COVID-19 has woken the world’s collective consciousness to the indispensability of equitable access to health for all. But we know all too well of another global health nightmare that has, for many decades, both been one of the most visible examples of inequity in health, and one of the most readily preventable drivers of avoidable death in women worldwide - especially in Africa. Cervical cancer is the fourth most common cancer among women globally. In the highest risk countries, mainly in Sub-Saharan Africa, 75 per 100,000 women suffer from cervical cancer, compared to fewer than 10 women in low-risk nations. If available actions are not taken, new cases of cervical cancer are expected to rise from 570,000, which was recorded in 2018, to 700,000 by 2030. The annual number of deaths is also projected to increase from 311,000 to 400,000. These alarming numbers represent a crisis for all of humanity, not just one of females. As with COVID-19, inequity is at the core of the cervical cancer crisis: incidence of cervical cancer is nearly twice as high in low- and middle-income countries compared to high-income nations. Nearly 90% of cervical cancer deaths worldwide occur in low- and middle-income countries. This tragedy is playing out especially in Africa, cutting the prospects and lives of many girls and women short. The impact of the disease on afflicted families and communities is significant, as it is on national progress in achieving the health and development targets set by the Sustainable Development Goals. On today’s Global Day of Action for Cervical Cancer Elimination, we are uniting in a call for urgent action to make vaccines, tests and treatments accessible to all, so that no girl or woman, no matter where they live, how old they are or how much they earn, lacks access to these basic life-saving tools. The gaps are clear and need immediate filling. For example, 79 countries, mainly low- and middle-income, account for 6 in 10 of all cervical cancer cases. But the vaccine that protects against cervical cancer by preventing infection against the human papilloma virus that causes the disease has yet to be introduced in any of these nations. Instead, high-income countries, where the cervical cancer burden tends to be the lowest, have been able to introduce widescale vaccination, the majority even for boys. This imbalance must be addressed rapidly. The quest to eliminate cervical cancer is one we are all committed to, and one which is the focus of the WHO global initiative that countries adopted a year ago to eliminate cervical cancer in the lifetime of young girls alive today. To achieve this goal, all countries must reach and maintain an incidence rate of below four cases per 100,000 women. Doing this demands action in three key areas by 2030. We must vaccinate 90% of all girls against the cancer-causing human papilloma virus before the age of 15. We must also provide enough screening services to ensure that 70% of women can access a high-performance test before they turn 35, and again by the age of 45. Finally, we must ensure that 90% of women with pre-cancer can get the treatment they need, and that 90% of women with invasive cancer receive the services they require to manage their condition and pain. We are optimistic that all this can be achieved. But, as with COVID-19, action rests on the shoulders of those who make investment decisions and those who produce the tools. Here, we call on governments to take a comprehensive approach when deciding on where to invest their resources, and providing the conditions for girls and women to thrive and survive. As the pandemic has shown, good health is a necessary foundation for development. As for manufacturers of vaccines, diagnostics and treatments, they must make these tools affordable and available in sufficient quantities to enable governments across Africa and beyond to play their part in eliminating cervical cancer globally. Vaccines have been commercially available for well over a decade, but high costs have put them out of reach for most who need them. Sufficient supplies, therefore, must be made available at an affordable price to immunize all girls aged nine to 14 to protect them from cervical cancer in low- and middle- income settings. Their futures matter. To move forward, we must equip countries, fairly and effectively, to eliminate cervical cancer. For achieving this is no longer a dream. The power is in our hands to lift the veil on this nightmare and give our daughters, sisters, wives and mothers everywhere the chance for bright and healthy futures. Authors: H.E. Mrs Adjoavi Sika Kabore, First Lady of Burkina Faso H.E. Mrs Jeannette Kagame, First Lady of Rwanda H.E. Mrs Neo Jane Masisi, First Lady of Botswana H.E. Dr Tsepho Ramaphosa, First Lady of South Africa Dr Tedros Adhanom Ghebreyesus, Director-General, World Health Organization
