Preventing cervical cancer in Africa: Why scaling HPV vaccination is a priority

Every two minutes, a woman’s life is claimed by cervical cancer—a largely preventable disease—yet, the human papillomavirus (HPV) vaccine could save up to 560,000 lives every year.

Cervical cancer is a worldwide challenge, and Africa pays the heaviest price. Among the 20 countries with the highest cervical cancer burden, 19 are in sub-Saharan Africa. In 2022, Africa accounted for 23% (153,000 lives) of global cervical cancer mortality. HPV—a common sexually transmitted infection—is the primary cause of nearly all cervical cancer cases, with certain high-risk strains responsible for the majority of infections that lead to cancerous cell changes. Nearly all men and women who are sexually active will become infected with HPV at some point in their lives.

HPV vaccinations are a powerful tool in preventing cervical cancer. The HPV vaccine is safe and reduces the risk of developing cervical cancer by up to 90%, making it a crucial step in protecting future generations from a preventable form of cancer and reducing the burden of cancer on individuals and health care systems.

Nov. 17 is the Cervical Cancer Elimination International Day of Action, which highlights efforts to eradicate this disease.

Why it matters

East Africa is home to 80 million adolescent girls aged 9 to 14 in 2024; in 10 years, this number will increase to 95 million adolescent girls. An estimated 60% of them (60 million) are expected to be infected by HPV, which puts them at risk of developing cervical cancer later in life. Similarly, over 52,633 women in East Africa are diagnosed with cervical cancer each year and 70% will die of the disease.

The burden of cervical cancer weighs heavily on the health and well-being of those afflicted and is compounded by social stigma. It strains the finances of families and communities. For instance, advanced-stage cervical cancer treatment can exceed $50,000 per patient in some countries like Eswatini, and productivity losses to society can add up to $1 million per case.

However, widespread use of the HPV vaccine could  prevent up to 85% of cervical cancer cases, potentially saving more than 30,000 lives each year in the region. Coupled with broader access to cancer screening and treatment for all women, HPV vaccination provides a path towards eliminating cervical cancer entirely and is already part of the routine immunization schedules in 29 out of the 54 African countries.

^{Source: Accelerating HPV vaccination in Africa for health equity}

The challenge of reaching out-of-schools girls

Despite the life-saving potential of the HPV vaccine, coverage in many countries in Africa varies significant, ranging from 13 percent (Cameroon, Malawi) to 99 percent (Eritrea). The rollout of HPV vaccination programs faces socio-cultural (health literacy, vaccine hesitancy, stigma, and lack of adolescent-friendly services), logistical barriers (identifying target population, outreach, and monitoring the unvaccinated), and systemic (policy coherence, financing, coordination).

In Uganda, socio-cultural misconceptions about the HPV vaccines have further fueled resistance.  These misconceptions include concerns that it promotes early sexual activity, as well as concerns about long-term side effects, vaccine safety and efficacy, and the government’s intentions in promoting the vaccine. These beliefs ultimately result to parents fearing to send their children to get vaccinated.

To address these challenges, Uganda is developing a strategy for improved adolescent health delivery, targeting coverage in the 12 poorest performing districts and leveraging a digital dashboard to track real-time data on HPV vaccination status. Uganda implemented targeted community-based outreach strategies, engaging local leaders, parents, teachers and adolescents as vaccination advocates, and conducted sensitization sessions in local languages to dispel myths and reduce resistance within communities.

In Mozambique, the rollout of the HPV vaccine faced logistic challenges due to the shortage of HPV vaccines globally, a large number of out of school adolescents, long distances between schools and health centers, lack of support from schools and misconceptions about HPV that hindered coordination efforts.  To address these challenges, Mozambique has integrated school-based HPV vaccination campaigns complemented by routine vaccination in health centers, with a transition to single dose vaccination in 2024, and a scheduled multi-age vaccination campaign planned for 2025 to help “catch up” girls that may have missed their vaccinations.

How are we taking up the challenge?

Some African countries, such as Rwanda, Ethiopia, Eritrea, Botswana, Cabo Verde and Mauritius, have achieved exceptionally high vaccination coverage rates of over 70%. Rwanda attained 98% coverage through a school-based program and a strong communication campaign led by community health workers and local figures. They addressed cultural barriers like myths regarding infertility and promiscuity. 

^{Source: Accelerating HPV vaccination in Africa for health equity}

The World Bank and Global Financing Facility for Women, Children and Adolescents (GFF) have invested more than $400 million across countries to provide HPV screening, vaccination, and treatment, and expect to invest at least an additional $400 million for HPV-related programs over the next three years, in key focus areas such as strengthening countries’ programmatic and policy responses, supporting operations that scale up key HPV-related activities, and partnering globally and locally with key partners on this agenda. The GFF also leads complementary efforts to integrate cervical cancer interventions across health systems: making sure that health insurance covers cervical cancer services; strengthening the health workforce by integrating cervical cancer in trainings; and enhancing health management information systems. This integrative approach makes each step of the health journey safer for African girls and women.

The path forward

Eradicating HPV and cervical cancer is a significant challenge in Africa, as it is worldwide. However, there is hope on the horizon with political and financial commitments that support a clear path to fight cervical cancer. This year, 43 African leaders signed a declaration committing to vaccinating 40% of girls aged 15 by 2025, while global health actors like the World Bank, the GFF and Bill & Melinda Gates Foundation, announced nearly $600 million in new funding to save hundreds of thousands of lives by 2030 from cervical cancer.

Bridging the final gap demands bold innovation and unwavering resolve: from combating myths with grassroots education to harnessing digital tools and multi-sectoral alliances, every effort must rise to meet the challenge—until every girl and woman stands shielded from cervical cancer.

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