Cervical cancer is a public health concern with a global annual burden of over 500,000 new cases and 300,000 deaths. Unfortunately, 90% of these preventable cervical cancer deaths occur in low-and-middle-income countries (LMICs), especially in Africa. If we do nothing, the annual incidence and deaths from the disease will increase to 700,000 and 400,000, respectively. Based on available evidence, the World Health Organization (WHO) developed an ambitious and all-inclusive Global strategy to accelerate the elimination of cervical cancer as a public health problem (https://www.who.int/initiatives/cervical-cancer-elimination-initiative). Despite the raging COVID-19 pandemic, the WHO and member nations launched this global strategy on 17th November 2020.
WHO’s elimination strategy sets out clear goals and targets; thus, countries should reach and maintain an incidence rate below four per 100,000 women to eliminate cervical cancer. Achieving that goal rests on three key interventions and targets for the year 2030 (the “90-70-90 targets”):
- Vaccination: 90% of girls fully vaccinated with the HPV vaccine by the age of 15
- Screening: 70% of women screened using a high-performance test by the age of 35, and again by the age of 45 (the current guideline emphasizes HPV-based screening. Available @ https://www.who.int/publications/i/item/9789240030824)
- Treatment: 90% of women with pre-cancer treated and 90% of women with invasive cancer managed
Member nations are making progress, including Nigeria, but there is a need to urgently accelerate the elimination strategy in Nigeria, starting with the most realistic and achievable intervention, i.e., HPV vaccination inclusion into the National Immunization Programme. However, there exists a surmountable global challenge of HPV vaccine inequity where a majority of the vaccines are procured by rich nations despite having a minority of cervical cancer burden.
As a member of the WHO Expert Group for the Elimination of Cervical Cancer Initiative, Prof. Cyril DIM’s mission is to mobilize stakeholders to advocate for implementing cervical cancer elimination strategy in Nigeria. Noting that the Catholic church and other religious bodies are at the forefront of health care delivery and promotion in Nigeria, he took the campaign to the Catholic Bishops Conference of Nigeria (CBCN), which has its 2nd Plenary session in Enugu, Nigeria from 17 -19 August 2021. On Friday, 20th August 2021, he had a rare opportunity to present to the CBCN. After informing members about the burden, cause, disease course, and the 90-70-90 elimination strategy, he made the following requests:
- At the Nigerian Government level, to advocate (jointly and individually) for implementing the WHO 90-70-90 cervical cancer elimination strategy in Nigeria, starting with the most feasible intervention, i.e., inclusion of HPV vaccination into the routine immunization schedule of Nigeria. Following this inclusion, CBCN is encouraged to use its extensive global linkages to assist the government in surmounting the existing global inequity in HPV vaccine distribution.
- At the Diocesan level, he encouraged them to work through their individual Diocesan Health Commission to create cervical cancer prevention awareness and incorporate HPV vaccination into the routine immunization schedule in the Diocesan health system. Also, they should work through the Diocesan Education Commission to initiate school-based HPV vaccination of eligible girls. Because HPV vaccine is expensive, these Diocesan level interventions would be at a fee to each recipient, which can be subsidized by partnering with philanthropic individuals and groups.
The President and members of CBCN received his message warmly and expressed willingness to advocate for cervical cancer elimination in Nigeria. Prof Dim is very grateful to the CBCN, a very credible body, for allowing him to interact with her members. He also acknowledges the Episcopal Chairman of CBCN’s Health Committee, Most Rev. Stephen Mamza, Bishop of Yola Diocese, for facilitating his presentation.