Stopping Women’s Next Biggest Killer
APR 14, 2015
GENEVA – For women,
the act of bringing life into this world has historically meant risking
their own lives, with the real prospect of death during childbirth. But,
though great strides are being made in reducing maternal deaths in poor
countries, those gains could be undone by a growing threat to women’s
health. For the first time, the number of deaths caused by cervical
cancer every year is poised to outstrip the total caused by childbirth.
The trend partly reflects the success of efforts to reduce maternal deaths. Since 1990, the number of women dying as a result of childbirth has been nearly halved, to 289,000 per year. Over the same period, however, annual deaths from cervical cancer
have increased by almost 40%, to 266,000. Even as better standards of
care continue to cut maternal mortality, cervical cancer deaths are
expected to rise further. By 2035, the disease is expected to cause
416,000 women to die slowly and painfully every year – virtually all of
them in developing countries (mostly Sub-Saharan Africa and South Asia).
The tragedy is that
these deaths are almost entirely preventable. Human papillomavirus (HPV)
vaccines, coupled with screening and treatment, could prevent the vast
majority of cervical cancer cases. But almost 90% of the women who die
from cervical cancer are in developing countries, where, for too many of them, screening services are unavailable, and treatment even less so.
As former Additional
Secretary at the Ministry of Health and Family Welfare in India, the
country with the largest number of cervical cancer deaths in the world, I
have seen the impact of the disease with my own eyes. What is
particularly devastating is how it also quashes hope. Women with HIV,
for example, are particularly prone to the disease. Yet, with better
treatments for HIV becoming available, women are now surviving HIV only
to die from cervical cancer.
In 2010, the total
global cost of cervical cancer was estimated to be around $2.7 billion
per year. By 2030, this is expected to increase to $4.7 billion, unless
we do something about it now.
Vaccines,
fortunately, are becoming increasingly available. Safe and effective HPV
vaccines have been on the market since 2006, protecting against HPV
types 16 and 18, which cause 70% of all cervical cancer cases. Newly
approved vaccines provide even greater protection.
In wealthy countries,
HPV vaccines are often priced at more than $100 per dose. But Gavi, the
Vaccine Alliance, has worked with manufacturers to reduce prices in
developing countries. Recently, we secured a record-low price for HPV vaccines
of $4.50 a dose, opening the door for millions of the poorest girls to
be vaccinated in 27 countries. By 2020, we estimate that Gavi will have
helped over 30 million girls in more than 40 developing countries
receive vaccinations against HPV.
The economic benefits
of vaccines are substantial. It takes time and significant investment
to set up effective screening and treatment services. And, given that
even high-income countries struggle to meet the cost of cancer
treatments, prevention is clearly a far more efficient option. Moreover,
cervical cancer strikes women during their most economically productive
years, when their contribution to society and the economy is greatest.
The disease does not just destroy lives; it also impoverishes families
and undermines economic growth.
A recommendation last
year by the World Health Organization’s Strategic Advisory Group of
Experts on Immunization promises to boost vaccines’ cost-effectiveness
further, by calling for just two doses of the HPV vaccine, rather than
the three doses previously thought to be required. This will not only
reduce the overall cost of vaccine procurement and delivery; it will
also make it easier for health-care workers and the girls themselves.
A study
published by WHO and the London School of Hygiene and Tropical Medicine
in June predicts that vaccinating 58 million girls in 179 countries
would prevent 690,000 cases of cervical cancer and 420,000 deaths from
the disease. Unfortunately, the study also found that of the 33
countries where HPV vaccines are most likely to have the greatest effect
in preventing cancer, 26 had not yet introduced the vaccine.
There is much work to
be done. We should congratulate ourselves for nearly halving the
maternal death rate since 1990. But we must keep the threat of cervical
cancer firmly in our sights. It is imperative to act now to ensure that
every girl has access to HPV vaccines and a healthy future free from
cervical cancer, no matter where she lives.
Anuradha Gupta is Deputy CEO of Gavi, the Vaccine Alliance.
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