Lesotho Steps Up Fight Against Cervical Cancer
Lesotho has one of the world’s highest cervical cancer rates – but with enhanced HPV vaccination and screening campaigns, and a brand-new cancer hospital now under construction, women’s prospects are looking up.
2 April 2025 by Pascalinah Kabi
Est. Read Time: 7m
“To my guardians who allowed me to receive this HPV vaccination, I thank them because I believe they played a major role in ensuring I am not among the women diagnosed with cervical cancer,” said Palesa Mothae.
Mothae, now aged 24, was immunised against the human papillomavirus (HPV) during her primary school years in Lesotho, providing her with protection from cervical cancer. HPV is the cause of the vast majority of cases of cervical cancer, the most common cancer in Lesotho.
Mothae was part of a lucky cohort who received the vaccine before Lesotho’s first HPV immunisation programme was abandoned, due to funding constraints, in 2015. In May 2022, with Gavi support, the cancer-blocking jab was introduced into the national vaccination schedule for a second time – and not a moment too soon.
“Health workers in Berea district launched a door-to-door campaign. … [O]ne parent who initially opposed it is now leading efforts to recruit others to allow their children to be vaccinated.”
– Susan Ramakhunoane, Ministry of Health, Lesotho
Each year, some 600 women in Lesotho are diagnosed with cervical cancer, said Susan Ramakhunoane, a public health nurse and an official with Lesotho’s Ministry of Health. That’s a big number for a tiny country. Speaking to VaccinesWork earlier this month, Ramakhunoane also revealed that well over half of those women die of the disease.
“To help reduce these numbers, the Ministry of Health is working diligently to ensure every girl aged 9–14 receives the HPV vaccine, as it protects them against the disease,” Ramakhunoane said. Dr Lucy Mapota-Masoabi, the Ministry of Health’s Director of Clinical Services, added that the ministry is also redoubling its efforts to extend HPV testing and cervical cancer screening to women of childbearing age.
A three-pronged attack on cervical cancer
Is the elimination of cervical cancer in sight for Lesotho, and for the world? The World Health Organization (WHO) says yes – on three conditions. If countries can:
- Vaccinate 90 percent of girls with the HPV vaccine by age 15;
- Screen 70 percent of women for cervical cancer by age 35; and
- Treat 90 percent of women with pre-cancers and invasive cancers
Then we’ll be on track to bring down incidence below 4 cases per every 100,000 women – the elimination threshold – within the next century.
No question that it’s a big hill to climb. In 2020, an estimated 604,127 women worldwide developed cervical cancer – expressible in incidence terms as 13.3 cases per 100,000 women-years, a rate more than three times as high than the elimination threshold. And in some countries, cervical cancer incidence is way higher than the global average: Eswatini, also in southern Africa, topped these most unenviable rankings with 84.6 cases per 100,000 women in 2020; Lesotho logged an incidence of 49.9 cases per 100,000 women.
But both these countries, and many others, are responding to the challenge – and Gavi is stepping up in support. Learn more in our guide to the HPV vaccine.
Community partnerships
Lesotho may be small, but the mountain kingdom can present steep challenges to public health workers. Some remote areas are extremely isolated – accessible only by helicopter or on horseback, Ramakhunoane said. As such, the HPV vaccination programme’s success has depended on strong partnerships with local communities.
“They are crucial,” Ramakhunoane said. “Working with [community partners] has helped increase vaccine uptake and counter misinformation. Our social mobilisers are ensuring that no child is left unvaccinated,” Ramakhunoane said.
“|I believe this vaccine is crucial for our health, and I encourage parents to ensure their children receive it. I fully agree with the saying ‘prevention is better than cure.’ Let’s act now and avoid future regrets.”
– Palesa Mothae
In late February, health teams across the country shouldered vaccine carriers and set out for schools. This campaign would target girls who had recently turned 9. While the vaccine is typically earmarked for girls aged 9–14 – the age window in which the World Health Organization (WHO) recommends that it can achieve its maximum effect – a nationwide HPV vaccination drive in 2024, led by Minister of Health Selibe Mochoboroane, had already covered older age groups. But Ramakhunoane quickly explained that girls aged 10–14 who missed the nationwide 2024 drive were still able to receive the life-saving vaccine.
