New Report on Cervical Cancer Investments in LICs/LMICs: Diverging Trajectories for Elimination Targets
15 November, 2024
On November 17th, 2020, Member States of the World Health Organization approved a Global Strategy to Eliminate Cervical Cancer as a Public Health Problem. The Strategy calls for the global scale-up of three core prevention activities:
- Vaccinating 90% of girls against HPV by the age of 15 years;
- Screening 70% of women a high-performance test by 35 years of age and again by 45 years of age; and
- Treating 90% of women identified with cervical disease including 90% of women with precancer as well as 90% of women with invasive cancer.
The structure of the Strategy can be summarized as providing lifetime protection for today’s girls against cervical cancer later in life, while ensuring that today’s adult women – the great majority of whom are unvaccinated – can access screening and lifesaving treatment services. Achieving these targets is a matter of life-or-death, for far too many. The most recent annual data from 2022 estimates that over 662,000 women were diagnosed with cervical cancer globally and 349,000 lost their lives.
The world has commemorated every November 17th since that date in 2020 as the Global Cervical Cancer Elimination Day of Action, highlighting global and local events raising awareness of cervical cancer and the opportunity to put this preventable cancer in the history books.
Every year TogetHER for Health publishes our estimates of investments for cervical cancer prevention in low-income countries (LICs) and lower middle-income countries (LMICs). This year’s report – our sixth edition, incorporating data from 2018 through 2023 – provides some context for how the world is measuring up to its 2020 commitments. Our data from 2023 reveals some welcome news but also some concerning trends.
First, the good news: Funding for HPV vaccination in LICs/LMICs rose to by far the highest level since TogetHER began tracking such investments, topping out at $202.8 million USD. This increase stems heavily from investments by Gavi, the Vaccine Alliance, whose Board approved an initiative in late 2022 to provide new country resources for HPV vaccine introduction and to strengthen routine immunization programs. Gavi’s increased investments were bolstered by contributions from Gavi-eligible countries and self-funding LMICs.
The most recent data shows that 27% of eligible girls have been vaccinated against HPV globally, a sharp rise from just a few years ago. As Gavi realizes its commitment to vaccinate 86 million girls by the end of 2025, there’s optimism that many of today’s girls will live lives free from cervical cancer.
The picture is less optimistic when we look at cervical cancer screening and treatment. Estimated funding for 2023 totaled $54.9 million, a decrease of around 18% from 2022 levels as some of the more prominent programs supporting screening and treatment in LICs/LMICs wound down and others transitioned to new priorities. Future funding levels may be under further threat given political challenges focused on the largest funder of screening and treatment in LICs/MICs – the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR).
At the recent World Cancer Congress,TogetHER co-hosted an event to highlight this worrying trend regarding waning support for screening and treatment programming globally. Support for these key interventions is not keeping up with vaccination, but that’s just one part of the problem. Many programs supporting screening and treatment have yet to begin the transition to the high-performance HPV molecular diagnostics emphasized by WHO guidelines, opting for less expensive but also far less sensitive visual inspection methods.
Women living in LICs and LMICs today deserve access to accurate screening and safe treatment just as their children deserve the protection of vaccination.
What steps need to be taken to be sure that these women are not left behind? Our report puts forth a number of recommendations, including the following:
- Funders must step up. Member states that ratified the Strategy must meet that commitment with the financial and political resources necessary to realize the Strategy’s goals. The March announcement of a significant increase in support for cervical cancer elimination from a number of global partners including the World Bank and the Bill & Melinda Gates Foundation is a promising step forward.
- Funders must be more transparent. TogetHER’s estimates are likely low, since it can be difficult to break out cervical cancer-specific investments from those for programs in which cervical cancer prevention activities are integrated with other women’s health services. But a lack of disaggregated investment data limits accountability around the actual level of commitment toward cervical cancer elimination. That same March announcement lacked specificity in how funding could be accessed and to what priorities it would be applied.
- It’s time to address the high cost of HPV testing, possibly through the application of a new or an existing pooled procurement mechanism that supports negotiations to reduce the per-test price. Visual inspection is often the best screening method available, but it is neither accurate enough or scalable to levels needed to achieve the WHO’s elimination targets.
- Regardless of the context, advocacy and awareness remain key supportive elements to ensuring that cervical cancer prevention programs can reach women and girls no matter where they are.
2025 will mark the halfway point between the launch of the elimination strategy launch and its endpoint of 2030, and we anticipate there will be a sizable effort to take stock of progress, to see if the global commitments made in 2020 have inspired significant improvements in reducing the number of cervical cancer diagnoses and deaths. TogetHER looks forward to celebrating the tireless efforts of groups striving to make elimination a reality, even as we continue our fight ensuring that those groups have the support they need to succeed.