The global elimination of a cancer may sound like an impossible dream. What many don’t know is that in the case of cervical cancer, we already have the means to help make this dream a reality.
Vaccines against the human papillomavirus, the cause of up to 99% of cervical cancers, have begun to significantly reduce new cases of disease among those who have been vaccinated. Screening for abnormal cervical cells, which could indicate pre-cancer or early signs of cancer, can be treated quickly and inexpensively — and ideally in the same visit by a woman to a health provider.
Elimination isn’t being held up by the search for new scientific breakthroughs. The primary challenge involves getting effective interventions to women and girls where they are needed the most. Global cervical cancer mortality rates are increasing, and are highest among women in low- and middle-income countries, where some 90% of all cervical cancer deaths now occur.
So, what’s standing between cervical cancer prevention and the women who need it? Lack of resources is an obvious challenge. The pace of funding for cervical cancer prevention in low- and lower-middle-income countries is less than 10% of what the World Health Organization projects will be needed by 2030 to set these countries on the path to eliminating the disease.
But it’s not just about money. A lack of resources is just one element preventing access to cervical cancer prevention, alongside a persistent lack of awareness, stigma, logistical challenges, and the need for greater policy support.
TogetHER for Health — a partnership igniting the movement to end cervical cancer through advocacy and action — is committed to identifying solutions to these critical issues and highlighting effective programs and models to drive forward elimination efforts around the world. At TogetHER, we know that removing the multifaceted barriers standing in the way of cervical cancer elimination will require one element above all: leadership.
When it comes to fighting cervical cancer, we applaud national leaders who are committed to deploying the proven tools and strategies necessary to give access to vaccination, screening, and early treatment. Women's lives depend on it.
As an example of such leadership, we can look to a country where national cervical cancer prevention and control have been a public health priority for decades, despite many competing priorities.
Zambia’s cervical cancer incidence rate of over 66 diagnoses per 100,000 women is one of the highest in Africa, and cervical cancer is the most common female cancer among Zambian women. This is compounded by Zambia’s high prevalence of HIV and AIDS, a condition that increases the risk of developing cervical cancer sixfold.
Recognizing the threat of this disease among the 9.3 million women in the country, the Zambian government has activated a national strategic plan to achieve the three goals on which the WHO’s global cervical cancer elimination strategy is constructed: vaccinating 90% of Zambian girls against HPV, ensuring that 70% of Zambian women are screened with a high-performance test at ages 35 and 45, and building capacity to ensure that 90% of women diagnosed with precancerous lesions or cancer receive treatment.
Implementing these interventions requires thoughtful planning.The national strategic plan, one of the first developed by a country in the region, incorporates partnerships with Gavi, the Vaccine Alliance, to procure and distribute HPV vaccinations primarily in school-based settings, and with the Go Further collaboration scaling up cervical screening and treatment.
One area where Zambia is showing leadership is in demonstrating the use of testing for HPV infection, a technology that allows for early identification of risk and prioritization of screening services for women most in need.
Molecular tests to identify high-risk HPV known to cause cervical disease are much faster, less invasive, and more accurate than commonly used Pap smears or visual inspection with acetic acid — and have the added benefit of allowing a woman to take her own vaginal sample instead of undergoing a gynecologic exam which women in many settings find uncomfortable and embarrassing. Deployed at scale, self-sampling for HPV could be a game changer as access to HPV testing becomes more widespread.
Zambia’s government is ensuring that resources are prioritized for lifesaving cervical cancer prevention. But leadership is just as critical at the community level to ensure those interventions are seen as relevant to all the women in the country.
The Teal Sisters Foundation of Zambia began as a social media awareness campaign but has since expanded to in-person community and rural outreach. The Teal Sisters play a critical role in promoting HPV vaccination and cervical screening and treatment in the country, answering community questions, and dispelling harmful misinformation that can reduce women’s interest in seeking cervical health services.
Results are adding up. Since 2015, 440,725 Zambian girls have received at least one dose, each representing one less potential diagnosis as she reaches adulthood. Almost 645,000 women living with HIV have been screened through the Go Further program, even after disruptions stemming from the COVID-19 pandemic. Each one of these women and girls can look forward to building families and leading communities without fear of cervical cancer undermining their lives and those of their loved ones.
Lives are being saved in Zambia, but there’s still much work to be done. The leadership shown by Zambia in protecting its own women must also act as a model for other countries, inspiring its regional neighbors and countries around the world. And just as importantly will be advocacy leadership shown by groups such as the Teal Sisters to provide their communities with information and context-appropriate messages to ensure uptake of cervical cancer prevention.
The next several years will be critical to putting the world on the path to eliminating cervical cancer. The time is now for countries and communities to lead the way.