Cervical cancer elimination: Why we need partnerships to scale equitable access to vaccines and screening

A health concern of global significance, cervical cancer is one of the most common cancers women face worldwide. Yet, despite its high prevalence, cervical cancer is largely preventable and treatable if detected early and managed effectively.

Human papillomavirus (HPV) vaccination and cervical cancer screening have been designated as 'best-buy interventions' for cervical cancer elimination and have an immediate investment return. These tools are only meaningful if they reach the people who need them.

The pandemic has demonstrated the effectiveness of partnerships in developing solutions fast and at scale. With countries now emerging from the pandemic, the world has the opportunity to eliminate one cancer that we can prevent – cervical cancer.

There is a renewed opportunity to advocate for equitable access to prevention tools leveraging the health investments from COVID-19 and increased momentum for multi-stakeholder collaboration to address global health challenges.

A global commitment to eliminating cervical cancer launched in 2020 by the World Health Organization (WHO) identified three key pillars and their corresponding ‘90-70-90’ targets to accelerate efforts.

The strategy created a shared vision for countries to eliminate cervical cancer by 2030 – reaching and maintaining an incidence rate below four per 100,000 women.

The global burden of cervical cancer starkly reflects inequity – women in low and middle-income countries and high-income countries from marginalized groups are disproportionately affected.

As we mark the second anniversary of the elimination strategy on November 17, we must foster high-level commitment and intersectoral collaboration to accelerate elimination.

Multi-sectoral collaboration can scale strategies for a more significant impact. In support of a coordinated approach, here are examples of partnerships enabling the establishment of sustainable national programmes, creating awareness and prevention support to increase uptake, and capacity building through health system strengthening.

Cervical cancer is among the top cancer killer of women in Africa, and women living with HIV are six times more likely to develop cervical cancer.

The Go Further partnership is an innovative public-private partnership between PEPFAR, the Bush Institute, UNAIDS, Merck (MSD), and Roche to strengthen cervical cancer elimination efforts.

The partnership works in 12 African countries with the highest HIV and HPV co-infections to reduce new cervical cancer cases by 95% among women living with HIV in these countries.

In Eswatini (previously Swaziland), the partnership is co-creating a sustainable cervical cancer programme with the Ministry of Health and other key stakeholders, aimed at digital and in-person patient navigation to streamline patient journeys in the healthcare system and improve health outcomes.

Cervical cancer is the third major cancer among women in Malaysia. Many barriers to screening, such as lack of information, time constraint, financial cost, and fear of treatment has resulted in the low coverage screening rates in the Southeast Asian country.

Program ROSE (Removing Obstacles in Cervical Screening) is a multi-stakeholder collaboration initiated to improve screening rates and reduce the burden of cervical cancer in Malaysia, especially among hard-to-reach underserved and under-screened populations.

It introduced self-sampling, HPV DNA testing, and a digital e-health platform to deliver real-time reporting to women. This collaboration is among academic partners – the University of Malaya, the Malaysian Ministry of Health, the Australian Centre for the Prevention of Cervical Cancer, in-vitro diagnostic (IVD) company, laboratory and telecommunications.

Meanwhile, the First Ladies Against Cancer (FLAC) initiative in Nigeria is a coalition of the spouses of current and former state governors working to address gaps in cancer care. FLAC has its political net worth to secure the institution of sub-national cervical cancer elimination programmes in 10 states with a combined population of over 65 million citizens.

FLAC interventions have reached more than 300,000 women with cervical cancer prevention messaging. This has included piloting school-based HPV vaccination campaigns and reaching over 1,000 adolescent girls, providing cervical cancer screening services along with treatment of early lesions to over 27,000 women in 2022 – all in partnership with state ministries of health, the private sector, Clinton Health Access Initiative (CHAI), Unitaid and the WHO.

Cervical cancer is caused by the human papillomavirus, and almost all women will be exposed to HPV in their lifetime.

To this effect, non-profit organization Cervivor brings cervical cancer survivors together and helps to spread awareness, education and support.

In 2014, Cervivor launched the multi-stakeholder initiative Cervivor School to educate and empower cervical cancer patients and survivors to act as advocates and work together to change the future of women’s health.

Cervivor School graduates collaborate with leading organizations such as the World Health Organization (WHO), the President's Cancer Panel, the American Cancer Society's National Cervical Cancer Roundtable, the National Cancer Institute (NCI), and the National Institutes of Health (NIH) to advocate and address the impact of stigma on cervical cancer prevention.

These collaborative experiences will be essential to scale and sustain cervical cancer elimination efforts globally to ensure no-one is left behind.

As we journey on the road to 2030, we must continue to develop innovative collaborations and work together for a multi-stakeholder approach to sustaining efforts and adequate resources for sustainable cervical cancer elimination programmes. We call on all stakeholders to join these key policy next steps:

1. Cervical cancer is a major public health burden with a significant economic impact on affected persons, their families and their broader communities. We must continue to increase knowledge, reduce stigma, raise awareness to educate young girls, women, advocates and all stakeholders about the global burden of cervical cancer, and promote WHO’s elimination strategy.

2. Eliminating cervical cancer requires interventions along the care continuum. We must encourage social, political and sustainable financial commitments through increased public funding for health to ensure equitable access to cervical cancer services.

3. Achieve vaccine equity by increasing HPV vaccination rates among young girls and boys, and cervical cancer screening for under-screened and underserved women and people with a cervix – as it could also affect transgender men – will reduce the incidence and mortality of cervical cancer. We must advocate for health system strengthening, including laboratory infrastructure and workforce training to implement and deliver quality and effective cervical cancer programmes.

4. Working with stakeholders to address the complex challenges we must overcome to achieve WHO’s cervical cancer elimination targets. Multisectoral partnerships to mobilize resources and collaborate on innovative service delivery to increase access and quality of care and improve health outcomes.

Cervical cancer is preventable and curable. Now is the time to seize the opportunity for multi-stakeholders to work together to try and eliminate it worldwide.