Preparing the way for a new tool in the fight against cervical cancer

Over the past few years, young women in India, Peru, Uganda, and Vietnam have become among the first in the developing world to be vaccinated against cervical cancer. These four countries are laying the groundwork for effective vaccination strategies in Africa, Asia, and Latin America.

Missed opportunities to save lives

Nearly 530,000 women each year contract cervical cancer and 275,000 die from it. A disproportionate number of those deaths occur in developing countries.

In wealthy countries, screening programs help keep cervical cancer rates low. These programs are effective because most women can easily get to health facilities for regular Pap smears to detect signs of precancer. If those signs are found early, patients can be successfully treated. But developing countries often lack these resources, and women there miss out on lifesaving screening and treatment.

Protection against a cancer-causing virus

Vaccines now are available to improve women’s health by protecting them against the strains of the human papillomavirus (HPV) that cause most cervical cancer. The new vaccines will make it possible to protect women before they become infected—adding another line of defense.

HPV is the most common sexually transmitted infection in the world. There are more than 100 strains of the virus, but only a handful cause cancer. Women are usually infected in their teens, 20s, or early 30s, but they don’t show symptoms until much later, so they are not aware. Without screening, there are no warning signs until the cancer has become life-threatening.

Clinical trials show that the new vaccines are safe and nearly 100 percent effective against the main cancer-causing strains of HPV when girls and young women are vaccinated before they’ve been exposed to the virus. Widespread vaccination could reduce the number of cases of cervical cancer by at least half over the next 50 years.

Speeding availability for women in need

We know from experience that it can take decades for new vaccines to become available in developing countries. Market forces are often not strong enough, initially, to overcome the logistical and economic challenges of integrating new vaccines into developing-country health systems. Changing that is where PATH comes in.

PATH’s projects in India, Peru, Uganda, and Vietnam are preparing the way for the new HPV vaccines by providing decision-makers in the developing world with the information they need to decide when and how best to add the vaccines to their health programs. Lessons learned can be applied to other countries with similar cultural, economic, and health contexts. We are also working with an array of stakeholders—vaccine producers, global vaccine distributors, and developing-country governments—to identify and resolve the logistical challenges of procuring, storing, transporting, and administering the new vaccines.

Learning from the frontlines

Our first step was to understand and address each country’s special challenges related to the use of HPV vaccine. PATH and our partners began by conducting formative research to learn more about community attitudes—information that helped us tailor introduction approaches in each country. The vaccine is most effective if given to girls before they have been exposed to the virus during sex, but in the developing world young adolescents rarely access health services unless they are ill. We assessed new strategies to reach these girls both through health centers and at schools. And because levels of knowledge about the vaccine were low, even among health care providers, we took special care with training and community education initiatives to reach families and providers with important information to make informed choices.

Vaccination + screening = good public health policy

The new vaccines alone won’t wipe out cervical cancer. If the HPV vaccines became available worldwide tomorrow, there would still be many women already infected with HPV who would be at risk of disease later in life. And not all cancer-causing HPV types are covered by the vaccines. Therefore, efforts to bring screening and treatment to women in the developing world remain essential—and a core part of PATH’s ongoing work (see also our work with the Alliance for Cervical Cancer Prevention and in developing biochemical tests for cervical cancer).

Our efforts today mean that more women will receive the services they need and that the new HPV vaccines will be available in developing countries without delay—so that women tomorrow won’t have to die simply because of where they live.

Photos, from top: Richard Lord, Miguel Alvarez.