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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

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