Since the launch of the global strategy against cervical cancer in 2020, the World Health Organization (WHO) has accelerated the initiative by virtue of commitments and strategies offered by governments and organisations worldwide. Australia is on track to become one of the first nations to achieve this, and countries like Bangladesh and Indonesia have introduced HPV vaccines. Let's examine Asia's efforts in eliminating cervical cancer and whether the continent is on track to meet WHO’s targets by 2030.

Cervical cancer is the second most prevalent cancer affecting women globally. Projections indicate a rise in the annual incidence of new cases from 570,000 to 700,000 between 2018 and 2030, with corresponding deaths expected to increase from 311,000 to 400,000. The majority of these fatalities are concentrated in low-and lower-middle-income countries (LMICs), highlighting the challenge posed by insufficient access to cervical cancer prevention, screening, and treatment. 

To urgently address the disparity, the WHO launched the global strategy in 2020 to eliminate cervical cancer. Targets for 2030 include 90 per cent HPV ( human papillomavirus) vaccination for girls by the age of 15, 70 per cent high-performance screening for women at 35 and 45, and treating 90 per cent of pre-cancer and invasive cases. Meeting these 90–70–90 targets is essential for each country to eliminate cervical cancer globally by the next century.

“The WHO’s call to eliminate cervical cancer from 2018 was bolstered by the 2020 Global Strategy to eliminate cervical cancer, which included targets for prevention, screening, and treatment by 2030. This initiative inspired attention for what is currently a lagging effort around the world,” said Anuradha Gupta, President, Global Immunisation at Sabin Vaccine Institute, USA.  Sabin is dedicated to making vaccines more accessible, enabling innovation and expanding immunisation across the globe.

Various countries have announced action plans in response to WHO’s call to eliminate cervical cancer. Let’s examine the initiatives in detail. 

APAC initiatives 

There has been significant progress in terms of immunisation, screenings, and raising awareness. Countries in the Asia Pacific (APAC) region have launched specific cervical cancer programmes or bolstered existing ones in terms of infrastructure and outreach efforts.

Leading among them is Australia which is set to be among the first countries in the world to eliminate cervical cancer, which the country anticipates to achieve in the next 10 years.  In November 2023, Australia announced investments totaling $48.2 million over four years in the National Strategy, with an aim of eradicating cervical cancer by 2035. The strategy involves extending HPV vaccination to boys, setting a 70 per cent screening target for 25- to 74-year-olds every five years, and allocating $8.3 million for innovative screening models in priority populations. Initiatives, such as self-collected Cervical Screening Tests, address barriers for underrepresented groups. Additionally, the Australian Government committed $12.5 million to the Indo-Pacific Elimination Partnership for Cervical Cancer (EPICC).

Indonesia has also taken various initiatives recently. In November 2023, the country declared a commitment to achieve the WHO’s 90-70-90 targets for cervical cancer elimination through its National Cervical Cancer Elimination Plan (2023-2030). In September 2023, Indonesia’s Ministry of Health and the Sabin Vaccine Institute entered into a three-year agreement to collaborate on cervical cancer prevention and elimination strategy.

In October 2023, Bangladesh rolled out a nationwide HPV vaccination campaign. The campaign will be rolled out across the country in three phases. Upon the completion of all three phases, the HPV vaccine will be integrated into the routine immunisation programme for girls. India has initiated HPV vaccination targeting cervical cancer in the northeastern state of Sikkim, with plans to expand the programme to other states. 

Malaysia has been proactive in eliminating cervical cancer, evident through its national HPV immunisation programme. Since its inception in 2010, the programme has consistently achieved an impressive 80-95 per cent coverage among adolescent girls. In response to WHO's goals, Malaysia has rolled out the 'Action Plan Towards the Elimination of Cervical Cancer in Malaysia 2021-2030.' This initiative outlines objectives for increasing HPV vaccination, intensifying cervical screening, and improving precancer and cancer treatment. 

Malaysia has achieved high coverage of HPV vaccination, but screening rates remain low. The ROSE (removing obstacles to cervical screening) Programme, integrating self-sampling, HPV testing, and e-health technology, has been a revolutionary solution. The ROSE Foundation celebrated a significant milestone in November 2023, having successfully screened over 25,000 women  and ensured 90 per cent of women with abnormal tests receive proper follow-up.

Singapore launched the Temasek Foundation Human Papillomavirus (HPV) Immunisation Programme, in partnership with the Singapore Cancer Society (SCS) in 2022. This new programme will be helmed and implemented by SCS and seeks to cover the out-of-pocket costs for each HPV vaccine dose for women from low-income backgrounds,  enhancing accessibility and promoting higher vaccine uptake. Singapore also provides  subsidised cervical cancer screening at Community Health Assist Scheme (CHAS) since 2017. 

