In the next two minutes, two women will die from cervical cancer. By the time you finish reading this piece, another two women will die. Every single death from cervical cancer is a visceral reminder of the reality we have come to know so well: that women’s health is a global health crisis.
Cervical cancer affects 340,000 women globally annually. In 2021, my sister-in-law, Angie, was one of them. Her birth, living, and work conditions contributed to her disease, ultimately leading to her death. Living in Jos, Nigeria, she initially staged her cancer at 2, but as it spread, she needed more help to fight this formidable adversary.
Inequities in access to high-quality treatment in Nigeria persist, with an estimated 28 women dying daily from cervical cancer. Despite evidence-based treatment and care, cervical cancer continues to cut lives short. The impact of her death and the estimated 340,000 women dying this year from cervical cancer need to be addressed head-on. We must move from lower-tier hospitals to higher-tier ones and upgrade staging of cancer from a 2 to 4, ensuring the best possible care for all affected women.
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The 90-70-90 global targets to eliminate cervical cancer gave the world yet another opportunity to lead the way by 2030. It calls for 90 percent of girls to be fully vaccinated with the HPV vaccine by the age of 15, 70 percent of women to be screened using high-performance tests, and 90 percent of women with pre-cancer treatment and 90 percent of women with invasive cancer to be managed. None of these targets have been implemented without challenges.
There is also no indication that many low- and middle-income countries (LMICs), where over 90 percent of deaths occur, will be able to achieve these targets. In fact, it is highly unlikely. Limited health care infrastructure, a lack of a trained workforce, vaccine hesitancy, the absence of universal screening, and no access to treatment services are among the challenges. Many LMICs still need help achieving the 5 P’s of public health recently released by the WHO Director General, whereby they promote, provide, protect, power, and perform these key tasks that will enable all of us to end cervical cancer effectively.
So why isn’t the world rallying together to end cervical cancer now?
In my view, vaccination and screening with human papillomavirus (HPV) remain the most effective ways of preventing and detecting cervical cancer. Yet coordination of both programmes in many low- and middle-income countries is severely hampered by limited resources and an unwillingness to create policies that save the lives of girls and women.
Take, for example, Nigeria, which recently rolled out HPV vaccines into its routine immunisation scheme. The programme targeted 7.7 million girls with a single dose of a vaccine known to be highly effective against HPV 16 and 18, which cause at least 70 percent of all cervical cancers. Despite the availability of free vaccines, the country still fell short of its coverage by 22 percent.
Read also: WHO alerts to rising cancer mortality rate in Africa
A very popular song in Nigeria speaks of how “water has no enemy. If you want to wash, you will use water.” If you want to cook, do the same. You will use water. There is nothing without water, hence why it has no enemies.
I have seen how a diagnosis of cervical cancer changes all that. They say healthcare is at its best when people have the right to health in any setting they find themselves in and at any time. To be clear, this also includes access to well-trained specialists and resources for necessities like sterile gloves. Yet, in Africa’s most populous country, Nigeria, there are only nine comprehensive cancer control centres providing a full complement of pathology, radiotherapy, surgery, and chemotherapy services for a population of 200,000 million people.
Angie’s diagnosis and subsequent death nearly three years ago remain a powerful reminder of how vulnerable many women are to cervical cancer in settings where resources for basic things are limited. Since her death, we have joined many to raise questions that women and communities everywhere should be asking. Here is one: why is it that some families refuse to vaccinate their girls with HPV vaccines, despite the national vaccine rollout that recently occurred in Nigeria? Here is another: why are there no self-testing kits that allow women to screen in the privacy of their homes and get their results immediately?
If we want to bend the curve to ensure that women’s health is not a global health crisis, we must act with urgency to end cervical cancer now. Otherwise, if we don’t change course, our children and grandchildren will learn for themselves one day why women’s lives are still not worth saving.
Juliet Iwelunmor is a doctor and professor of medicine and an associate director for global health and dissemination at the Washington University School of Medicine.
