A Preventable Cancer on Two Continents: What the United States Can Learn From Rwanda's School-Based HPV Vaccination Program
[Student Name]
University of Phoenix
NSG/486: Public Health: Health Promotion and Disease Prevention
Week 5 Assignment
[Instructor Name]
[Date]
The county example is a composite written for a model paper; national and international figures are cited.
Cervical cancer is one of the few cancers that the world knows how to eliminate. A vaccine prevents most of the infections that cause it, screening finds precancer early and treatment of precancer prevents progression. Yet the disease still kills hundreds of thousands of women a year, most of them in low- and middle-income countries. The difference between countries is not whether the tools exist; it is whether the systems that deliver them reach girls before they are exposed. This paper compares cervical cancer prevention in the United States and Rwanda, focusing on human papillomavirus (HPV) vaccination, and considers what the United States can learn from Rwanda's approach.
The Global Burden and the Elimination Goal
Sung et al. (2021), reporting global cancer statistics for 2020, estimated about 604,000 new cases of cervical cancer and about 342,000 deaths worldwide, with the highest incidence and mortality in sub-Saharan Africa. In 2020 the World Health Organization (WHO, 2020) launched a global strategy to eliminate cervical cancer as a public health problem, with three targets to be met by 2030: 90% of girls fully vaccinated against HPV by age 15, 70% of women screened with a high-performance test by age 35 and again by 45, and 90% of women identified with cervical disease receiving treatment.
The vaccine target rests on strong evidence. Lei et al. (2020), studying 1.7 million girls and women in Sweden, found that HPV vaccination was associated with a substantially lower risk of invasive cervical cancer, with the greatest reduction among those vaccinated before age 17. Vaccination at younger ages matters because the vaccine works best before exposure to the virus.
Rwanda's Approach
In 2011 Rwanda became one of the first African countries to introduce a national HPV vaccination program. Binagwaho et al. (2012) described how the Ministry of Health partnered with a vaccine manufacturer to obtain vaccine and built the program on the school system, vaccinating girls in the sixth grade in their schools and reaching girls who were not in school through community health workers and local leaders. In its first year, the program reported coverage of more than 93% of eligible girls for the full series.
Several features explain the result. The program used existing systems rather than building new ones, relying on schools that most girls attended and a large network of community health workers already trusted in villages. Community leaders, teachers and parents were informed before vaccination began, which reduced resistance. The vaccine was free, and girls did not need to travel to a clinic. The government treated the program as a national priority with clear leadership from the top.
The United States Approach
In the United States, HPV vaccine is recommended routinely at ages 11 to 12 for all adolescents and can be started at age 9. It is delivered mainly through primary care offices, with public funding for eligible children through the Vaccines for Children program. School-based delivery is uncommon. Pingali et al. (2023) reported that in 2022 about 76% of U.S. adolescents aged 13 to 17 had started the HPV series with one or more doses, and about 63% were up to date with the series, with coverage lower in rural areas than in urban areas.
The U.S. approach reaches adolescents who have regular preventive care visits, but many adolescents do not. Coverage also depends on a clinician's recommendation at each visit and on parents' decisions, which are influenced by concerns about safety and by the vaccine's association with a sexually transmitted infection. Unlike the other adolescent vaccines, HPV vaccine is not required for school entry in most states.
Why the Results Differ
Rwanda's coverage exceeded the United States' despite far fewer resources, which suggests that delivery design matters more than wealth. Three differences stand out. First, Rwanda brought the vaccine to where girls already were, while the United States waits for adolescents to come to a clinic. Second, Rwanda made the program a single national priority with coordinated leadership, while U.S. delivery is spread across thousands of practices and depends on individual clinician recommendations. Third, Rwanda engaged communities before vaccinating, which built trust, while U.S. public messaging has struggled with vaccine hesitancy and misinformation.
The comparison has limits. Rwanda's program vaccinated girls only at first, while the United States vaccinates both sexes. Rwanda's centralized health system allows decisions that a federal system like that of the United States cannot make nationally. And Rwanda still faces challenges in screening and treatment that the United States has largely met. The lesson is not that the United States should copy Rwanda's system, but that some of its design features can be adapted.
Screening and Treatment, the Other Two Targets
Vaccination protects future generations, but women who are already adults depend on screening and treatment. Here the comparison reverses. The United States has long-established cervical screening, with cytology and HPV testing widely available through primary care, although screening rates are lower among uninsured, rural and immigrant women. Rwanda, like many low-income countries, has had to build screening capacity, and approaches recommended by the WHO for such settings, including HPV testing with self-collected samples and screen-and-treat visits that remove the need for a second trip, are designed to reach women who cannot easily return to a clinic (WHO, 2020). A complete comparison therefore shows each country ahead on a different target: Rwanda on reaching girls with vaccine, the United States on screening adult women. Elimination requires both, which is why the WHO strategy sets all three targets together rather than letting countries choose the easiest one.
