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

Over the next several years, young women in India, Peru, Uganda, and Vietnam will become the first in the developing world to live without fear of cervical cancer—as PATH and our partners begin pilot introduction of new vaccines for the disease. These four countries are laying the groundwork for vaccination throughout the developing world.

Missed opportunities to save lives

Nearly 500,000 women each year are diagnosed with cervical cancer, and nearly 250,000 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 cancer. When cancer is found, it can be successfully treated while still in the early stages. But developing countries often lack these resources, and women there miss out on lifesaving screening and treatment.

Protection against a cancer-causing virus

New 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—another line of defense for those who don’t have access to regular screening.

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 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.

We are preparing the way for the new HPV vaccines by providing decision-makers with the information they need to decide whether and how to add the vaccines to their health programs. 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

Working closely with governmental partners, PATH is supporting HPV vaccine demonstration projects in India, Peru, Uganda, and Vietnam. All four countries have shown a commitment to preventing cervical cancer, have strong existing vaccination programs, and are likely to expand successful demonstration projects. Lessons learned could be applied to other countries with similar cultural, economic, and health contexts.

A first step will be to address some of the special challenges related to use of HPV vaccine. The vaccine is most effective if given to girls before they have been exposed to the virus during sex, but in the developing world, pre-teens and adolescents rarely access health services unless they are ill. We will need new strategies to reach these girls. And because in many places only girls—not boys—will be immunized, some communities may view the vaccine with suspicion. PATH and our partners are conducting formative research to learn more about community attitudes, information that will help us tailor introduction approaches in each country.

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 who are already infected with HPV and would still be at risk. 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.

Photo: Richard Lord.