Yes, we can eliminate cervical cancer

Cervical cancer is preventable and curable, and in August 2020, the World Health Assembly adopted the Global Strategy for Cervical Cancer Elimination. Yes, you read that right; we may never have a universal cure for cancer but there are some we can prevent by vaccination. The WHO’ s strategy is a call to collective arms, to eliminate cervical cancer.

The HPV vaccine became available in 2006. It is based on the legendary discovery by Ian Frazer who led the work that led to the development of this incredibly effective vaccine, which protects against not only cervical cancer but also other cancers of the genitals, mouth, and throat.

WHO’S bold initiative followed years of concerted efforts in the medical and public health communities to curb the incidence of this preventable disease. The goal is ambitious, but quite realisable. It calls for countries to achieve three key targets by 2030: vaccinating 90 percent of girls against the virus by age 15, screening 70 percent of women by age 35 and again at 45, and treating 90 percent of those diagnosed with cervical disease. It’s a simple recipe; vaccinate 90 percent, screen 70 percent, treat 90 percent. But the ingredients? Political will, accessible healthcare, and a dash of community magic. This framework, if implemented worldwide, could save millions of lives.

Why cervical cancer?

Cervical cancer starts in the cells on the surface of the cervix. The current story of cervical cancer includes a plot that only poverty could write, it now being a preventable disease but still flourishing where help is hardest to reach. The primary cause of cervical cancer is persistent infection with high-risk strains of HPV, a virus than can be prevented through vaccination. And eventually, eliminated in a community; like other viruses, once vaccination rates are high enough in the community, it can no longer be transmitted – in other words, it’s game over for the virus. Cervical cancer is not only preventable but also curable when detected early.

And yet … every year, more than 600,000 women worldwide are diagnosed, and more than 300,000 die, with most of these deaths occurring in low-resource settings. These numbers are especially tragic when you consider that we have effective vaccines and also screening methods already exist.

Rwanda and Scotland show us how

Here’s a fact that might stand you in good stead on quiz night: Rwanda and Scotland are leading the way in the elimination of cervical cancer.

Rwanda, often cited as a global leader in HPV vaccination, was the first low-income country to roll out a national HPV vaccination programme, offering free vaccines to girls aged 12 in 2011. The results have been remarkable: over 93 percent of girls in Rwanda have been vaccinated against HPV. Rwanda’s achievement reflects a strong political will, community engagement, and successful partnerships with global health organisations. Who’d have thought? Rwanda exemplifies success powered by grit and community resolve rather than GDP.

Scotland has a similar success story to show and tell, albeit in a different, and more familiar, context. Scotland, where misty highlands meet high vaccination rates, is rewriting the narrative. The villains – cervical abnormalities – are dropping like midges in the cold. Since introducing its national HPV vaccination programme in 2008, the country has achieved a vaccination rate of over 90 percent.

Research has shown that the programme has led to a 90 percent reduction in pre-cancerous cervical abnormalities among vaccinated women. If Rwanda shows us what can be done with a lower GDP, Scotland is on track to become one of the first countries to eliminate cervical cancer, showing us how robust vaccination and screening programmes can drastically reduce the disease burden even in high-income settings.

What about us?

New Zealand has a well-established cervical screening programme that began in 1990, and cervical cancer rates have fallen significantly over the last three decades as a result. The introduction of the HPV vaccine in 2008 has further accelerated this trend, with the vaccine now part of the National Immunisation Schedule, offered free to all boys and girls aged 9-26.

Men and boys may not have a cervix or a vulva, but they can become infected with the virus and pass it on. They also benefit directly as the vaccine prevents other HPV-related cancers including penile cancer, anal cancer, and oropharyngeal cancer. And let’s not forget genital warts which affects both males and females.

There are challenges. New Zealand has not yet reached the WHO’s targets for HPV vaccination or cervical screening coverage. One of the key obstacles is the gap in access to health services, particularly for Māori and Pacific women, who continue to experience higher rates of cervical cancer than non-Māori. Systemic inequities in the healthcare system mean these groups are less likely to participate in cervical screening programmes and may face barriers such as cost, cultural stigma, and geographic isolation.

The low uptake of the HPV vaccine is another concern. New Zealand is not performing well compared with many other countries – it has not yet achieved close to the 90 percent target set by the WHO; we’re sitting at around 65 percent for one dose and for Māori this is 58 percent. Overcoming vaccine hesitancy and improving access to healthcare services in underserved communities remains a significant challenge. Vaccine uptake should be a no-brainer, right? Yet here we are, wrestling with a hydra-headed beast called ‘hesitancy’.

What’s stopping us?

Talking of hydras; if we want to eliminate cervical cancer in New Zealand, we need to take a multi-pronged approach, focusing on equitable access to healthcare for all women.

Improving vaccination coverage, especially among Māori and Pacific populations, is a key priority. We need public health campaigns tailored to these communities, combined with efforts to make vaccination more accessible.

We also need to get more women to take part in the national cervical screening programme. New Zealand recently moved to a new primary screening test: HPV testing, which is more effective than the traditional Pap smear, and can detect high-risk strains of the virus before cancer develops, allowing for earlier and more effective treatment. And last year, New Zealand rolled out self-testing options which could increase screening rates, particularly among women who can’t easily access a healthcare provider.

A global effort

The WHO’s declaration is a call to action, not just for governments, but for communities, healthcare workers, and individuals. Cervical cancer is one of the few cancers that can be eliminated, and countries such as Rwanda and Scotland show that it is possible.

In New Zealand, progress has been made, but we need to work harder on ensuring that all women benefit from these life-saving interventions. By continuing to address health inequities, improving vaccine uptake, and expanding access to screening, New Zealand can move closer to the WHO’s goal of eliminating cervical cancer.

The notion of ‘eliminating cancer’ may have once sounded like the stuff of dreams, but the WHO’s initiative offers a rare reality check: some good futures are within reach. It is a rare opportunity in public health to make a disease history, and the WHO’s declaration gives us the blueprint to achieve it, and cervical cancer a tragedy of the past rather than a persistent threat of the future.