REGIONAL PERSPECTIVES
50 CANCER CONTROL 2021
cases and deaths are Bangladesh, India, Nigeria, South
Africa and Tanzania. Furthermore, data shows the highest
regional incidence and mortality rates per population in the
Commonwealth are seen in the Africa region, with the rates
elevated in Southern Africa and Western Africa. Relatively
speaking, the rates are 7 to 10 times lower in North America,
Australia/New Zealand and Western Asia (5). Moreover, 7
of 8 sub-Saharan African countries - all of which are part of
the Commonwealth - including the Gambia, Kenya, Malawi,
the Seychelles, South Africa, Uganda and Zimbabwe, have
experienced uniform rises in mortality rates (6). It is clear
that the large part of success in North America, Australia,
New Zealand and Western Asia is due to the effects of
population-based cytological screening programmes in which
have helped with declines in cervical cancer rates upon their
implementation in the aforementioned countries.
Few LMICs have implemented country-wide HPV
vaccination programmes, the factors of which are complex
and multi-faceted. As of May 2020, less than 30% of LMICs
had implemented national HPV vaccination programmes,
compared with more than 80% of high-income countries
(7). Further, in LMICs, just 44% of women have had at least
one screening for cervical cancer, with the median range in
sub-Saharan Africa at the country level being 16.9 percent
(8). These higher incidence rates typically occur in countries
with a high prevalence of HPV and human immunodeficiency
virus (HIV), a lack of population wide cervical cancer screening
programmes and often low uptake where they are established),
and a lack of HPV vaccination programmes (9).
Research has indicated that widespread coverage of both
the HPV vaccination and cervical cancer screening has the
potential to avoid 13 million cervical cancer cases globally by
2069 (10). Implementing such initiatives is critical, with figures
showing that in the absence of effective cancer preventive
and control programmes, countries have experienced
rapid increases in premature cervical cancer mortality in
recent generations. Furthermore, to help accelerate cancer
elimination strategies, there is a need for an uninterrupted
supply of quality-assured and affordable HPV vaccines,
screening tests, as well as palliative care medicines and other
strategic commodities.
Challenges to equitable access to health commodities
One of the major factors contributing to global cervical
cancer disparities is the challenge of access to oncology
health commodities. Access to oncology health commodities
can be assessed across three major dimensions: availability,
affordability, and accessibility (11). Availability, typically
requires marketing authorization for a product followed
by launch of the medicine by the company Accessibility
encompasses the ability to obtain a prescription for the
medicine and also factors associated with the pharmaceutical
supply chain. Affordability includes the coverage status of the
medicine and the insurance status of the patient, as well as
other out-of-pocket costs and individual drug prices.
On the affordability of medicines, a report launched in
2020 from the WHO found that cancer medicine prices are
disproportionately higher than other types of pharmaceuticals
and therapies, and that the price of cancer drugs is continuing
to increase at a rapid and alarming rate (12). Whilst HPV
vaccination is predicted to be cost-effective, further
addressing of the affordability issue requires countries to
have good policies in place to improve health infrastructure
and financing, as well as mechanisms to ensure that there is
also a rational use of medicines (12). Whilst favourable policies
seem to be a precursor, equally important is for countries to
have reliable information on medicine prices and availability,
from both the pharmaceutical industry as well as countries,
to assist them in constructing sound medicine pricing policies
and to also evaluate whether their expenditure on medicines is
comparable to that of other countries, which can subsequently
lead to governments making negotiations for cheaper prices.
With high rising prices of cancer drugs and other health
commodities including those for cervical cancer, it is clear
that for the achievement of elimination and attainment of
the WHO's 90-70-90 target, the affordability of essential
medicines, vaccines and health technologies needs to be
addressed adequately as countries approach 2030 (13).
In recognition of this challenge, Commonwealth Health
Ministers at the 2018 Commonwealth Health Ministers
Meeting (CHMM) called for collective action to invest in
cervical cancer prevention and treatment strategies, including
to reduce the cost of medicines and address shortages of
vaccines. Health Ministers deliberated on sharing pricing
information through the creation of a Commonwealth
database which could detail the prices of essential medicines,
vaccines and health technologies.
Developing a Commonwealth-led solution to
inequitable access
Given the Commonwealth's significant burden of cervical
cancer, the Commonwealth Secretariat has made greater
Table 1: Number of cervical cancer Incidences and deaths per
Commonwealth region
Region Incidence (#) Deaths (#)
Africa 66,655 41,449
Asia 113,208 83,450
Caribbean 2,312 6,426
Europe 4,396 1,058
Pacific 5,342 3,057
Globocan, 2018