POLICY BRIEF

HPV and Cervical Cancer Elimination
in Alignment with WHO’s Strategy

Cervical cancer is the fourth most common cancer among women, with more than 600,000 new cases and 340,000 deaths annually. Nearly all cases are caused by persistent infection with human papillomavirus (HPV). Recognizing cervical cancer as preventable and curable when detected early and effectively managed, the World Health Organization (WHO) launched the Global Strategy to Accelerate the Elimination of Cervical Cancer. The strategy aims to achieve the elimination of cervical cancer, defined as an incidence rate of fewer than 4 cases per 100,000 women. Achieving the goal relies on a comprehensive approach including primary prevention through HPV vaccination, secondary prevention through screening, and robust systems for referral, confirmation, and treatment. This Fast-Track Health policy brief addresses innovative approaches to cervical cancer elimination, illustrated through five case studies, and provides recommendations for municipal, national, and regional health authorities.

Gender-Neutral HPV Vaccination in Australia: Australia became the first country to implement a national gender-neutral HPV vaccination program in 2013. The program offers free HPV vaccines to boys and girls aged 12-13 through school-based delivery, achieving over 80% coverage. By including boys, Australia has reduced the prevalence of high-risk HPV types in both genders. The program is supported by comprehensive public education campaigns and a national HPV registry to monitor vaccination rates. (The Lancet Public Health, 2022).

HPV DNA Testing in Rwanda: Rwanda has emerged as a leader in Africa for cervical cancer prevention by scaling up HPV DNA testing as the primary screening method. The government provides free HPV screening for women aged 30-49 at health centers nationwide. Community health workers play a vital role in mobilizing women for screening and follow-up care. The program has significantly increased early detection of cervical precancer, enabling timely treatment. Rwanda’s experience underscores the importance of integrating screening into primary care and leveraging community engagement (WHO, 2023).

Integrated Screening and Treatment in Thailand: Thailand has implemented a “screen-and-treat” approach using visual inspection with acetic acid (VIA) and cryotherapy for immediate treatment of cervical precancer. This low-cost, effective model is particularly impactful in rural areas where access to laboratory facilities is limited. Training primary healthcare workers to perform VIA and cryotherapy has expanded the reach of the program, reducing the incidence of advanced cervical cancer. The program demonstrates the value of decentralized care and task-shifting in low-resource settings (BMJ Global Health, 2023).

Robust Referral and Care Systems in the United Kingdom (UK): The UK has developed a robust cervical cancer care pathway that ensures timely referral, confirmation, and treatment for abnormal screening results. Women with abnormal Pap smears are referred to colposcopy clinics within two weeks, where further evaluation and biopsy are performed. A dedicated cancer registry tracks patients through the care continuum, ensuring no one is lost to follow-up. This integrated approach has contributed to high survival rates and underscores the importance of well-coordinated referral systems (National Health Service, 2022).

Self-Sampling Pilots in Mexico: To overcome barriers to cervical cancer screening, Mexico has introduced HPV self-sampling in rural and underserved areas. Women receive kits to collect samples at home, which are then sent to centralized labs for HPV DNA testing. This approach has increased participation in screening programs and reduced stigma associated with cervical exams. Early evaluations show high acceptability and comparable diagnostic accuracy to clinician-collected samples. Self-sampling has the potential to revolutionize screening access in low-resource settings (The Lancet Regional Health Americas, 2023).

Efforts to eliminate cervical cancer face persistent challenges. Vaccine hesitancy and misinformation hinder HPV vaccination uptake, particularly in regions with limited health literacy. Screening coverage remains low in many low- and middle-income countries due to logistical barriers, inadequate healthcare infrastructure, and cultural stigma. Health systems often lack capacity for timely follow-up and treatment of abnormal screening results, with many women lost to care. The cost of HPV DNA tests and advanced treatments further limits accessibility, especially in resource-constrained settings. Although the recent launch of campaigns such as the Sabin Vaccine Institute’s Global HPV Consortium are drawing attention to and coalescing consortium partners to take action against cervical cancer, there is still insufficient awareness and advocacy for cervical cancer elimination, reducing political and financial prioritization, and thus presenting a challenge for achieving the WHO’s cervical cancer elimination goal.

Despite these challenges, significant opportunities exist to accelerate cervical cancer elimination. Expanding gender-neutral HPV vaccination programs can increase coverage and promote herd immunity. Advances in screening technologies, such as self-sampling and point-of-care HPV DNA tests, offer scalable solutions to improve access in low-resource settings. Integration of cervical cancer services into primary healthcare frameworks can streamline prevention, screening, and treatment. Strengthening health workforce capacity through training and task-shifting can expand the reach of services. Lastly, global partnerships and funding mechanisms, such as Gavi’s support for HPV vaccines, provide critical resources to overcome financial barriers and scale interventions, although the current funding environment for primary prevention through HPV vaccination remains insufficient.