Those missed-out girls were relatively few, however. Between 2022 and August 2024, 139,000 eligible girls were vaccinated against HPV, bringing Lesotho to an impressive 93 percent coverage rate.
Reaching the unprotected minority
But Ramakhuoane explained that reaching every last eligible child remains a challenge.
In Berea district, for instance, social mobilisers discovered earlier this year that at one school, no parents had given permission for their children to be vaccinated.
“They launched a door-to-door campaign targeting families of children whose parents refused the vaccine. One parent who initially opposed it is now leading efforts to recruit others to allow their children to be vaccinated,” Ramakhunoane said.
“Health workers in Berea district launched a door-to-door campaign. … [O]ne parent who initially opposed it is now leading efforts to recruit others to allow their children to be vaccinated.” – Susan Ramakhunoane, Ministry of Health, Lesotho.
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She also highlighted the strong collaboration between her ministry and the Ministry of Education and Training. This partnership has enabled them to vaccinate children in schools through the District Immunisation Steering Committees, chaired by District Administrators across Lesotho’s ten districts.
Originally focused on the HPV vaccine, the committee now addresses all vaccine-related matters. Ramakhunoane noted that it plays a crucial role in raising awareness among parents and guardians about the importance of childhood vaccines.
“Its impact will be seen in the future”
For Palesa Mothae, it’s been a decade that she’s felt confident in being protected from developing cervical cancer. Speaking to VaccinesWork, she urged parents to give the same security to their children.
“I believe this vaccine is crucial for our health, and I encourage parents to ensure their children receive it. I fully agree with the saying ‘prevention is better than cure.’ Let’s act now and avoid future regrets,” Mothae concluded.
“When it comes to vaccination, the results won’t be immediate, depending on when girls received the vaccine, but its impact will be seen in the future. We are also testing for HPV by drawing samples to check if a woman is infected. Our efforts to eliminate cancer are now doubled,” said Dr Mapota-Masoabi.
Recently, the routine collection of samples from every woman after childbirth has been temporarily suspended, due to a funding crunch amid shifts in international aid policy. “But this doesn’t stop us from screening. There are still several ways to screen for cervical cancer. While HPV testing helped with early detection by identifying signs, we now rely on cervical screening,” she said.
A new cancer hospital
As Lesotho steps up prevention, efforts are also under way to strengthen treatment for those for whom vaccination is coming too late.
Dr Kabelo Mputsoe, Lesotho’s first oncologist, leads the Senkatana Oncology Clinic. In January, Dr Mputsoe spoke at the ground-breaking ceremony of a new US$ 37.3 million specialist premises, to be built in Maseru over three years – a bold step by the government to curb cancer-related deaths.
“The Government of Lesotho pays 220,000 maloti for each cancer patient to receive treatment abroad. Cancer cases are rising, particularly cervical, breast and prostate cancers,” Dr Mputsoe said.
And delays in accessing necessary care can cost patients a chance at recovery. “For those seeking treatment outside the country in January, they won’t start until August. Cancer spreads,” she added.
Dr Mputsoe emphasised that the new hospital will significantly reduce waiting times for treatment, allowing cancer patients to receive chemotherapy and other necessary interventions without leaving the country.
Dr Mapota-Masoabi explained that once the hospital is operational, it will provide comprehensive chemotherapy coverage for all cancers. “Everyone who is sick wants to receive care in their own country, close to their loved ones. This facility will not only address a medical issue, but also a social one, as it will allow patients to have the support they need from family and friends. It will tackle the lack of social and family support that many currently face,” Dr Mapota-Masoabi explained.
She added, “We will also significantly reduce the money spent on sending patients to Bloemfontein, South Africa, for care.”
Additionally, Dr Mapota-Masoabi noted that clinicians will gain hands-on experience in cancer treatment, strengthening Lesotho’s capacity to manage the disease.
“As clinicians, we currently diagnose cancer and send patients to Bloemfontein. However, even if we are trained in treating chemotherapy side-effects in medical school, daily hands-on experience with patients allows us to perfect our skills, as no two patients present in the same way,” she said.
With these combined efforts – HPV vaccination, cervical cancer screening and improved treatment – Dr Mapota-Masoabi said the Government of Lesotho is taking critical steps towards reducing the country’s cervical cancer burden.
This story was originally produced and published by VaccinesWork.
