Rising to the Challenge of Cervical Cancer in Developing Countries: GAVI and the “cancer vaccine”

The fifth Global Alliance for Vaccines and Immunizations (GAVI) Partners Forum took place in Dar es Salaam, Tanzania, from December 5 -7, 2012 and the theme was: Rising to the Challenge. At this meeting, and for the first time during a Partners Forum, GAVI publicly rose to the challenge of combatting cervical cancer in developing countries. The vaccine to prevent infection with the Human Papilloma Virus (HPV), the virus that causes virtually all cases of cervical cancer,  was a prominent topic of the three-day meeting. Political leaders, including first ladies and parliamentarians, as well as representatives from civil society organizations, academia, the private sector, and multilateral and bilateral agencies lent their voices to the discussions. GAVI plans to reach 28 million girls with the HPV vaccine by 2020. The conversations and plans coming out of the Partners Forum made clear that the time for action has come and we must protect young adolescents from HPV infection as part of national immunization programs. Targeting young adolescents, an age group not typically reached by public health programs, requires that countries have the right messaging, delivered at the right time, in the right place, in the right language, and through the right medium such as social media. It is important to regard adolescents not just as beneficiaries but also as leaders, so as to encourage other adolescents to accept the vaccination program. Identifying role models among them to become advocates and spokespersons to their peers will help advance this global agenda. Promoting HPV vaccine as a "cancer vaccine" has helped to demystify and enhance its acceptance by both parents and adolescents. In developed countries, three HPV vaccine doses cost approximately $390.00. Thanks to GAVI, developing countries that cannot afford this exorbitant cost and are GAVI-eligible (Gross National Income less than $1500/year) will pay only 20 cents per vaccine. Compared with the cost of treating a woman with cervical cancer, this is peanuts. Although the HPV vaccine is beneficial, it is not sufficient to provide just HPV vaccinations when fighting cervical cancer. Countries need comprehensive cervical cancer control programs that address the entire continuum of cancer care and control: primary prevention with education and awareness raising in addition to HPV vaccination; secondary prevention with basic and advanced diagnostics and treatment, including a single-visit approach of visual inspection with acetic acid (VIA) and cryotherapy; loop electrosurgical excision procedure (LEEP); surgery; chemoradiation; and of course palliative care. Every year, more than half a million women receive a diagnosis of cervical cancer and over a quarter of a million women die from the disease. The majority of these deaths are in developing countries where women delay seeking help because of ignorance, stigma and poor access to quality care. More than 85% of the global burden of cervical cancer occurs in developing countries, where it accounts for 13% of all female cancers.  Despite these staggering statistics, fewer than 5 percent of women are screened even once in their lifetime. Up to this point, the burden of preventable communicable diseases has diverted the global community’s attention away from cancers and other non-communicable diseases in developing countries. Recently, it has been recognized that developing countries are facing a triple burden of disease, namely communicable diseases, non-communicable diseases, and injuries. Pink Ribbon Red Ribbon partners are rising to the challenge by supporting countries, including Botswana, Rwanda and Zambia, to provide HPV vaccination through GAVI-supported demonstration programs. This support is made possible through the generosity and compassion of our members, including Merck Vaccines and GlaxoSmithKline. Pink Ribbon Red Ribbon is an initiative to expand the availability of vital cervical and breast cancer screening and treatment for women at risk in developing nations in sub-Saharan Africa and Latin America. Founding member institutions include the George W. Bush Institute, the President’s Emergency Plan for AIDS Relief (PEPFAR), Susan G. Komen for the Cure® and the Joint United Nations Programme on HIV/AIDS. Corporate partners include BD (Becton, Dickinson and Company), Bristol-Myers Squibb, Caris Foundation, GlaxoSmithKline, IBM, Merck and QIAGEN. Join us, world, as we strive to save young girls from developing cervical cancer in adulthood.

This post was written by Doyin Oluwole, MD, FRCP, founding Executive Director of Pink Ribbon Red Ribbon, based at the George W. Bush Institute.