In 2009, China launched a cervical and breast cancer screening programme for rural women, which later became a National Basic Public Health Service Project in 2019. Aligned with the Healthy China Action Plan (2019–2030) and responding to the WHO's 2020 Global Strategy, China aims to achieve the 90-70-90 goal by 2030. The China Women’s Development Guidelines (2021–2030) and the 'Accelerate the Elimination of Cervical Cancer (2023–2030)' issued in January 2023 further emphasise awareness, free HPV vaccination, innovative screening technologies, and comprehensive control capacity to accelerate cervical cancer elimination in the country.

Concept to Action 

Although efforts have been made to reduce the incidence of the disease, the progress is somewhat insufficient. 

According to a Lancet study, global completion of the full HPV vaccination course for adolescent girls dropped from 14 per cent in 2019 to 12 per cent in 2021. In Asia, first-dose HPV vaccination coverage is as low as 6 per cent in the Western Pacific Region and 3 per cent in the South East Asia Region. About half of ANCCA (Asian National Cancer Centers Alliance) member countries (Bangladesh, Bhutan, Brunei, China, India, Indonesia, Japan, Laos, Malaysia, Mongolia, Singapore, South Korea, Thailand and Vietnam) include HPV vaccination in their national or school health programs. While nearly 76 per cent of ANCCA member countries have a national cervical cancer screening programme, only 24 per cent achieve over 50 per cent screening coverage among women aged 30 to 49 in the previous 5 years, including Bhutan, Japan, South Korea, Singapore, and Thailand.

“To turn this initiative into action, organisations like those in the Global HPV Consortium are coming together to build momentum, amplify and share messaging and develop sustainable cervical cancer elimination efforts for individual countries,” said Anuradha Gupta, President, Global Immunisation at Sabin Vaccine Institute, USA. Sabin is the Secretariat for the Global HPV Consortium.

In June 2023, Crowell & Moring International partnered with Roche, TogetHER for Health, CAPED, and Jhpiego to form the Asia-Pacific Women's Cancer Coalition, addressing rising breast and cervical cancer cases. The coalition focuses on strategic partnerships, innovative technologies, and advocacy to reduce incidence and mortality. In September 2023, the Global HPV Consortium was launched in Kuala Lumpur, led by the Sabin Vaccine Institute. This worldwide collaboration aims to accelerate HPV prevention and eliminate cervical cancer. It involves public and private stakeholders, including vaccination, cancer control, and reproductive health organisations.

Project Teal, a joint initiative by the University of Hong Kong, Roche Diagnostics, Karen Leung Foundation, Christian Action, and the Family Planning Association of Hong Kong, incorporates self-sampling for cervical cancer screening. In phase 3, nearly 600 participants were enrolled, achieving a 65 per cent return rate. The project offers free screening tests for eligible women and explores the potential of home-based self-sampling as a research project.

Cervical cancer is treatable, and we possess the tools to eliminate it. The primary obstacles lie in ensuring access for those in need.

“Cervical cancer is a leading cause of death in women in many countries. While Pap testing was developed last century and has been an important screening tool, many countries have not had the capacity to implement it,” said Professor Karen Canfell, Director of the Daffodil Centre (a joint venture between Cancer Council New South Wales and the University of Sydney in Australia).

New research, led by the Daffodil Centre and published in the journal Nature Medicine, shows cervical cancer death rates in low-to-middle-income countries could be reduced by more than 63 per cent through implementation of WHO guidelines.

“Insufficient health system capacity represents a massive barrier to achieving global scale-up goals for many health areas, including elimination of HPV/cervical cancer. I am encouraged by new cervical cancer prevention strategies that both reduce burdens on system capacity and provide for a more patient-centric approach. The two most notable examples are the move toward single-dose HPV vaccination schedules, now officially endorsed by WHO/SAGE, and the still-untapped potential to expand access to diagnostics which utilise self-sampling – both of which simplify service delivery and provide an opportunity to increase coverage for vaccination and screening among underserved women and girls globally,” said Dr Heather White, Executive Director, TogetHER for Health, USA. 

TogetHER is a global partnership ensuring the elimination of cervical cancer through advocacy, partnership, and knowledge-sharing, enabling equitable access to effective prevention and care.

Professor Canfell, says the disease could be eliminated through a three-pillar approach combining vaccination, screening and referral to treatment.

Asian countries have intensified their efforts in combating cervical cancer, yet there is still considerable work to be done to eradicate the disease completely. Early screening and immunisations continue to be the most effective tools in putting an end to the scourge. It is imperative to address access gaps, ensuring that treatments and prevention techniques reach all individuals. 

Ayesha Siddiqui