A few weeks ago, President Joe Biden and the leaders of Australia, India and Japan gathered at Biden’s home in Delaware to announce with much fanfare “the Quad Cancer Moonshot initiative”, which aims to reduce cervical cancer in the Indo-Pacific region by helping countries achieve the World Health Organization’s recommendation to vaccinate 90% of girls with the highly effective and safe HPV vaccine.
The vaccine, approved by the WHO in 2009eliminates the human papillomavirus, the leading cause of cervical cancer. The vaccine is a scientific triumph – a miracle cure that could single-handedly virtually end one of the most common and deadly forms of cancer.
The Moonshot calls on U.S. Navy hospital ships to conduct cervical cancer screenings and deliver vaccines in the Indo-Pacific region. India, one of the world’s largest vaccine manufacturers, is tasked with making and distributing the vaccines, and Japan will provide the technological infrastructure to support the initiative. The US and Australia have agreed to support further research into the cause of the region’s very high rates of cervical cancer.
It is an admirable program. But as US-based oncologists who have had the heartbreaking task of delivering devastating cancer diagnoses to women, we urge the leaders gathered in Delaware: “Physician, heal thyself.”
That’s because (like this WHO HPV Vaccination Dashboard makes clear) only one of the four Moonshot partners, Australia, is within reach of the WHO recommendation for the protection of women.
Japan’s HPV vaccination rate even fell from 70% for girls born between 1995 and 1999, to just 1% in 2020 for girls born after 2002 after the media reported cases of side effects from the vaccine. Instead of responding by the data demonstrating the safety and effectiveness of the vaccine against cervical cancer, a fatal disease, the The government of Japan simply dropped the vaccine from the list of recommended vaccinations. HPV vaccination rates in Japan have since started to recover, but not nearly enough.
HPV vaccination rates in the US remain stuck below 75% – they have long battled often-false narratives about side effects and the myth that the vaccine promotes promiscuity. As cancer doctors, we are concerned vaccine skeptics in the US. who have targeted the HPV vaccine in recent weeks by spreading misinformation.
Meanwhile, India announced its intention earlier this year Delivering HPV vaccinations to all girls across the country. But that hasn’t happened yet.
We absolutely can and must do better.
A decade and a half after the WHO recommendation for the HPV vaccine, cervical cancer – now highly preventable – remains the fourth most common cancer among women worldwide and kills more than 340,000 women annually. This includes 4,000 women in the US. (Many of them would have been infected before the HPV vaccine came on the market in 2006.) It is a tragedy and a travesty that more than 25% of countries in the world still do not include HPV vaccinations in their national immunization program.
There is no shortage of countries around the world demonstrating the way forward.
ccountries included Bhutan, Burkina FasoNorway, Portugal, RwandaTanzania, Turkmenistan and Uzbekistan have managed to vaccinate and protect around 90% of their young women – and are now on track to virtually eliminate cervical cancer.
These countries show that healthcare systems do not need huge budgets and high-tech facilities to succeed.
What they need is a commitment to protecting women and an honest assessment of all the reasons why so many women remain unprotected, fifteen years after we should have eradicated the scourge of deaths from cervical cancer.
Yes, we need more research into why certain countries have high rates of cervical cancer. And we must ensure vaccines are available and affordable and strengthen health care systems so they can reach every woman in every community. For example, in many low- and middle-income countries, such as Nepal, where two of your authors support the Center for Women’s Cancer Access and Advocacy Project, health care systems do not yet have the capacity to roll out national HPV vaccinations and screening programs. Cervical cancer therefore remains a stubborn and tragic cause most common cause of cancer deaths among women. In fact, more than 2,000 women cervical cancer is diagnosed every year in Nepal – 80% already at a late stage.
But we also have to take it seriously increasingly widespread challenge of disinformation. This includes more research about what causes skepticism and what can overcome it, and the hard work of identifying and equipping effective vaccine champions, including the media, to comfort and persuade concerned parents.
Especially when it comes to such a cost-effective and simple intervention as immunization and screening. The list price for a single dose of the vaccine is $286.78. A Pap smear, the most common form of cervical cancer screening in the US, costs about the same. In contrast, the costs of inaction are high: treatment for cervical cancer, including hospitalization, surgery, radiation therapy, chemotherapy, medications, and doctor visits and tests, costs more than $200,000.
We applaud the commitment to the Cancer Moonshot in the Indo-Pacific region. But we must also ensure that women from the US, Japan and India are not left behind. That means recognizing the hard truth that the challenge of reaching the WHO-recommended 90% coverage of girls in the coming years may have less to do with capacity and more to do with will.
As such, doctors cannot remain above the fray. In the US and around the world, we need to equip doctors, especially pediatricians, with… the resources and training to effectively and respectfully address patient concerns and persuasively share the benefits of HPV vaccination to combat the myths and misinformation that are emerging.
Fengting Yan is a medical oncologist focusing on women’s cancer at the Swedish Cancer Institute in Seattle and a cancer prevention educator with the media. Binay Shah is a hematologist-oncologist based in Seattle and co-founder of the Binaytara Foundation, a nonprofit organization dedicated to eliminating disparities in cancer care. Siddhartha Yadav is a medical oncologist specializing in the treatment of breast and gynecologic cancers at the Mayo Clinic.