As the world commemorates International Women’s Day on March 8, the recent commitments at Cartagena de Indias, Colombia on March 5, 2024 by Global Cervical Cancer Elimination Forum on Advancing the Call to Action, which marks a historic step towards the elimination of cervical cancer, a major health challenge facing women, is a step in the right direction, writes Chiemelie Ezeobi
At Cartagena de Indias, Colombia, the Global Cervical Cancer Elimination Forum was held to “Advancing the Call to Action” in catalysing national and global momentum to end this preventable malaise of cervical cancer.
During the course of the forum, new country, policy and program commitments, plus nearly US$600 million in new funding, at the first-ever global forum, offered a chance to save hundreds of thousands of lives by 2030.
This milestone forum was co-sponsored by the Governments of Colombia and Spain in partnership with the Pan American Health Organisation (PAHO); World Health Organisation (WHO); UNICEF; the Bill & Melinda Gates Foundation; Unitaid; the Global Financing Facility for Women, Children and Adolescents (GFF); Gavi, the Vaccine Alliance; the United States Agency for International Development (USAID); and the World Bank.
Global Malaise of Cervical Cancer
Cervical cancer is the fourth most common cancer in women worldwide, and continues to disproportionately impact women and their families in low- and middle-income countries (LMICs).
In fact, every two minutes, a woman dies from cervical cancer, although the knowledge and the tools to prevent and even eliminate this disease already exist.
In 2020, an estimated 604,127 women were diagnosed with cervical cancer globally, accounting for 348,186 deaths.
According to experts, annual deaths from cervical cancer will likely reach 410,000 by 2030 if hasty decisions are not made, thus the reason the forum eas held as a first step to secure government commitments to eliminate, for the first time, a full category of cancer on a global scale.
Cervical Cancer in Nigeria
In Nigeria, it is not any better as Cervical Cancer is the third most common cancer and the second most frequent cause of cancer deaths among women aged between 15 and 44 years. In 2020 – the latest year for which data is available – the country recorded 12,000 new cases and 8,000 deaths from cervical cancer.
“The loss of about 8000 Nigerian women yearly from a disease that is preventable is completely unacceptable,” Muhammad Ali Pate, the Coordinating Minister of Health & Social Welfare, recently lamented.
Challenges
Are there chances of eliminating Cervical Cancer? Of course, but there are many challenges on that path as due to supply constraints, delivery challenges, and the COVID-19 pandemic, just one in five eligible adolescent girls were vaccinated in 2022.
Also, even with cost-effective and evidence-based tools for screening and treatment, fewer than five per cent of women in many LMICs are ever screened for cervical cancer.
Meanwhile, health system constraints, costs, logistical issues, and lack of political will are obstacles to implementing comprehensive programs for cervical cancer prevention and treatment.
According to the Forum, these barriers have led to deep inequity: of the estimated 348,000 cervical cancer deaths in 2022, over 90 per cent took place in LMICs. With governments and partners recommitting urgently to the global agenda, it is possible to reverse the tide and prevent annual deaths from rising to 410,000 by 2030, as currently estimated.
Commitments
Burdened by these, governments, donors, multilateral institutions, and partners announced major new policy, programmatic and financial commitments, including nearly US$600 million in new funding, to eliminate cervical cancer and if these ambitions to expand vaccine coverage and strengthen screening and treatment programs are fully realised, the world could eliminate a cancer for the first time.
The nearly US$600 million in new funding includes US$180 million from the Bill & Melinda Gates Foundation, US$10 million from UNICEF, and US$400 million from the World Bank.
The commitments announced at the forum mark a watershed moment to accelerate progress on a promise made in 2020, when 194 countries adopted WHO’s global strategy to eliminate cervical cancer.
“We have the knowledge and the tools to make cervical cancer history, but vaccination, screening and treatment programmes are still not reaching the scale required,” said Dr. Tedros Adhanom Ghebreyesus, WHO Director-General.
“This first global forum is an important opportunity for governments and partners to invest in the global elimination strategy and addressing the inequities that deny women and girls’ access to the life-saving tools they need.”
In addition to a re-commitment by Indonesia to its National Action Plan 2023, other country commitments include the Democratic Republic of Congo, which committed to start introducing the HPV vaccine as early as possible using the WHO-recommended single-dose schedule. It also commits to do everything to get, as early as possible, to the cervical cancer elimination strategy immunisation’s coverage target for girls aged 9 to 14 years.
Ethiopia committed to implement a robust vaccine delivery strategy across the country, targeting at least 95 per cent coverage in 2024 for all 14-year old girls, regardless of their socioeconomic status, whether in school or out of school. The country also committed to screen 1 million eligible women every year for cervical cancer and to treat 90 per cent of those screened, who present with positive precancerous lesions. Further, HPV single dose has been approved to be introduced this year and scaled up as part of the country’s Expanded Program on Immunisation plans.
Nigeria launched its HPV vaccine national program this year, adopting the single-dose schedule for girls 9 to 14 years old, and now commits to achieving at least 80 per cent vaccine coverage of girls. They are committed to continuing to increase coverage of the HPV vaccine through a robust delivery strategy that will meet the girls where they are. For girls who are in school, they will concentrate on school-based delivery; for girls that are not in school, they will commit to implementing outreach activities at key moments in the year, with the target of at least 80 per cent coverage of girls targeted by 2026.
For the Government of Colombia, in its commitment to guaranteeing the rights of women in their diversities, it is imperative to advance in the elimination of cervical cancer; a disease that affects millions of girls and women. Hence, hosted the first Global Forum for the Elimination of Cervical Cancer.
