale—can you share with us your motivations for deciding to dedicate your time to this effort?
You know, the incidence of cervical cancer in Africa, and the number of our women dying from cervical cancer, is the highest in the world. When I received your call, I thought right away, this was an exciting initiative, and something I wanted to be part of. As a medical doctor, I have always embraced my professional calling, to save and improve lives, with a personal passion. And when it comes to the issue of cervical cancer, because of the too-long list of patients I have cared for who were so badly affected by this disease, I am compelled to do more. Many of my patients over the years have presented in the late stages of the disease, when all I could offer them was palliative care—sitting with the pain and anguish of a woman whose strength and promise for her community has been overcome by this preventable disease and holding the hands of family members as they grieve the loss of a woman in her prime. There have been so many times throughout my career when it was hard not to give in to feelings of hopelessness and frustration.
When I was First Lady, I wanted this vaccine for my own country because it offers a message of hope: our daughters need not die from cancer of the cervix. We can prevent it. We know the science behind this vaccine and behind immunization program efforts needed to make it accessible. What remains is the will and the push to implement proven strategies.
And yes, even for women who have aged out of the vaccination window, a good screening program represents the second and third components of a successful approach to cervical cancer: we can successfully treat cervical cancer only if we identify it early on.
This is my motivation, these are the reasons I decided to accept your invitation—I want to share the hope I have drawn from the few cervical cancer survivors I have been privileged to know, and my belief in our society’s ability to take the actions necessary to protect our girls for tomorrow. This is why I am involved in this cause and how I hope to work with the HPV CHIC Council to spread access to this vaccine, and the brighter future it offers, across our region.
You played a very important role in the introduction of HPV vaccines into the national immunization program in Zambia. Looking back, are there any actions you took, any conversations you had, that you feel were particularly critical in the national decision to go ahead with the vaccination program?
Being the First Lady of a country such as Zambia, you’re presented with a wealth of opportunities to meet and work with local, regional, and international leaders. In my very first few months in the role of First Lady, I worked with former U.S. President George Bush and his Institute, in developing an optimal approach for the Pink Ribbon Red Ribbon (PRRR) initiative to integrate cervical and breast cancer prevention and treatment efforts with our national HIV/AIDS programming. In December of 2011, Zambia became the first country to launch the PRRR initiative. I have always felt keenly that health—and disease—do not recognize borders, and it was important to me to support efforts to introduce sustainable approaches to preventing deaths from cancer and HIV/AIDS that were starting up in other countries around Zambia. I reached out to Mrs. Penehupifo Pohamba, the First Lady of Namibia at the time, who is a very good friend of mine, and encouraged her to add her voice, which led to more First Ladies getting involved. And so, I was able to play a key role in mobilizing some of these other First Ladies to add their voices to advocate for an integrated approach to cervical cancer prevention and other reproductive health cancers, at a time when those voices were particularly impactful.
Soon after this, in late 2011, as Gavi was opening up funding streams for HPV vaccine pilot programs, my involvement in advocating for prevention and women’s health put me in the position where the leadership of the Zambian health system counted on my support and advice on starting such a pilot in our country. Zambia’s pilot was one of the earlier ones, and I got to help Gavi better understand how best to introduce what was, at the time, a newly available tool to prevent cancer across Africa.
The physicians, scientists, and vaccine program experts on the HPV CHIC Council are keenly interested in better understanding how HPV vaccine touch-points might be leveraged to deliver other adolescent-centered health services. Could you tell us more about why you have suggested that the global community pay attention to integration with HIV/AIDS services?
Both HIV/AIDS and cervical cancer are major health concerns in sub-Saharan Africa. Cervical cancer is actually considered an AIDS-defining illness: having HIV/AIDS impairs the immune system’s ability to fight off high-risk strains of HPV, which puts a person at higher risk of developing HPV-related cancers, like that of the cervix.
I was a young attending physician when the very first antiretroviral therapies became available. During my first years of practice, our hospitals, including maternity wards, lost patients to HIV/AIDS almost on a daily basis. But today, those mothers have survived, and their children have survived, and antiretroviral therapies are presenting us with a novel challenge. There are so many girls who are entering their young adolescent years and have been on antiretrovirals their entire lives. Many families didn’t know how to explain the pills to a child, but now their girls have questions, and it’s time to explain. It just so happens that around that same age, girls are also eligible for HPV vaccination, and a girl with HIV/AIDS should receive an additional dose of the vaccine, beyond the routine schedule. By offering integration of HIV/AIDS services with HPV vaccination, clinics and health systems can provide support to these girls, and their families, to face this difficult set of conversations and transitions with a message of hope for their futures.
Ahead of the 33 rd board meeting of the Global Fund, I spoke out in support of the Fund allocating funding for cervical cancer programs. I was elated to learn of the board’s permissive recommendation to fund HIV/AIDS comorbidities, including cervical cancer and HPV infections. A few years later, that work for me came full circle as the Global Fund entered into a partnership agreement with PRRR that was focused on integration of screening and treatment programs. And, just as we’ve reached a tipping point in the Zambian national HPV vaccine program, we’re seeing families and girls coming into the clinic with a demand for access to the vaccine. I can see a future where adolescent girls, and boys, are sufficiently empowered that they come into the clinics asking for holistic care and they demand that their country’s health systems put their wants and needs first.
Dr. Kaseba-Sata will serve as the keynote speaker at a regional HPV vaccination technical advocacy workshop on the theme of energizing countries to “get it done” in Addis Ababa, Ethiopia, on September 26, 2022, hosted by the CHIC Council.