In late 2020, while the world was fully focused on halting the spread of COVID-19, the global health community achieved a key milestone with the adoption of the World Health Organization’s Global Strategy to Accelerate the Elimination of Cervical Cancer. This historic commitment aims to end another unnecessary epidemic: over 300,000 annual deaths from cervical cancer, which would be largely preventable through vaccination.
Noncommunicable diseases such as cancer generally develop through changes or mutations in the cells of the body and are not primarily caused by a virus. Cervical cancer is an exception since 70% of cases are caused by the human papillomavirus, which is contagious and can therefore be contained through prophylactic vaccination. HPV also contributes to approximately 90% of anal cancers in men.
The most recent disease to be eradicated through vaccination was polio when, in August 2020, Nigeria, my home country, was the last to report four years without a new case. We now harbor the same hopes for cervical cancer — the first time the world would see a noncommunicable disease eliminated as a public health problem.
What will it take in terms of resources and funding to implement the historic commitment to eliminate cervical cancer and ensure that future generations of women do not die prematurely from a preventable disease? Certainly, the cost of doing nothing is much higher, not only in terms of lives lost but also with regards to the financial strain placed on public health systems and on country productivity.
The cost of elimination vs. the price of doing nothing
According to WHO, an average of $0.40 per person per year is needed in low-income settings to finance elimination, and $0.20 per person per year in lower-middle-income countries. This certainly pales in comparison to the human, social, and economic cost of allowing people to die from a preventable disease.
In fact, every dollar invested in the next 30 years in interventions to meet the targets of WHO’s global strategy is estimated to return $26 thanks to a higher participation of women in the workforce and the benefits of improved women’s health on families, communities, and societies.
Indeed, in addition to the often high cost of treatment, there are also significant social costs in terms of loss of productivity, loss of quality of life, fractured communities, premature deaths of mothers, and other years of life lost due to premature mortality, and years of life lost or lived in states of less than full health, known as disability-adjusted life years or DALYs. Furthermore, issues of insecurity can make it more difficult and costly to cover populations living in remote areas, which contributes to drops in immunization rates.
Suffering and loss of life are considerably higher in low- and middle-income countries, which are expected to account for more than 95% of all deaths due to cervical cancer by 2030. This is largely due to low vaccination coverage, poor access to screening and early detection, and lack of treatment and care. Yet detecting cervical cancer at an early stage offers a five-year survival rate of 90% compared to less than 17% of those diagnosed with late-stage cervical cancer. The death rate in sub-Saharan Africa is nine times that of North America.
his also contributes to the high economic burden that cervical cancer places on health systems in LMICs. A study conducted in Eswatini estimated the total annual cost for cervical cancer care at $19 million, out of which precancerous treatment accounted for only 0.7%, or $94,161, highlighting the extent to which cancers are diagnosed at a much later stage.
Eliminating cervical cancer is critical — from a public health and financial perspective, and to drive women’s and minority rights and ensure more equitable health care.
In comparison, the cost of HPV vaccination, which would drastically reduce the number of cervical cancer cases within a generation, is far lower. For many countries in lower-resourced regions, however, the price tag for currently approved vaccines remains almost prohibitive.
Affordable vaccines exist but many have not been pre-qualified by WHO and they are therefore not among those distributed by Gavi, the Vaccine Alliance in lower-resourced regions. We would urge vaccine stakeholders and regulatory experts to address these challenges and improve access to vaccines in emerging countries.
For this, international bodies, civil society organizations, and the private sector must now work together with national health systems to make sure that the HPV vaccine reaches all countries regardless of their resources.
Overall, a comprehensive 10-year program to implement HPV vaccination and screening in 50 LMICs could prevent 5.2 million cases, 3.7 million deaths, and 22 million DALYs, at a total cost of $3.2 billion for the whole program for 50 countries — a fraction of the cost of doing nothing.
We all have a role to play
In addition to engaging national and international bodies in expanding the availability and affordability of HPV vaccines, government and health authorities must engage in a sustained campaign to ensure that accurate information is provided about cervical cancer and HPV vaccination, and address any anti-vaccine concerns or misinformation that exist.
In a study published in 2018, less than half of the surveyed caregivers of female children in Nigeria knew about HPV and even fewer knew how it is transmitted or that there is a vaccine.
Fortunately, this situation can be remedied. Knowledge about cervical cancer can increase screening uptake by nearly five times. It is sad, therefore, to read that awareness is on the decline in countries such as the United States, and racial disparities in relation to knowledge about cervical cancer and vaccination persist, leading to unacceptable differences in survival rates in the country.
At the community level, vaccination awareness campaigns must engage health workers, parents, teachers, and religious leaders to ensure that accurate information about the benefits and safety of the vaccine are communicated. Rwanda offers a striking example in this regard of what a country can achieve, even with very limited resources.
However, vaccination is not the only tool in fighting cervical cancer. Screenings to enable early diagnosis offer a better chance of survival. New diagnostics and detection tools, mobile units, and self-testing kits are increasing the capability of health systems in low-resource settings to reach a wider population, including women and girls living in remote areas.
Sadly, the availability of vaccination and screening services will not suffice if factors such as stigma and discrimination prevent women from effectively accessing these services. Studies conducted in Iran, Latin America and the Caribbean, New Zealand, Nigeria, and Senegal, as well as among ethnic minority women in the United Kingdom and in the U.S. — highlight the range of personal, social, cultural, and religious barriers that exist in many places, preventing women from receiving the care they need.
Eliminating cervical cancer is critical — from a public health and financial perspective, and to drive women’s and minority rights and ensure more equitable health care for all populations. We must push for more national and international funding for cervical cancer care.
To see this historic possibility become a reality will require the same goodwill, engagement, and cooperation from governments, NGOs, and the private sector worldwide as we witnessed for the COVID-19 response. It is a win-win proposition.