According to them, this is an opportunity that will allow the country, and the world, to exchange experiences and knowledge that will contribute to eliminating barriers to care, increasing vaccination against HPV and facilitating capacity development so that countries and partners continue adding actions for elimination of cervical cancer.
For the Spanish government, “Cervical cancer is a public health problem for which there are already prevention, detection, and treatment tools,” as stated by the Minister of Foreign Affairs, European Union, and Cooperation, José Manuel Albares, who is convinced that “with political will, we can address it. We are confident that, from this first forum, commitments and support will emerge from countries, international organisations, global initiatives, philanthropic entities, and civil society to boost government action and commitment to achieving the goals of the WHO strategy. In coherence with its feminist foreign and cooperation policy, Spain is ready to undertake significant commitments to achieve this”.
Scaling up HPVs
Vaccination against human papillomavirus (HPV) — the leading cause of cervical cancer — can prevent the vast majority of cases and, combined with screening and treatment, provides a path to elimination.
In an important shift, the World Health Organisation (WHO)’s 2022 global recommendation for one-dose HPV vaccine schedules significantly reduced barriers to scaling up vaccination programs. It was reinforced by a similar recommendation in the Americas Region in 2023.
The WHO’s Regional Office for Africa has just followed suit with its own recommendation for countries in the region to adopt the single-dose vaccination schedule. To date, 37 countries have reported switching or an intent to switch to a one-dose regimen.
On this, Dr. Chris Elias, President, Global Development, Bill & Melinda Gates Foundation said: “HPV vaccines are a miracle of modern medicine, yet too many girls in low- and middle-income countries do not have access to them.
“There is no reason why women should die from cervical cancer when a vaccine to prevent it exists. With the addition of WHO’s guidance for a one-dose HPV vaccine schedule, cervical cancer elimination is within reach. Now is the time for governments and partners around the world to increase HPV vaccine access and protect future generations from cervical cancer.”
Aurélia Nguyen, Chief Programme Officer, Gavi, the Vaccine Alliance said:
“The HPV vaccine is one of the most impactful vaccines on the planet and has already helped save thousands of lives. More girls urgently deserve the same protection, which is why in partnership with countries, Gavi has set an ambitious goal to help vaccinate 86 million adolescent girls by 2025. With bold commitment and decisive action, we can look forward to a future where cervical cancer has been eliminated for good.”
Juan Pablo Uribe, Director of the Global Financing Facility for Women, Children and Adolescents (GFF) and Global Director for Health Nutrition and Population at the World Bank noted that “The World Bank and the GFF are doubling down efforts for cervical cancer elimination, with at least US$400 million for HPV-related investments over the next three years.
“Every woman and every girl should have access to cervical cancer prevention, screening and treatment as part of regular health care services. Much more work is ahead of all of us with a shared goal: eliminate cervical cancer. We need to build on today’s momentum and support countries‘ leadership to accelerate progress.”
Dr. Jarbas Barbosa, Director, Pan American Health Organisation added that “We have the urgent need to scale up access and coverage for human papillomavirus (HPV) vaccination, screening and treatment. I express PAHO’s profound commitment to elevate the political will and prioritise cervical cancer elimination in the public health agenda of countries in the Americas.
“This is part of PAHO’s Disease Elimination Initiative, which aims to eliminate as many as 30 communicable diseases and related conditions, including cervical cancer, in the Americas by 2030. Through PAHO’s Regional Revolving Funds, high quality HPV vaccines, HPV diagnostic tests and ablative pre-cancer treatment devices are available at one price for all our Member States regardless of purchase size.”
Helga Fogstad, Director of Health, UNICEF posited that “For the first time, the end of an entire category of cancer is in sight. With the necessary tools at our disposal, commitment and political will are the next critical steps to a future free of cervical cancer for generations to come. UNICEF is dedicated to the shared global target of protecting the lives of 86 million girls by next year and pledges US $10 million to support 21 countries in vaccinating girls against HPV, in addition to our existing commitments to this important and urgent cause.
“The impact of these new funds will be amplified as a result of UNICEF’s multi-sectoral approach making the most of our school and community platforms and partnerships with girls’ and women’s rights organisations to ensure success in demand generation.”
Meanwhile, Marisol Touraine, Executive Board Chair, Unitaid noted that “We cannot accept that women die from cervical cancer, when we know how to prevent and treat this disease. At this pivotal moment, we must ensure the efficient tools we have are both affordable and available to every woman and girl in need.
” Our projects at Unitaid have dramatically reduced the cost of HPV screening and the price of lifesaving thermal ablation devices. We are launching another wave of investments that will focus on bringing cervical cancer screening outside of healthcare facilities and into communities. Together with our partners, we will continue to lay the groundwork for a future where all women have equitable access to the care they deserve, regardless of their socio-economic status or geographic location.”
On the other hand, Dr. Atul Gawande, Assistant Administrator for Global Health, United States Agency for International Development said:
“With the powerful shield of the HPV vaccine, regular screening, and early treatment, we can safeguard a generation from the devastating effects of cervical cancer. Every shot is a bold stride towards a future where cervical cancer is eliminated.
” USAID remains a steadfast partner to governments, communities, and Gavi, the Vaccine Alliance, for ensuring access to this life-saving intervention. Through PEPFAR’s Go Further partnership, USAID will also combat cervical cancer by extending screening and treatment options to the most vulnerable communities where people are at higher risk for acquiring HIV and HPV. Together, we’re forging a path towards a future where cervical cancer is no longer a threat to the health and wellbeing of women worldwide.”
With a comprehensive approach to prevent, screen and treat, cervical cancer can be eliminated as a public health problem within a generation and that is the goal this forum is seeking to achieve.
Pix credit: Google
