Cervical cancer is the number one cancer killing women in many developing countries. This year an estimated 266,000 women around the world will die from it, and 85 per cent of them will live in low-resource settings.
Incidence rates in the Pacific are equally alarming. The International Agency for Research on Cancer says Melanesia, with an annual age standardized incidence rate of 33.3 cases per 100,000 females and a mortality rate of 20.7 cases per 100,000 females, is a sub-region particularly at risk. In Polynesia and Micronesia the statistics are slightly better with an annual average incidence rate of 11 and 8.7 cases per 100,000 females and mortality rate of 5.1 and 2.7 per 100,000 females respectively.
What makes these figures particularly painful is that cervical cancer is preventable. Medical screening and the human papilloma virus (HPV) vaccine, first developed at the University of Queensland in Australia, have proven very effective for saving lives.
A National Cervical Screening Program in Australia in 1991 saw deaths from cervical cancer halved, from four to 1.8 deaths per 100,000 women. Where the vaccine is readily available it has the potential to reduce the global burden of cervical cancer by between 70 to 80 per cent.
A systematic review of cervical cancer in the Pacific region in 2012 highlighted that while the burden of cervical cancer is significant for the region, the delivery of preventative programs is insufficient.
The study highlighted the availability of cost-effective, evidence-based and feasible primary and secondary cervical cancer screening and management. Health systems in low-resource settings however often do not provide sufficient or appropriate services for adult women, beyond pregnancy-related care.
Cervical cancer is a development issue, albeit largely perceived as a women’s reproductive health issue.
And of course it not only places a medical burden on the patient, but it also adds social and economic impacts, including for the patient’s immediate and wider family.
Some Forum countries like Australia, Cook Islands, Federated States of Micronesia, Fiji, New Zealand, Marshall Islands and Palau have introduced vaccination programmes. However, with the current weight of other health conditions, such as non-communicable diseases, drawing a lot of attention from our already stretched, and in many cases under resourced health systems, it appears adequate solutions have been beyond the reach of all our people.
Regional approach to a regional concern
Inclusivity is an underlying principle driving Pacific regionalism. The broad concerns and issues of ordinary citizens, including women and girls, must inform regional priorities that Forum leaders adopt, and regional solutions to our development challenges in the Pacific must be relevant to people if they are to be meaningful and impactful.
In 2015, through the Pacific wide public consultation on regional public policy under the Framework for Pacific Regionalism, the Pacific Islands Forum Secretariat received a submission from Family Planning New South Wales in Australia which brought the issue to the attention of Forum Leaders.
At their meeting in Port Moresby that year the Leaders recognized its significance and made a decision to investigate what could be done through a regional collaborative mechanism.
Estimates put the cost at US $2.1 million for HPV vaccinations for 13-year-old girls for one year across all Pacific Islands Forum countries – highly affordable, particularly if obtained through a regional bulk purchase approach and with the power of collective bargaining.
The Forum Secretariat commissioned a study by the Fiji National University and worked with partners including the Pacific Community, United Nations and the Asian Development Bank. In the Federated States of Micronesia in 2016, Forum Leaders considered “the need for the development of a regional bulk procurement program for the cervical cancer vaccine (and screening and related equipment where possible)” and urged Forum Members to avail themselves of a bulk procurement programme, the Vaccine Independent Initiative (VII), being managed by the United Nations Children’s Fund (UNICEF).
On top of this momentum through the Forum, Pacific countries have committed to meeting many of the challenges posed by cervical cancer through two of the 17 United Nations Sustainable Development Goals (SDGs) – Goal 3 aims to improve health and well-being and Goal 5 is focused on gender equality.
The prioritization of cervical cancer at a regional level through the Framework for Pacific Regionalism has provided a unique opportunity to tangibly meet the challenge of cervical cancer in our region. This could translate to increased percentage (from 60 to 80 per cent) of Pacific Island countries that introduce HPV vaccinations into their national immunization programs: a terrific boost to the health and well-being of women across the region.
Women are one of our greatest assets. Over generations, in communities throughout our vast oceanic region, our women have been valued for their vital roles in home and community life, as mothers, wives, caregivers, transmitters of traditional knowledge and as decision makers.
Losing our women and girls to a preventable killer in cervical cancer is not only grossly unjust, but it has a material impact on our sustainable development.
In the Pacific, we continue to fail our women and girls by not making the required preventive vaccinations available. In our setting, the impact of cervical cancer is felt most acutely in the poorest of our countries and among the poorest women across our countries.
It is within our power to prevent cervical cancer through integrated sexual and reproductive health services, coupled with bulk procurement of HPV vaccines.
We know that cervical cancer is thoroughly preventable. We know the vaccinations exist, and we know from best practice in other parts of the world, as well as from local success stories, what it takes to roll out an effective program of prevention.
Political will is a prerequisite to address cervical cancer in the Pacific. Our governments must commit resources for our women’s sexual reproductive health and rights.
If they maintain their collective will and resolve to deal with it, I have no doubt that we can defeat cervical cancer within a generation.