Tomorrow kicks off World Immunization Week, a reminder that, just as disease can cross borders, so should our efforts to prevent it. Especially when we have an effective vaccine for one of the world’s top causes of cancer — but the people who need it most are less likely to get it.
Almost 90 percent of cervical-cancer deaths strike women in developing countries, where it is the second-most common cancer among women. In fact, over vast swaths of Africa, cervical cancer is the No. 1 cause of cancer death in women. (In the United States, it doesn’t even crack the Top 10.) While cervical cancer rates are holding steady in the developed world, in the coming decades they are projected to increase sharply in less developed regions.
Since 2006 there has been a vaccine for human papillomavirus (HPV), the virus that causes cervical cancer. Unfortunately, while this vaccine is making impressive strides in the developed world, it is almost out of reach in the developing world, where it could save the most lives. To fully realize this vaccine’s potential, it needs to be distributed worldwide — not just within rich countries that can afford it.
Fighting Cervical Cancer in the Developed World
HPV has been nicknamed “the common cold of STDs” — because pretty much every sexually active person will get it at some point. It can be transmitted by vaginal, anal, and oral sex, as well as by rubbing genitals together, even without penetration. HPV can cause cancers of the throat, anus, vagina, vulva, and penis — but is most “famous” for causing cancer of the cervix (the tissue that connects the vagina to the uterus). If you have a cervix, there are two big things you can do to protect its health: receive regular Pap testing after becoming sexually active, and get vaccinated against HPV before becoming sexually active. When you take both of these steps, you’ll maximize what modern medicine has to offer.
Since the 1950s, women in developed countries have been preventing cervical cancer by catching it in its early, “precancerous” stages, when cellular abnormalities can be treated before blossoming into cancer. This screening method is called a Pap test, and it was single-handedly responsible for transforming cervical cancer from the leading cause of cancer death among American women to a little-heard-of, nearly preventable cancer. In the first five decades of the Pap test’s existence, cervical cancer deaths fell by 70 percent in the United States. More than half of cervical-cancer deaths in the United States occur among people who haven’t been screened in the previous five years — or ever.
Gardasil 9, the most up-to-date version of the HPV vaccine, protects against sevenstrains of HPV that collectively cause 90 percent of cervical cancers, and also protects against the two HPV strains that cause 90 percent of genital warts. Vaccination against HPV has triggered declines in HPV infections and genital warts among American girls, and reduces the frequency of “precancers” — meaning less time, money, and anxiety spent dealing with follow-up procedures and treatments.
Fighting Cervical Cancer Worldwide
In developed countries like the United States, Pap testing and HPV vaccination have worked hand in hand to drive a formerly common cancer into obscurity. However, the vast majority of women worldwide don’t live in developed countries and lack access to Pap tests and HPV vaccination. In many of those countries, cervical cancer remains a major cause of death. That’s why distributing the vaccine is so important. HPV vaccines have the potential to save hundreds of thousands of lives if they can be distributed in countries where access to Pap testing is poor or nonexistent. Unfortunately, more than 9 out of 10 cervical cancers strike women in countries with no HPV vaccination programs.
By the end of 2015, an estimated 2.7 percent of HPV vaccine recipients were from low-income and lower-middle-income countries — while 68 percent of HPV vaccine recipients were from high-income countries, where only 14 percent of cervical cancer cases are diagnosed. Countries that are bearing the burden of cervical cancer need HPV vaccines the most, but their access to these vaccines is almost nil. The graph, which depicts the female population in gray and vaccine recipients in purple, shows how the HPV vaccine has barely made a dent in low- and lower-middle-income countries:
While it’s important to improve health-care infrastructure worldwide so that everyone can access lifesaving preventive health care like Pap tests, building that infrastructure takes time, and many experts say the best way to close the cervical-cancer gap between the developed and developing world is to deploy the vaccine across the world — quickly.
Organizations like the International Planned Parenthood Federation and Gavi are working to bring the HPV vaccine to all corners of the world. If you live somewhere with relatively easy access to the HPV vaccine, you should still get it for yourself or your children — after all, refusing a dose of Gardasil in the United States doesn’t make one magically appear in sub-Saharan Africa or South America, and you’ll still be doing your part to chip away at the virus’ prevalence in the world.
As part of its commitment to preventive health care, Planned Parenthood health centers offer Pap tests and vaccination with Gardasil 9, both of which reduce risk for cervical cancer. Planned Parenthood clinicians can also talk to you about safer-sex strategies that can further protect you from HPV.