“A regional response to cervical cancer can help alleviate the great pain and suffering currently affecting so many. We will explore all avenues to ensure adequate resourcing for prevention and treatment options, including the HPV vaccine that has already helped so many elsewhere in the world.” – Secretary General, Dame Meg Taylor (2015)
Cervical cancer is entirely preventable and yet available data for Pacific Island Countries indicates alarming incidence rates. Women are one of our greatest assets in the Pacific and losing our mothers, daughters, sister and aunts to this illness impacts the sustainable development of our communities and countries.
Cervical cancer infection and spread is largely preventable through the use of vaccination. The most successful primary prevention method, the HPV vaccine, is readily available and WHO estimates it has the potential to reduce the global burden of cervical cancer by 70-80%. Following the introduction of the National Cervical Screening Program in Australia in 1991, deaths from cervical cancer halved, from 4 to 1.8 deaths per 100,000 women.
A regional approach to cervical cancer across the Pacific could address this issue, particularly through collective bargaining and bulk purchase of vaccines, as well as through shared learning and support with regards to effective prevention policy. A current estimate of the cost of HPV vaccination for 13 year old girls for one year across all Pacific Island Forum countries sits at USD $2.1 million.
At the 2016 Pacific Islands Forum meeting, Pacific Leaders considered “the need for the development of a regional bulk procurement programme for the cervical cancer vaccine (and screening and related equipment where possible).” Leaders highlighted an existing bulk procurement programme managed by the United Nations Children’s Fund (UNICEF) and urged Members to avail themselves of this programme.
In their consideration of this issue, Forum Leaders recognised that cervical cancer can be prevented with vaccines and well-established pre-cancer screening, and that deaths could be averted with treatment methods that avoid progression to invasive cancer. But such measures are only effective if people are aware of them and most importantly, have access to such services.
Forum Leaders are also aware of the barriers that each country faces in trying to procure HPV vaccines on their own, particularly due to the high vaccine cost. They noted that lobbying manufacturers as a group through a bulk procurement mechanism would likely ensure some cost reduction. The Vaccine Independence Initiative (VII) – a bulk procurement mechanism for vaccines which currently exists in the Pacific, and is administered by UNICEF – is the obvious existing mechanism through which bulk procurement of HPV vaccines should occur.
While the introduction of new vaccines such as HPV has progressed in developed countries and some low income countries thanks to Gavi’s support, many middle income Pacific countries have not been able to introduce the new vaccines in routine vaccination programmes due to their high cost. Successful introductions of some new vaccines in Fiji (DFAT), Kiribati (Gavi and UNICEF), Solomon Islands (Gavi), Federated States of Micronesia Centers for Disease Control (CDC), Republic of Marshall Islands (CDC), and Palau (CDC) have been achieved only because of significant donor support.
Status of HPV vaccine introduction in Pacific island countries
Figure 1 above shows five countries that have introduced HPV as a new vaccine into their immunization programmes, and five countries that have at least a tangible plan for the introduction of new vaccines such as HPV. The remaining Pacific Island Countries and Territories currently have no plan or policy in place for new vaccine introduction.
In addition, four countries (Samoa, Tonga, Tuvalu, and Vanuatu) are earmarked for ADB funding support, and it is anticipated that they will prioritise the purchase of HPV vaccines with this funding. UNICEF is negotiating for the inclusion of Kiribati in the ADB funding, as well as with other donors for support to other countries, including Nauru, Niue and Tokelau. The Pacific Islands Forum Secretariat supports these efforts, by advocating for the prevention of cervical cancer, and by lobbying development partners and donors to support the introduction of HPV into countries’ immunization programmes.