In 2020, the World Health Organization (WHO) released its draft Global Strategy Towards Eliminating Cervical Cancer, including an achievable target of 90-70-90 by 2030: 90% of girls to be fully vaccinated with the human papilloma virus (HPV) vaccine by 15 years of age; 70% of women to be screened at 35 and 45 years of age; and 90% of women identified with cervical disease to receive treatment for precancerous lesions or invasive cancer.
The Global Strategy notes that urgent and bold action is needed, and that proven and cost-effective measures exist to eliminate this disease. It aims to bring the issue to the attention of policymakers, and provide organisations working in development with a legitimate document from which to formulate interventions to eliminate cervical cancer.
While Australia is on track to eliminate cervical cancer as a public health problem by 2035 (defined as reaching an incidence rate of less than 4 cases per 100,000 women), the disease is still prolific in the Pacific. It is the second most common cancer in Melanesia and the sixth in Polynesia. Despite cervical cancer being one of the most preventable and treatable forms of cancer due to a combination of the HPV vaccine and screening to detect and treat precancerous lesions and invasive cancers early, many nations within the Pacific continue to fall behind other parts of the world. This does not need to be the case.
With Australia committing to roll out a COVID-19 vaccine to the Pacific, and in the context of the Australian Government’s Partnerships for Development strategy which places health security as a key pillar, a cervical cancer elimination program fits well within Australia’s strategic interests.
Australia can be a champion
Australia has a strong history of leadership in cervical cancer prevention, with the development of the HPV vaccine by Professor Ian Frazer and his partner the late Dr Jian Zhou at the University of Queensland paving the way for Australia to become the first country in the world to have a national cervical cancer vaccination program. Australia was also one of the first countries globally to switch its National Cervical Screening Program from cytology-based Pap testing to primary HPV screening in 2017 and continues to set an example for best-practice cervical cancer prevention on the global stage.
Key institutions such as the Department of Foreign Affairs and Trade have the opportunity to lead the way in the elimination of this disease in the Pacific, by mobilising a range of stakeholders including sexual and reproductive health organisations and professional colleges to share expertise, education and resources. Non-governmental organisations have proven to be effective in catalysing national cancer control efforts in low- and middle-income countries.
By investing in the Pacific’s capacity to provide routine cervical screening, HPV vaccinations and public awareness campaigns, Australia’s development funding can assist in eliminating cervical cancer from the region. This will save lives, bolster economic outputs and have flow-on social benefits such as increased access to education and healthcare, and empower women to engage in civil and political processes. Given that WHO estimates that for every dollar invested in cervical cancer through 2050, US$3.20 will be returned to the economy due to increases in women’s workforce participation, and US$26 when societal benefits are also incorporated, this is an investment we cannot afford to ignore.
Pacific Island priorities for cervical cancer
There is a growing interest in the Pacific to eliminate cervical cancer, from multilateral support for HPV vaccinations, to regional discussions on bulk purchasing HPV screening equipment, to country-led initiatives to implement programs.
One such country-led initiative is in Solomon Islands. In 2015 Family Planning Australia was invited by Solomon Islands Ministry of Health and Medical Services to support the rollout of a cervical cancer screening and treatment program. Family Planning Australia had experience with a similar program in Fiji. Starting with pilot sites across Honiara and Isabel Province, and currently expanding across the country, the program utilises a single visit ‘screen and treat’ approach to detect pre-cancerous lesions and treat them immediately. This approach removes the need for multiple appointments and is well accepted as an appropriate and effective model of care in the Pacific. Ensuring that all future HPV based screening programs are both easily accessible and acceptable to women will be the best way to prevent cervical cancer, and these screen and treat programs are paving the way for cervical cancer elimination in the Pacific.
Learning from this experience, Family Planning Australia is now working with Tuvalu stakeholders to roll out a similar program. Both the Solomon Islands and Tuvalu projects are continuing during this COVID-19 period, including delivery of remote training and purchasing of clinical equipment. This is because cervical cancer screening is preventive care, a core pillar of health system strengthening and of health security.
Governments in the region have also highlighted a strong interest in establishing the policy context to allow such programs to succeed. To this end, Family Planning Australia is working with UNFPA and the governments in Fiji, Kiribati, Samoa, Solomon Islands, Tonga, and Vanuatu to develop or update cervical cancer policies and guidelines over the coming 12 months. This will set the policy scene to support the needed injection of funds to roll out programs across the region.
Elimination of cervical cancer in the Pacific is possible
There is growing global awareness of both the need and the potential to eliminate cervical cancer. Australia is well placed to champion this initiative in the Pacific. COVID-19 has reinforced awareness of the importance of preventative healthcare, and an appreciation that investing in health is an investment in supporting resilience and long term growth of countries around the globe.
Eliminating cervical cancer within a set timeframe in the Pacific would be a win for the economic, social, and health outcomes of Pacific communities. Australia is well positioned to support this over the long run. Such an achievement would support achievement of the Sustainable Development Goals, as well as harness and intensify existing development programs in the Pacific. This is a moment in time to invest in a health solution that is achievable, measurable, and most importantly, impactful on the lives of women and girls in the Pacific.
The work by Family Planning Australia detailed in this article is funded primarily through the Australian NGO Cooperation Program and the John James Foundation.