After a three-day convention, the World Health Organization (WHO) Strategic Advisory Group of Experts on Immunization announced that a single-dose schedule for the vaccine against human papillomavirus (HPV) “offers solid protection against cervical cancer.” 

This is a major development in the global movement to eliminate cervical cancer, which plagues women in low- and middle-income countries around the world. 

According to WHO, “more than 95% of cervical cancer is caused by sexually transmitted HPV.” Mass vaccination against HPV makes cervical cancer one of the most preventable diseases in global health. But as universal health coverage schemes around the world proliferate, cervical cancer services are often pushed to the side, leaving women and girls vulnerable. 

Last month, ThinkWell released four country profiles commissioned by the Union for International Cancer Control on financing challenges for cervical cancer elimination. Each profile includes analyses of current funding, key stakeholder interviews, and policy recommendations for improving national financing for cervical cancer elimination, including HPV vaccination. 

While each nation studied—Burkina Faso, Côte d’Ivoire, Guatemala, and the Philippines―has unique circumstances and most are pushing for increased visibility and infrastructure for cervical cancer elimination, a common theme spanned the four countries: insufficient funding. 

Though low- and middle-income nations are building programs to address this gap in services, the programs languish because they don’t receive the necessary resources, including to make the HPV vaccine available and accessible. In addition to limited fiscal space, education and advocacy for cervical cancer elimination at health facilities are often poor because facilities may not prioritize it as a major women’s health issue. 

A single-dose schedule for the HPV vaccine will not only ease the budgetary burden on national governments and incentivize financing vaccine programs, but it will also simplify mass vaccination for women and girls who may face physical and economic barriers associated with a two-dose schedule. 

This WHO recommendation is an enormous step towards streamlined and widely accessible HPV vaccines and, broadly, cervical cancer elimination. This World Immunization Week, ThinkWell celebrates this announcement and what it means for improved universal health coverage, but the work doesn’t stop here. Continued advocacy and pressure on national governments to take advantage of this development, establish and finance cervical cancer service programs, and raise awareness of the danger of HPV are crucial in the fight to eliminate cervical cancer. 

A single dose means fewer costs and wider access, but it’s up to advocates, governments, and practitioners to make sure that every woman everywhere has the means to get the jab. 

Written by Andrea Bare (Program Director, ThinkWell)

According to the World Health Organization (WHO), universal health coverage (UHC) means that all people have access to the health services they need, when and where they need them, without financial hardship.

Cervical cancer elimination is one of countless areas to be addressed through UHC, but noteworthy given that the disease can be prevented through vaccination against human papillomavirus (HPV), which is a main cause of cervical cancer, as well as through early screening and treatment for precancerous lesions. Yet, preventative care coverage for services like HPV vaccination, HPV testing, and Pap smears are not prioritized when governments build their health budgets.

Building on ThinkWell’s health financing expertise, particularly in oncology, UICC commissioned ThinkWell to investigate cervical cancer financing challenges and how governments can create policy to close this gap in care and strive for the WHO elimination targets. This work was conducted within the scope of the Scale-Up Cervical Cancer Elimination with Secondary prevention Strategy (SUCCESS) project, funded by Unitaid, led by Expertise France and implemented in partnership with Jhpiego. It seeks to provide key stakeholders and civil society with an understanding of how financing can and must be leveraged across different country contexts to drive progress towards elimination.

ThinkWell conducted stakeholder interviews and literature reviews of health financing for cervical cancer in the four countries where the SUCCESS project is established: Burkina Faso, Côte d’Ivoire, Guatemala, and the Philippines. The profiles include policy recommendations that can support advocacy efforts to advance progress towards more comprehensive and accessible cervical cancer prevention and control financing and implementation strategies.

Pushing for UHC

As the global health community moves towards UHC as an international standard, low- and middle-income countries are leading the way in terms of policy goals; with that, addressing gaps in coverage and accessibility and health budgets will be essential to tackle ambitious yet attainable goals like eliminating cervical cancer. The four-country analysis revealed common themes while also highlighting the unique conditions within each country.

In the face of political and economic volatility, the Government of Burkina Faso has dedicated greater spending on health in pursuit of UHC, but cervical cancer elimination is not a financing or implementation priority. Côte d’Ivoire lacks funding for the national HPV vaccine program as well as screening services, though there is strong evidence that these prevent the development of cervical cancer. In Guatemala, access to services and knowledge about prevention and treatment are often determined by social, Indigenous, and economic status, as well as physical access to care and health facilities (e.g., urban vs. rural areas).

Access to early detection and screening for cervical cancer is limited and often requires out-of-pocket payments (OOP), marginalizing women who are unable to afford these services. In the Philippines, OOP accounted for 44.7% of health expenditures in 2020, and, while this is improving, the percentage of OOP costs spent on health impacts 13 million Filipino women living below the poverty threshold.

Financing for UHC

Working with both national and local policymakers to increase funding and allocation for health is necessary to reach people and get them the care they need. Advocates can encourage policymakers to intensify focus on issues like cervical cancer in several ways:

• Support increased government funding for cervical cancer elimination rather than relying on external donor support
• Highlight how effective prevention and control can prevent disease, free up health resources, and contribute to national development objectives
• Engage trusted local-level governmental and non-governmental organizations that work with communities, to ensure they have the funds, tools, and capacity to support implementation of financing and policy advances

What’s next?

The financing barriers facing all countries, including Burkina Faso, Côte d’Ivoire, Guatemala, and the Philippines, are multifaceted and complex. Furthermore, while each government faces unique challenges, the overarching conclusion is that expanding fiscal space for health and preventable diseases such as cervical cancer should continue to be a top priority in the future.

Each country has context-specific development goals, but greater investment in diseases such as cervical cancer which can be eliminated is an investment not only in future generations but also in the stability and growth of each nation. This is about women’s health but also their ability to be productive members of society and there for their own daughters and sons.