Rwanda is actively pursuing the elimination of cervical cancer by 2027, aiming to achieve the World Health Organization’s (WHO) ambitious 90-70-90 targets three years ahead of the 2030 global deadline. Rwanda aims to become the first African country to reach this milestone, by integrating widespread human papillomavirus (HPV) vaccination, advanced screening methods, and timely treatment. It is working to protect millions of women from a preventable and curable disease, showcasing the impact of strong healthcare policies and innovation in driving meaningful public health progress. ALSO READ: WHO commends Rwanda’s efforts to eliminate cervical cancer Dr. Theoneste Maniragaba, the Director of the Cancer Programme at Rwanda Biomedical Centre (RBC), explained the urgency of the goal. “We are determined to save lives and demonstrate that cervical cancer can be eradicated even in resource-limited settings,” he said. The WHO defines cervical cancer elimination as reducing annual new cases to four, or fewer, per 100,000 women. To achieve this, countries must meet the “90-70-90” targets which include 90% of girls vaccinated with the HPV vaccine by age 15, 70% of women screened using a high-quality HPV test by ages 35 and 45, and 90% of women with cervical disease receiving timely treatment. ALSO READ: For the first time, the elimination of a cancer is within our reach Maniragaba noted that Rwanda began its fight against cervical cancer in 2011 with the introduction of the HPV vaccine. Since then, the country has achieved a 90% vaccination coverage among eligible girls. To simplify the process and further increase coverage, Rwanda plans to transition to a single-dose HPV vaccine, he added. “By simplifying the immunization process, we aim to ensure that every eligible girl is vaccinated before the age of 15,” Dr. Maniragaba explained. He said that this effort aligns with the WHO’s recommendation that HPV vaccines be prioritized for girls aged 9 to 14 before they become sexually active. ALSO READ: Taking a critical look at cervical cancer in HIV infected women Rwanda’s cervical cancer elimination strategy extends beyond vaccination to include comprehensive screening and treatment programs. These efforts aim to catch and treat precancerous lesions before they progress to invasive cancer, he said. “We have implemented a national cervical cancer programme with a ‘screen-and-treat’ approach that starts at the health center level,” Dr. Maniragaba said, explaining that the programme uses high-performance HPV DNA tests to identify at-risk women and provides timely management of precancerous conditions. To date, 23 districts have established cervical cancer screening programmes, with Gicumbi and Karongi districts already meeting the 90-70-90 targets. Other districts, including Kayonza, Rubavu, Kirehe, and Nyabihu, are on track to achieve these goals, he said. Between 2019 and 2023, Rwanda conducted 505,298 screenings nationwide, resulting in the treatment of 17,342 precancerous lesions and 3,262 cases of invasive cervical cancer. “Despite these efforts, screening coverage remains at 31%, far below the 70% target. We are committed to expanding our reach, particularly in remote areas where access to healthcare services is limited,” Dr. Maniragaba emphasized. While Rwanda’s progress is remarkable, Dr. Maniragaba stressed, challenges remain. For instance, little public awareness and stigma around cervical cancer are major barriers, as more than 50% of patients seek care only after the disease has reached an advanced stage. “Raising awareness is crucial to encouraging early detection and treatment.” Financial constraints also pose a challenge as screening and chemotherapy are not yet covered under Community Based Health Insurance (Mutuelle de santé), creating financial barriers for many patients. “We are working on a health benefits package to ensure that these services are accessible to all.” Another hurdle is the shortage of specialized healthcare professionals. Lately, only 10 clinical and medical oncologists and two gynecologic oncologists serve a population of 13.5 million. “This shortage leads to delays in diagnosis and treatment, which can have devastating consequences for patients,” Dr. Maniragaba explained. According to the World Health Organisation, as of 2023, six HPV vaccines are available globally, all of which protect against the high-risk HPV types 16 and 18 responsible for most cervical cancer cases. The UN health agency emphasizes that these vaccines are safe, effective, and critical to eliminating the disease. Some countries vaccinate boys to further reduce HPV prevalence in the community and prevent HPV-related cancers in men. However, Rwanda’s current focus remains on vaccinating girls to achieve the elimination target.