Lessons for a County School System
A public health nurse in a composite U.S. county where only about half of adolescents are up to date on HPV vaccination could adapt three features of Rwanda's program.
1. Bring the vaccine to schools. The health department can offer HPV vaccination at school-based clinics for sixth and seventh graders, with parental consent, alongside the other adolescent vaccines already required for school entry.
2. Engage the community first. Before the clinics, the nurse meets with school nurses, parent groups, faith leaders and pediatricians to explain the vaccine's purpose as cancer prevention, answer questions and invite trusted local voices to support the program.
3. Coordinate across providers. The health department can send reminders through the state immunization registry to families of adolescents who are due, and share school clinic records with each child's primary care office so that the series is completed in one place or the other.
The nurse would track the proportion of adolescents in the county who are up to date on HPV vaccination by age 13, using registry data, with the WHO target of 90% by age 15 as the long-term goal.
Conclusion
Cervical cancer can be eliminated, and HPV vaccination before exposure is the foundation. Rwanda, a low-income country, reached high coverage quickly by delivering the vaccine through schools, engaging communities and leading the program nationally. The United States, with more resources, has lower coverage because its delivery depends on clinic visits and individual decisions. A public health nurse can bring the lessons of Rwanda's program to a U.S. county through school-based clinics, community engagement and coordination, moving the county closer to the global goal.
References
Binagwaho, A., Wagner, C. M., Gatera, M., Karema, C., Nutt, C. T., & Ngabo, F. (2012). Achieving high coverage in Rwanda's national human papillomavirus vaccination programme. Bulletin of the World Health Organization, 90(8), 623-628. https://doi.org/10.2471/BLT.11.097253
Lei, J., Ploner, A., Elfstrom, K. M., Wang, J., Roth, A., Fang, F., Sundstrom, K., Dillner, J., & Sparen, P. (2020). HPV vaccination and the risk of invasive cervical cancer. New England Journal of Medicine, 383(14), 1340-1348. https://doi.org/10.1056/NEJMoa1917338
Pingali, C., Yankey, D., Elam-Evans, L. D., Markowitz, L. E., Valier, M. R., Fredua, B., Crowe, S. J., DeSisto, C. L., Stokley, S., & Singleton, J. A. (2023). Vaccination coverage among adolescents aged 13-17 years: National Immunization Survey-Teen, United States, 2022. MMWR Morbidity and Mortality Weekly Report, 72(34), 912-919. https://doi.org/10.15585/mmwr.mm7234a3
Sung, H., Ferlay, J., Siegel, R. L., Laversanne, M., Soerjomataram, I., Jemal, A., & Bray, F. (2021). Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA: A Cancer Journal for Clinicians, 71(3), 209-249. https://doi.org/10.3322/caac.21660
World Health Organization. (2020). Global strategy to accelerate the elimination of cervical cancer as a public health problem. https://www.who.int/publications/i/item/9789240014107
How this NSG 486 Week 5 example is structured
The University of Phoenix library guide for NSG/486 lists Week 5 as Global Health, the course's final week. The paper chooses one disease with a global target so the comparison has a measuring stick. It describes the global burden, then each country's approach and results, then explains why the outcomes differ before drawing lessons, so the recommendations follow from the comparison rather than from preference. The nurse's role closes the paper, linking global health back to local practice. Students search this week as NSG 486 Week 5, NSG486 Wk 5 or NSG/486 Wk 5; all three are the same assignment.
NSG/486 Week 5 questions, answered
What does NSG/486 Week 5 usually ask for?
The library guide for NSG/486 lists Week 5 as global health. Many sections ask for a paper comparing a health issue in the United States with another country, or describing a global health problem and the nurse's role, often with reference to World Health Organization goals. Check your instructions for whether a country is assigned.
How do I choose a country for the comparison?
Choose one with good published data on the issue and a clear contrast with the United States. A lower-income country that achieved a strong result, as Rwanda did with HPV vaccination, often makes a more interesting paper than a comparison with a similar high-income country.
Should the paper include recommendations?
Most global health prompts reward a paper that ends with what can be learned or applied. Keep recommendations tied to the evidence you presented and realistic for the setting you name.
Write yours, or have the desk draft it
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