Towards a World Without Cervical Cancer

Each year, cervical cancer claims the lives of over 300,000 women worldwide. Despite being a preventable cancer, curable if diagnosed and treated promptly, the current high mortality rates from cervical cancer are alarming. Most cervical cancers are caused by infection from certain types of Human Papillomavirus (HPV), which is sexually transmitted and can affect both women and men. Still, the burden of HPV-caused cancer is substantially higher in women than in men.

[This text has been originally published in Spanish in El País-Planeta Futuro. It has been written by Cristina Enguita and Yara Alonso, social anthropologists and researchers of ISGlobal's Maternal, Child and Reproductive Health Initiative]

Vaccines against HPV are the safest and most effective tool available to prevent cervical cancer and avoid the deaths of thousands of women every year. Yet, despite being approved since 2006, adoption of the vaccine has been unacceptably slow. To date, globally only 15% of 15 year-old girls receive the complete dose. Unsurprisingly, coverage rates correlate with global socio-economic inequality, with over 85% of high-income-countries having introduced the vaccine in national immunisation schedules compared to less than 25% of low-income countries. 90% of the deaths occur in low and middle-income countries. This scenario reveals the disproportionate burden of this public health problem on women in developing regions.

The drive towards expanding access to HPV vaccines has gained critical momentum in recent years. In 2020 the WHO launched the Global Strategy to Accelerate the Elimination of Cervical Cancer, the first of its kind in the elimination of cancer. The strategy seeks to reach the 90–70–90 targets by 2030, where 90% of the girls are vaccinated against HPV by the age of 15 years, 70% of women have access to high-performance screening tests for cervical cancer and 90% of women with cervical cancer have adequate access to quality treatment by 2030. Two years later, the WHO’s Strategic Advisory Group of Experts on Immunization (SAGE) finalised an extensive evidence review on the HPV vaccine which concluded that a single shot was enough to prevent HPV in girls and women between the ages of 9 and 20, raising hopes of reaching elimination targets and adding to the momentum in the fight against cervical cancer.

The drive towards expanding access to HPV vaccines has gained critical momentum in recent years

Following this momentum, and acknowledging that the vaccine against HPV is one of the most impactful vaccines of their portfolio, GAVI recently relaunched their HPV vaccination programme in order to boost efforts in expanding access to the vaccine. Over the next three years, GAVI, alongside partner organisations like the WHO and UNICEF, will focus on supporting the introduction of the vaccine into routine immunisation schedules and the catch-up of vaccinations missed during the COVID-19 pandemic. Reaching high HPV vaccination coverage rates is dependent on school-based delivery, a mechanism that was hit particularly hard by pandemic-related lockdowns. However, reasons for the unequal adoption of HPV vaccination programs or low vaccine coverage rates, especially in low-income countries, are manyfold. Beyond the significant disruptions posed by the COVID-19 pandemic on vaccine roll-out, together with the limited supply and production costs, other socio-behavioural factors (i.e. knowledge, attitudes, and practices related to cervical cancer, HPV infection, and HPV vaccines; local understandings of preventive care and healthcare practice; socio-cultural norms, religious adscription; etc.) can also significantly determine HPV vaccination rates. 

Photo: UN Women / Ryan Brown

Vaccine hesitancy, a complex phenomenon 

The COVID-19 pandemic has brought to light the phenomenon of vaccine hesitancy, although public health experts had been drawing attention to this issue of growing concern for a number of years prior to the onset of the pandemic. Vaccine hesitancy is a complex phenomenon that has affected the uptake of numerous vaccines before the introduction of COVID-19 vaccines, including the HPV vaccine. The case of Japan is a known example of how anxieties around a specific vaccine can spread and pose significant challenges to the healthcare systems charged with deploying them. Japan suspended the recommendation on the HPV vaccine for 9 years (from 2013-2022) due to messages of cases of adverse reactions circulating in the news and high vaccine hesitancy among parents. The rise of HPV vaccine hesitancy in Japan was credited with the spread of an anti-HPV vaccine movement that travelled around the world and that was traced to have sparked anti-HPV vaccine messaging in countries like Denmark, Colombia and Ireland. Common concerns shaping hesitancy around the HPV vaccine constitute fears over the long-term impacts of perceived side effects, particularly with regard to fertility, misconceptions around the vaccine’s health benefits and mistrust in public health authorities. Yet the specific form that these concerns take is inevitably dependent on the timing and socio-cultural context that embeds them.

Within the context of renewed global efforts to eliminate cervical cancer through expanding access to HPV vaccines, tailored approaches become critical to widely reach women and young girls

Within the context of renewed global efforts to eliminate cervical cancer through expanding access to HPV vaccines, tailored approaches become critical to widely reach women and young girls. Beyond programmatic strategies (such as integrated approaches to immunisation and other healthcare services), national governments and their partners (GAVI, UNICEF, civil society organisations) that are to introduce the HPV vaccine or strengthen existing HPV national programs should also invest efforts in identifying and understanding their population’s attitudes and receptivity towards the vaccine. It is, indeed, crucial to engage the local population to conveniently address any potential challenges proactively and ensure acceptability and high uptake of HPV vaccines.