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.
Published April 14, 2015. By Anuradha Gupta
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