When it comes to cervical cancer, the trajectory looks bleak at first glance. Globally, more than 44 million women stand to develop the disease between now and 2069, with almost all of these cases caused by high-risk strains of the human papillomavirus — some of which are now preventable through vaccination. The picture is starkest in low- and middle-income countries, where approximately 84% of global cases and nearly 90% of deaths from the disease occur. For women with HIV, their chance of developing cervical cancer is up to five times higher.
This makes cervical cancer a disease of vast inequality and a scourge on women around the world. Yet less than 1 in 3 eligible girls aged 9-14 live in a country with an HPV vaccine in the national immunization schedule. The same is true of screening, with around 1 in 3 low-income countries and half of LMICs having a cervical cancer screening program.
But we know we can beat cervical cancer through a combination of HPV vaccination, screening, and treatment of abnormal cervical cells. Rapid intervention by governments would bring cervical cancer rates down at remarkable pace, with rates of less than 4 cases per 100,000 women possible in high-income countries such as the U.K. by 2060 and in most other countries around the world by 2100. Australia is already on track to become the first country to eliminate cervical cancer as a public health problem within the next 20 years. The challenge, therefore, is not one of know-how; it is one of political will, behavioral change, and equity.
How we are responding
There is so much to do and, at the same time, so much opportunity for progress if governments, civil society, and the private sector join forces. This year marks an opportune moment for the global health community to coalesce around translating the targets on noncommunicable diseases within the Sustainable Development Goals into action. Tackling cervical cancer can and should be a key part of that. The World Health Organization is drafting a global strategy on how to eliminate cervical cancer with the aim of adoption at May’s World Health Assembly. In June, this will be followed by the next replenishment conference in London for Gavi, the Vaccine Alliance. A renewed focus on rolling out the HPV vaccine in LMICs would be a welcome starting point for implementation of the global strategy and move us closer in our efforts to achieving universal health coverage.
Cancer Research UK is responding to the WHO director-general’s call for action by co-funding — with the Bill & Melinda Gates Foundation and the National Cancer Institute, a part of the National Institutes of Health — the ongoing PRIMAVERA trial in Costa Rica. This is testing the protective immunity of a single dose of the HPV vaccine. We helped prove the link between HPV and cervical cancer back in the 1990s, paving the way for the development of the HPV vaccine, which now offers protection from the most common cancer-causing strains. A single-dose vaccine could soon become tenable, which would transform access and affordability. Robust screen-and-treat programs are needed to complement vaccination efforts and to help protect women who have missed the opportunity to receive the vaccination.
Lessons to be learned
There are lessons to be learned from LMICs already rolling out the HPV vaccine on how barriers can be overcome. In conversation with me in London recently, Dr. Feisul Idzwan Mustapha, deputy director for NCDs at the Malaysian Ministry of Health, reflected on his country’s success in achieving almost 100% HPV vaccination coverage in their school-based program and how they addressed potential political and cultural obstacles.
“Firstly, there was a good collaboration between Ministry of Health and Ministry of Education. The existing school health teams facilitated efficient delivery of the vaccines through the existing national immunization program, with some support from the pharmaceutical industry.
“Secondly, transparent, credible, and timely communications to all key stakeholders was given strong emphasis, including where there were religious hesitancies or fears around adverse events following immunization. Parents were treated as partners in the program and had convenient access to authorities to discuss and resolve concerns.”
It’s clear that tailor-made solutions are needed to respond to the specificities of each country’s political and health systems, infrastructure, and cultural norms. Over the past four years, CRUK’s international tobacco control program has funded policy research on tobacco taxes by researchers in LMICs, making the case for government interventions to reduce smoking-related cancers and providing us with a development model that is rooted in tailored approaches to local challenges. Similarly, on cervical cancer, building the capacity of local actors to develop policy approaches — supported by international experts — will ensure relevant and sustainable solutions are developed to tackle the disease head-on.
With more than 80% of eligible girls currently receiving the HPV vaccine in the U.K. and around 70% of women in Great Britain attending cervical screenings — figures that vary across socioeconomic demographics — CRUK will continue to champion progress in the region.
The scale of the task is huge, but if the international community gets this right, the figures for averted cervical cancer deaths could be approximately 2 million by 2040, 4.5 million by 2050, 39 million by 2100, and 62 million by 2120. We hope the global health and NCD community will throw its weight behind cervical cancer prevention this year and beyond. Real progress isn’t just possible, but overwhelmingly achievable.
Find out more about our role in beating cancer globally here.