The Union for In­ter­na­tion­al Can­cer Con­trol (UICC) says that Cer­vi­cal Can­cer elim­i­na­tion is threat­ened by the COVID-19 Pan­dem­ic and a lack of fund­ing. How­ev­er UICC con­tin­ues to work to in­crease ac­cess to screen­ing and treat­ment. De­tails fol­low in this press re­lease from UICC:

♦HPV vac­ci­na­tion cov­er­age to pre­vent cer­vi­cal can­cer has im­proved glob­al­ly but COVID-19 has slowed the rate of im­ple­men­ta­tion of rou­tine im­mu­ni­sa­tion pro­grammes.
♦Dis­rup­tions caused by pan­dem­ic, in­clud­ing de­lays in vac­ci­na­tion, screen­ing, treat­ment and scale-up of mea­sures, threat­en to un­der­mine ef­forts to reach glob­al elim­i­na­tion tar­gets and could lead to a sig­nif­i­cant in­crease in cer­vi­cal can­cer-re­lat­ed deaths in 78 LMICs.
♦Among oth­er ac­tions, UICC is work­ing to in­crease ac­cess to screen­ing and treat­ment in LMICs through SUC­CESS (Scale-up Cer­vi­cal Can­cer Elim­i­na­tion with Sec­ondary pre­ven­tion Strat­e­gy), a project fund­ed by Uni­taid and led by Ex­per­tise France in col­lab­o­ra­tion with Jh­piego and UICC.

A year af­ter the launch of WHO’s Glob­al Strat­e­gy to elim­i­nate cer­vi­cal can­cer, the Union for In­ter­na­tion­al Can­cer Con­trol (UICC) draws at­ten­tion to the im­pact of de­lays due to COVID-19 in im­ple­ment­ing the Strat­e­gy, while em­pha­sis­ing the im­por­tance of mo­bil­is­ing greater fund­ing in low- and mid­dle-in­come coun­tries (LMICs).

LMICs con­tin­ue to car­ry an over­whelm­ing share of the glob­al bur­den of cer­vi­cal can­cer, ac­count­ing for some 90% of all re­lat­ed pre­ma­ture deaths. Few dis­eases so stark­ly re­flect glob­al health dis­crep­an­cies and in­equity.

As of June 2020, over half of WHO Mem­ber States had in­tro­duced vac­ci­na­tion against the hu­man pa­pil­lo­mavirus (HPV), which caus­es most cas­es of cer­vi­cal can­cer, and UICC wel­comes and is en­cour­aged by this de­vel­op­ment. While HPV vac­ci­na­tion has been avail­able since 2007, 95% of the more than 100 mil­lion girls vac­ci­nat­ed be­tween 2007-2017 are from high-in­come coun­tries where im­mu­ni­sa­tion pro­grammes are now rou­tine.

COVID-19 has now slowed the im­ple­men­ta­tion of new im­mu­ni­sa­tion pro­grammes. The pan­dem­ic has caused de­lays and dis­rup­tions to on­go­ing tri­als of one-dose HPV vac­ci­na­tion, screen­ing pro­grammes, treat­ments, as well as to the sup­ply of reagents and test­ing sys­tems di­vert­ed to the COVID-19 re­sponse. These dis­rup­tions are un­der­min­ing ef­forts in pre­ven­tion and treat­ment to reach glob­al elim­i­na­tion tar­gets for cer­vi­cal can­cer.

The COVID-19 and Can­cer Glob­al Mod­el­ling Con­sor­tium, of which UICC is a part, pre­sent­ed find­ings at UICC’s re­cent World Can­cer Lead­ers’ Sum­mit that high­light­ed the risk of a sig­nif­i­cant in­crease in cer­vi­cal can­cer-re­lat­ed deaths in 78 LMICs due to de­lays in vac­ci­na­tion, screen­ing, treat­ment and scale-up of mea­sures.

“The threat of a sig­nif­i­cant rise in cer­vi­cal can­cer-re­lat­ed deaths due to dis­rup­tions caused by COVID-19 to vac­ci­na­tion and screen­ing pro­grammes and treat­ment should serve to reaf­firm glob­al com­mit­ment to elim­i­na­tion and the im­por­tance of build­ing more re­silient and eq­ui­table health sys­tems,” says Dr Cary Adams, CEO of UICC. “An av­er­age of USD 0.40 per per­son per year in low-in­come set­tings is re­quired to fi­nance elim­i­na­tion through vac­ci­na­tion, screen­ing and ear­ly treat­ment. Along­side the lives saved, the re­turn is sub­stan­tial in terms of im­proved health for women, high­er par­tic­i­pa­tion of women in the work­force, and greater fam­i­ly and so­cial co­he­sion and sta­bil­i­ty.”

Rwan­da demon­strates that it is pos­si­ble for low-in­come coun­tries to achieve WHO tar­gets. In 2011, the coun­try be­came the first African na­tion to im­ple­ment an HPV vac­ci­na­tion pro­gramme. As a re­sult, pop­u­la­tion-lev­el cov­er­age in­creased from 6% for girls born in 1993 up to a max­i­mum of 99% for those born in 2002. In line with the oth­er pil­lars of the Strat­e­gy, Rwan­da al­so im­ple­ment­ed a Screen, No­ti­fy, See, and Treat cer­vi­cal can­cer screen­ing pro­gramme in 2013 for women aged 35-45.

Over­all, a com­pre­hen­sive pro­gramme to im­ple­ment HPV vac­ci­na­tion and screen­ing in 50 LMICs could avert 5.2 mil­lion cas­es, 3.7 mil­lion deaths and 22 mil­lion Dis­abli­ty-Ad­just­ed Life Years (DALYs) over ten years, at a to­tal cost of USD 3.2 bil­lion per year.

Sup­port­ing the can­cer com­mu­ni­ty to ac­cel­er­ate cer­vi­cal can­cer elim­i­na­tion

UICC con­tin­ues to de­ploy a com­pre­hen­sive set of ac­tiv­i­ties in sup­port of the im­ple­men­ta­tion of the Glob­al Strat­e­gy, for ex­am­ple, in work­ing to in­crease ac­cess to screen­ing and treat­ment in LMICs through SUC­CESS (Scale-up Cer­vi­cal Can­cer Elim­i­na­tion with Sec­ondary pre­ven­tion Strat­e­gy), a project fund­ed by Uni­taid and led by Ex­per­tise France in col­lab­o­ra­tion with Jh­piego and UICC. The project sup­ports four tar­get coun­tries (Burk­i­na Fa­so, Côte d’Ivoire, Guatemala and the Philip­pines) and seeks to share the learn­ing and ex­per­tise gained to oth­er LMICs in the re­spec­tive re­gions.

The project has over­seen an ex­pan­sion of HPV test­ing, train­ing of clin­i­cal and lab­o­ra­to­ry staff, strength­en­ing of di­ag­nos­tic ca­pac­i­ty and an in­crease in the num­ber of de­vices avail­able for the treat­ment of pre­can­cer­ous le­sions. In ad­di­tion, the SUC­CESS project aims to mo­bilise and sup­port civ­il so­ci­ety to raise aware­ness and ad­vo­cate for im­proved cer­vi­cal can­cer screen­ing and treat­ment, long-term sus­tain­abil­i­ty and the im­ple­men­ta­tion of the Strat­e­gy at the na­tion­al lev­el.