"Cervical Cancer Prevention: HPV Vaccination and Screening in UNFPA Programming"

EXECUTIVE SUMMARY

Cervical cancer is the fourth most common cancer among women globally, with approximately 604,000 new cases and 342,000 deaths in 2020 (GLOBOCAN). Over 90 per cent of cervical cancer deaths occur in low- and middle-income countries, making it one of the starkest global health inequities. The disease is almost entirely preventable through HPV vaccination and screening, yet coverage of both interventions remains extremely low in the countries with the highest burden.

UNFPA's engagement with cervical cancer prevention has grown substantially, particularly through HPV vaccination support, VIA-based screening programmes, and integration of cervical cancer screening with HIV care (women living with HIV face 6 times the cervical cancer risk). WHO's Global Strategy to Accelerate the Elimination of Cervical Cancer (2020) set targets of 90% HPV vaccination, 70% screening, and 90% treatment by 2030 — targets that require massive scale-up from current coverage levels.

UNFPA's role is complementary to WHO (which leads on technical guidelines) and GAVI (which finances HPV vaccination in eligible countries). UNFPA contributes through: integration of cervical cancer screening into SRHR and maternal health services; community mobilisation for vaccination and screening; procurement of screening supplies; training of health workers in VIA and HPV testing; and advocacy for cervical cancer elimination as an SRHR priority.

KEY FACTS

Global burden (2020): 604,000 new cases, 342,000 deaths annually; approximately 90% of deaths in LMICs
HPV link: Over 99% of cervical cancers are caused by persistent HPV infection; HPV types 16 and 18 cause approximately 70% of cases
HPV vaccination: Highly effective (>90% protection against HPV 16/18); WHO recommends vaccination for girls aged 9–14; single-dose schedule approved by WHO in 2022
Global HPV vaccination coverage: Approximately 21% of girls aged 9–14 have received at least one dose (2023); far below the 90% target
Screening coverage: Less than 5% of women in SSA have ever been screened for cervical cancer
WHO elimination strategy (2020): 90-70-90 targets by 2030: 90% girls vaccinated by age 15; 70% women screened by ages 35 and 45; 90% of women with pre-cancer/cancer treated
GAVI support: GAVI has funded HPV vaccination in over 40 eligible countries; supply shortages delayed rollout 2018–2022
VIA (Visual Inspection with Acetic Acid): Low-cost screening method suitable for low-resource settings; can be performed by trained nurses/midwives
Screen-and-treat: Same-day screening and cryotherapy/thermal ablation for pre-cancerous lesions; reduces loss to follow-up
HIV intersection: Women living with HIV are 6x more likely to develop cervical cancer; integration of screening into HIV services is critical
AI-enhanced screening: Emerging technology pairing VIA with AI image analysis; UNFPA supports some pilots

DETAIL

UNFPA's Role in Cervical Cancer Prevention

UNFPA's contribution is through its existing SRHR service platform:

Integrating cervical cancer screening into routine SRHR visits (ANC, FP, postnatal care)
Training midwives and SRHR providers in VIA and HPV testing
Community mobilisation for HPV vaccination (building on UNFPA's community engagement expertise)
Procurement of screening and treatment supplies (acetic acid, cryotherapy equipment, HPV test kits)
Advocacy for cervical cancer as an SRHR priority, not only an oncology issue
Supporting data systems to track screening and vaccination coverage

The integration approach leverages UNFPA's existing health facility support and health worker training infrastructure, avoiding the creation of parallel cervical cancer programmes.

CURRENT STATUS

WHO single-dose HPV vaccination recommendation (2022) has dramatically simplified and reduced the cost of vaccination programmes
GAVI supply has stabilised, enabling accelerated rollout in eligible countries
Screen-and-treat approaches are scaling in several SSA countries
AI-enhanced screening is being piloted but not yet at scale
The 90-70-90 targets for 2030 are not on track at current pace
UNFPA's role is growing but remains secondary to WHO and GAVI in the cervical cancer landscape

SOURCES