(CNN)Girls began queuing at their local school with their friends, waiting for their names to be called. Many were apprehensive. After all, most of them had not had a vaccination since they were babies. It was 2013 and a new vaccine had arrived in Kanyirabanyana, a village in the Gakenke district of Rwanda.
Why Rwanda could be the first country to wipe out cervical cancer
Three years before, Rwanda had decided to make preventing cervical cancer a health priority. The government agreed a partnership with pharmaceutical company Merck to offer Rwandan girls the opportunity to be vaccinated against human papillomavirus (HPV), which causes cervical cancer.
Cervical cancer is the most common cancer in Rwandan women, and there were considerable cultural barriers to the vaccination program -- HPV is a sexually transmitted infection and talking about sex is taboo in Rwanda. Added to this, rumors that the vaccine could cause infertility made some parents reluctant to allow their daughters to be vaccinated.
Rwanda's economy and history also made it seem an improbable candidate for achieving high HPV vaccination coverage.
After the 1994 genocide, it was ranked as one of the poorest countries in the world. High-income countries had only achieved moderate coverage of the HPV vaccine; if the United States and France couldn't achieve high coverage, how could Rwanda?
Worldwide, cervical cancer is the fourth most common cancer in women. There were an estimated 570,000 new cases in 2018 -- and over 310,000 deaths, the vast majority in low- and middle-income countries. Sub-Saharan Africa has lagged behind the rest of the world in introducing the HPV vaccine and routine screening, which means the cancer often isn't identified and treated until it has reached an advanced stage.