Every year, more than 350,000 women die from cervical cancer and a further 660,000 are diagnosed with the disease. These losses leave their children orphaned, their families impoverished and their communities deprived of mothers, wives, daughters and sisters. However, unlike most other types of cancer, almost all of these cases and deaths are preventable. We have powerful vaccines that prevent human papillomavirus infection, which causes this cancer, as well as diagnostic tools to detect it early and treat patients. With these tools, it is possible not only to control this disease, but also to eliminate cancer for the first time. Some high-income countries are already close to achieving this goal, having managed to reduce the incidence to less than four cases per 100,000 women.
However, many low- and middle-income countries still lack these resources, which is why they account for 94% of deaths from cervical cancer. The double tragedy of this disease is that it is not only a health problem, but also a lack of justice.
Every November, we celebrate World Cervical Cancer Day of Action with vaccination and screening campaigns and awareness-raising events. Several iconic sites were illuminated in bluish-green light for the occasion, including the iconic Christ the Redeemer monument in Rio de Janeiro, where the G20 summit is taking place until Tuesday.
Many low- and middle-income countries still lack these resources, which is why they account for 94% of deaths from cervical cancer.
In 2018, WHO launched a global call to action to eliminate cervical cancer, prompting 194 Member States to adopt the Global Strategy to Accelerate the Elimination of Cervical Cancer as a Public Health Problem in 2020. It calls on all countries to achieve three goals by 2030: 90% coverage of girls with human papillomavirus vaccination, 70% coverage of women with timely screening, and 90% access to treatment for women with precancerous lesions and diagnosed cancer.
These goals are not impossible, but are achievable even in low- and middle-income countries. For example, Bhutan has already achieved this: it is the first country in the Southeast Asian region to achieve this. In the case of Rwanda, coverage is now 90% since the introduction of the vaccine in 2011, and today a national target was announced to meet three WHO targets three years ahead of schedule. For its part, Nigeria introduced the vaccine in October last year and has already vaccinated 12.3 million girls.
We have the resources and capacity to eliminate cervical cancer. But to make this aspiration a reality, strong political leadership is needed.
We have the resources and capacity to eliminate cervical cancer. But turning this aspiration into reality requires strong political leadership. We need world leaders gathered in Brazil for the G20 summit to commit to maximizing access to the tools needed to achieve this goal.
First, we ask you to support access to HPV vaccines for all girls in all countries. Since WHO launched a global call to action in 2018, more than 60 countries have started using the vaccine in their immunization programs, and 144 countries are now consistently preventing cervical cancer in girls later in life. Thanks to scientific advances, we can now immunize against the disease with one dose, which 60 countries already do.
The largest supplier of these vaccines to low- and middle-income countries is Gavi, the Global Vaccine Alliance, which plans to vaccinate 120 million girls by 2030. However, this plan requires sustained investment in health care. Likewise, we expect manufacturers to confirm and meet their commitments to supply vaccines to these countries in the coming years to avoid supply issues that have slowed progress in the past.
However, we cannot rely solely on vaccines. The benefits of rapid expansion of vaccination in girls will not be fully appreciated for several decades, when they reach the adult age at which this cancer typically appears. To save lives now, we must match increased vaccinations with parallel increases in screening and treatment. That’s why, secondly, we ask G20 leaders to support access to screening in all countries.
Decades ago, vaginal cytology rapidly reduced mortality from cervical cancer in developed countries. Today we have even more convincing evidence. More than 60 countries use high-throughput tests to detect human papillomavirus in their screening programs. These tests allow women to collect their own samples, removing barriers to accessing vital services. In Australia, which is on track to become one of the first countries to achieve elimination, more than a quarter of screening tests are carried out this way.
We ask leaders to move beyond ad hoc and opportunistic testing and invest in organized screening programs to ensure high coverage across the entire population. This is necessary to achieve the 70% target. However, high test prices and margins maintained by traders remain a hurdle.
We ask leaders to move beyond ad hoc and opportunistic testing and invest in organized screening programs to ensure high coverage across the entire population.
On the other hand, several countries are exploring the use of artificial intelligence to improve screening accuracy in resource-limited settings. When precancerous lesions are discovered, many women are treated using portable, battery-powered devices that can be used in remote areas.
Third, we call on G20 leaders to support expanding access to treatment in all countries. Women with advanced cancer need to be referred for surgery, radiation therapy and palliative care, but many patients die because treatments used in high-income countries are not available where they live. In other countries, radiation therapy equipment does not work, and patients wait in vain for their tumors to grow. No woman should have to travel abroad for treatment or die while waiting in her own country for the necessary equipment to treat her.
The Covid-19 pandemic has demonstrated the extraordinary life-saving power of vaccines, tests and treatments, but it has also exposed inequalities in access that lead to preventable deaths. Therefore, we call on all leaders, industries and communities to join us in ending this disease once and for all.
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