Advancing global efforts in cervical cancer elimination

Prebo Barango, Co-chair of the UN Joint Action Group for the Cervical Cancer Elimination Initiative at the World Health Organization (WHO), and Nicholas Banatvala, Head of the Secretariat for the UN Interagency Task Force on the Prevention and Control of Noncommunicable Diseases, discuss the challenges and progress in the efforts to eliminate cervical cancer

Cervical cancer remains a leading cause of cancer-related deaths in LMICs. What key factors are hindering the fight against cervical cancer elimination?

Cervical cancer is the fourth most common cancer in women globally, with the latest statistics indicating there are around 660,00 new cases and around 350,00 deaths each year. These figures will increase to 700,000 new cases and 400,000 deaths by 2050 unless we scale up actions to prevent and treat women at risk and with cervical cancer. More than 95% of cervical cancer cases are caused by HPV.

The highest rates of cervical cancer incidence and mortality are in low- and middle-income countries. Ninety-four per cent of the 350,000 deaths caused by cervical cancer occurred in low- and middle-income countries. This reflects major inequities driven by lack of access to national HPV vaccination, cervical screening and treatment services and social and economic determinants. Women living with HIV are six times more likely to develop cervical cancer than those who are HIV negative. Effective primary prevention (HPV vaccination) and secondary prevention (screening and treating pre-cancerous lesions) can prevent most cervical cancer cases. In addition, cervical cancer is largely curable, particularly if detected early and adequately treated.

In populations most impacted by cervical cancer, access to the HPV vaccine is limited, screening is unavailable or suboptimal, and women are therefore too often diagnosed late. Access to treatment in many countries is also limited. The result is women dying when they need not: tragedy for the woman concerned and her family. But these preventable deaths are also a significant drag on the community and the country’s socioeconomic development.

Underpinning these issues are broader governance challenges in many countries. This includes the attention paid to human rights, women’s health and wellbeing and the ability of women and girls to access health services. A lack of finance for health services is a critical issue; adequate financing for healthcare is also critical. National cervical cancer programmes should be fully integrated into universal health coverage, with primary care as the main entry point to ensure access to high coverage. It is also important to ensure adequate maintenance of equipment and uninterrupted supply chains. Health systems need to take into account the prevailing social and cultural/traditional norms and beliefs of women and girls. Inadequate levels of health literacy, including how to prevent and seek treatment for cervical cancer, are also a hindrance to the fight against this preventable disease.

Which of the three pillars of the WHO’s strategy for cervical cancer elimination – vaccination, screening, or treatment – seems most difficult to implement?

While there has been progress in advancing HPV vaccination, screening, and treatment, we still have to do a lot more to reach each one of the three global targets that were endorsed by the World Health Assembly in 2020 as part of the global strategy for the elimination of cervical cancer as a public health problem.

• By 2030, 90% of girls fully vaccinated with the HPV vaccine by 15 years of age.
• By 2030, 70% of women screened using a high-performance test by 35 years of age and again by 45 years of age.
• By 2030, 90% of women with cervical disease are treated (90% of women with pre-cancer treated and 90% of women with invasive cancer managed).

While HPV vaccination programs continue to expand, many countries continue to face challenges in vaccine rollout, including the cost of vaccine procurement, lack of funding and political will from governments and their partners, and inadequate infrastructure for cold chain storage and transport. Stigma, misinformation, lack of education and awareness, and vaccine hesitancy are additional barriers in the successful rollout of vaccination programmes.

There are major gaps when it comes to screening and treatment, particularly in low- and middle-income countries (LMICs). Many women still lack access to high-performance tests, and even when they are screened, follow-up care and treatment for pre-cancerous lesions are not always available. New technologies like HPV self-testing have the potential to improve screening rates, but strong health system integration and clear treatment pathways are essential to ensure that screening translates into timely and effective care.

New technologies and innovations that can advance cervical cancer prevention, diagnosis, and treatment are not always accessible to the communities that need them most. Strengthened investments and country-level support are necessary to ensure that these innovations are widely accessible and can be effectively integrated into national health programs.

Many countries face gaps in trained healthcare workers, diagnostic and treatment infrastructure. Access to cancer diagnostic and treatment services is limited in several LMICs. In a WHO survey conducted in 2023, 52% of low-income countries reported having pathology services available in the public health system, compared to 98% in high-income countries. Opportunities to address these challenges include expanding healthcare workforce training, strengthening diagnostic and treatment capacity, and integrating cervical cancer services into broader health systems.

A critical but under-recognized challenge is the lack of sustainable and predictable financing. Cervical cancer programming often relies on short-term funding through external grants, rather than long-term, sustainable government funding. Innovative financing mechanisms, including through public-private partnerships, provide opportunities for increasing cervical cancer services and ensuring that cervical cancer prevention, management and care are included in universal health coverage benefit packages.

As of 2024, only 46% of low-income countries had implemented national HPV vaccination programs, compared to 98% of high-income countries. How can we enhance vaccine infrastructure to ensure a sustainable supply of HPV vaccines, reduce logistical and financial barriers, and overcome delivery challenges?

Single-dose HPV vaccination: Six vaccines are currently on the WHO List of Prequalified Vaccines. Recent evidence has shown that single-dose HPV vaccine provides strong protection against infection and can be used as an alternative to the two-dose schedule. Single-dose HPV vaccines could be a game-changer for many countries, as they reduce costs, simplify delivery, and thereby increase the likelihood that more girls will be fully protected, with the opportunity to accelerate progress toward the 90% global vaccination coverage target.

Are countries committing to the objectives set for 2030? What are the upcoming global milestones for joint advocacy efforts?

In 2020, 194 countries committed to eliminating a specific cancer for the first time, through the adoption of the Global Strategy to accelerate the elimination of cervical cancer as a public health problem, despite a global pandemic. Since then, countries have continued to prioritize elimination efforts, reinforcing the role of sustained leadership and high-level advocacy in driving progress. WHO reports to the World Health Assembly on progress being made by Member States in their efforts to reduce the burden of cervical cancer. Additionally, this year, all Member States reaffirmed their commitment to eliminating cervical cancer by adopting a resolution to designate November 17 every year as World Cervical Cancer Elimination Day.

Platforms like the Global Fora on Cervical Cancer Elimination are important in maintaining this momentum by facilitating the sharing of country-level experience and expertise.

Heads of State and Government have highlighted the importance of cervical cancer in the political declaration, and it was a focal point at the fourth high-level meeting of the General Assembly on the prevention and control of NCDs and the promotion of mental health and wellbeing on 25 September 2025.