War on cervical cancer gathers momentum

Countries in the Middle East should follow the example of the UAE, Libya and Australia to eliminate Human Papillomavirus

Recently, as Mother’s Day was celebrated across much of the Middle East and North Africa, a new Cervical Cancer Crisis Card highlighted the scale of the challenge and opportunity to tackle what is now considered an almost entirely preventable disease.

Cervical cancer is a noncommunicable disease (NCD) caused by the Human Papillomavirus (HPV). Every year the disease kills 270,000 women worldwide. In the Middle East and North African region, it is the second leading cause of death among women.

To tackle the disease, it’s important countries employ a comprehensive approach, which includes rolling out the preventive vaccine to adolescent girls and boys (HPV affects men as well as women) and providing quality screening services so that cervical cancer can be detected quickly and treated effectively.

The closest thing we have to a silver bullet to prevent the disease is a vaccine that can target multiple strands of the HPV. Following a collaborative effort between both the public and private sectors, a vaccine was developed that now has the capacity to make HPV a thing of the past.

The cervical cancer card acts as both encouragement and a warning. There’s been a great deal of progress. In the UAE, Abu Dhabi recommended free HPV vaccine to girls in school settings ten years ago, which was a key milestone for the country and region. This decision has undoubtedly saved lives. Libya has also introduced the HPV vaccine in 2013 as part of its National Immunisation Programme. It is currently considering offering it to boys and girls.

Looking internationally, Australia is a model of how to effectively roll out a comprehensive package of HPV vaccines, screening and treatment and is now on track toward elimination. The Journal of Infectious Diseases highlights that since the introduction of a vaccine to tackle Human Papillomavirus (HPV) ten years ago, the HPV rate in women ages 18 to 24 dropped from more than one in five women to approximately just one per cent and because boys have been vaccinated too, cases of genital warts caused by HPV have also reduced exponentially.

Across the Middle East and North Africa (Mena), unless countries follow the example of the UAE, Libya and Australia then the situation will only get worse. At present, due to a lack of a vaccine roll-out, as well as low screening and treatment rates over 25 women die every single day from preventable cervical cancer in the Middle East and North Africa. And the situation will only get worse if we’re not able to ensure a comprehensive scale up of vaccination, screening and treatment. The WHO predicts that case numbers will almost double by 2030 if governments don’t take action.

Momentum is building across the region for comprehensive prevention, screening and treatment for HPV-related diseases.

A new coalition, the Eastern Mediterranean Region Alliance on Non-Communicable Diseases released a landmark statement on HPV this month calling for “key decision makers to politically and financially commit to HPV screenings and vaccine uptake.” They also noted that the WHO lists the HPV vaccination as a ‘best buy’, as it is both cost-effective and evidence-based, and the urgency needed to increase political will and fight the barriers of stigma and misinformation.

Affordable screening

Elimination is feasible, but accelerated political and financial support is needed to stop women and girls from needlessly dying from a preventable cancer. As momentum builds around HPV elimination, now is the time to turn green shoots of hope into concrete actions to save more lives.

The new WHO High-Level Commission on NCDs, which I co-chair along with political leaders, civil society and the private sector from around the world are looking at how to best accelerate progress from around the world. HPV is an area where we have already done the research and development needed to save a lot of lives.

As well as rolling out the vaccine, it’s critical that screening is made more available and affordable so that women who have not been vaccinated can be put onto treatment as quickly as possible, giving them the best chance of beating the disease.

Women’s rights are human rights and without equality of health for women there can be no equality of any other kind. Without access to equal health care and investment, as we know from too much experience, this inequality compounds and weighs on young girls’ prospects as they grow up to become students, workers, wives and mothers. Across the world and in the Middle East, we have a blueprint for eliminating HPV; now leaders must follow in the footsteps of Abu Dhabi and Australia and take action.

■ Dr Sania Nishtar is co-chair of the WHO’s Independent High-Level Commission on Noncommuncable Diseases.