A few weeks ago, President Joe Biden and the leaders of Australia, India, and Japan gathered at Biden’s home in Delaware to announce to much fanfare “the Quad Cancer Moonshot Initiative,” which aims to reduce cervical cancer in the Indo-Pacific region by helping countries achieve the World Health Organization’s recommendation for vaccinating 90% of girls with the highly effective and safe HPV vaccine.
The vaccine, approved by the WHO in 2009, eliminates the human papilloma virus, which is the leading cause of cervical cancer. The vaccine is a scientific triumph — a silver bullet that could, single-handedly, virtually end one of the most common and deadly forms of cancer.
The Moonshot calls for U.S. Navy hospital ships to conduct cervical cancer screenings and deliver vaccines in the Indo-Pacific region. India, one of the world’s biggest vaccine manufacturers, is tasked with making and distributing the vaccines, and Japan will provide technological infrastructure to support the initiative. The U.S. and Australia have agreed to support further research on the cause for very high rates of cervical cancer in the region.
It’s an admirable program. But as U.S.-based oncologists who have had the heartbreaking task of delivering devastating cancer diagnoses to women, we urge the leaders who gathered in Delaware, “Physician, heal thyself.”
That’s because (as this WHO HPV vaccination dashboard makes clear) only one of the four Moonshot partners, Australia, is within reach of the WHO’s recommendation for protecting women.
Indeed, Japan’s HPV vaccination rate dropped from 70% for girls born from 1995 to 1999 to just 1% in 2020 among girls born after 2002 after the media reported on cases of side effects from the vaccine. Instead of responding by sharing the data demonstrating the vaccine’s safety and effectiveness against cervical cancer, a deadly disease, the government of Japan simply dropped the vaccine from its list of recommended immunizations. HPV vaccination rates in Japan have since started to recover, but not nearly enough.
HPV vaccination rates in the U.S. remain stuck under 75% — they have long struggled against often incorrect stories about side effects and the myth that the vaccine promotes promiscuity. As cancer physicians, we are alarmed by vaccine skeptics in the U.S. who have, in recent weeks, taken aim against the HPV vaccine by spreading misinformation.
Meanwhile, India announced earlier this year its intention to deliver HPV vaccinations to all girls nationwide. But it has not yet done so.
We absolutely can and must do better.
A decade and a half after the WHO’s recommendation of the HPV vaccine, cervical cancer — now highly preventable — remains the fourth most common form of cancer among women worldwide and kills more than 340,000 women each year. This includes 4,000 women in the U.S. (Many of them would have been infected before the HPV vaccine became available in 2006.) It is a tragedy and travesty that more than 25% of the world’s countries still do not include HPV vaccinations in their national immunization program.
There is no shortage of countries around the world demonstrating the path forward.
Countries including Bhutan, Burkina Faso, Norway, Portugal, Rwanda, Tanzania, Turkmenistan, and Uzbekistan have succeeded in vaccinating and protecting about 90% of their young women — and are now on track to virtually eliminate cervical cancer.
These countries demonstrate that health systems don’t need huge budgets and high-tech facilities to succeed.
What they need is a commitment to protect women and an honest assessment of the full range of reasons why so many women remain unprotected 15 years after we should have eliminated the scourge of deaths from cervical cancer.
Yes, we need more research on why certain countries have high rates of cervical cancer. And we need to ensure that vaccines are available and affordable and to strengthen health systems so that they are able to reach every woman in every community. For example, in many low- and middle-income countries, like Nepal, where two of your authors support the Center for Women’s Cancer Access and Advocacy Project, health systems do not yet have the capacity to roll out national HPV vaccinations and screening programs. So cervical cancer stubbornly and tragically remains the most common cause of cancer deaths among women. Indeed, more than 2,000 women in Nepal are diagnosed with cervical cancer each year — 80% of them already in a late stage.
But we also need to take seriously the increasingly widespread challenge of misinformation. This includes more research on what causes skepticism and what can overcome it and the hard work of identifying and equipping effective vaccine champions, including the media, to comfort and persuade worried parents.
Especially when it comes to such a cost-effective and simple intervention as immunization and screening. The list price for a single dose of the vaccine is $286.78. A pap smear, the most common type of cervical cancer screening in the U.S., costs about the same. The cost of inaction, on the other hand, is steep: Treatment for cervical cancer, including hospitalization, surgery, radiation therapy, chemotherapy, medications, and doctor visits and tests costs more than $200,000.
We applaud the commitment to the Cancer Moonshot in the Indo-Pacific region. But we also must ensure that women from the U.S., Japan, and India are not left behind. That means recognizing the hard truth that over the coming years, the challenge to reaching the WHO’s recommended coverage of 90% of girls may have less to do with capacity and more to do with will.
As such, physicians cannot remain above the fray. In the U.S. and around the world, we must equip physicians, especially pediatricians, with the resources and training to effectively and respectfully address patients’ concerns and persuasively share the benefits of HPV vaccination to counter the myths and misinformation taking hold.
Fengting Yan is a medical oncologist focusing on women’s cancer with Swedish Cancer Institute in Seattle and an educator who engages with the media on cancer prevention. Binay Shah is a hematologist oncologist based in Seattle and the co-founder of the Binaytara Foundation, a nonprofit that works to eliminate cancer care disparities. Siddhartha Yadav is a medical oncologist specializing in the treatment of breast and gynecologic cancers with the Mayo Clinic.
