These Countries Are Doing Something About HPV. Why Isn't the U.S.?
As a consultant to charities and advocacy groups with more than a decade of experience in the space, Sarah Goltz sees at least one bright spot in public health in the developing world: the rate of adoption of a vaccine against cervical cancer.
“In my opinion, cervical cancer is a real success story,” she says. “It has been a very, very rapid uptake for a vaccine,” said Goltz.
Global health advocates are launching new programs from Argentina to Uganda to vaccinate against largely preventable deaths from cervical cancer in some the world's most vulnerable communities.
Ironically, while people in wealthy countries generally enjoy better health and longer life than their poorer neighbors, one country that has been lagging in acceptance of the cervical cancer vaccine is the United States.
"Unfortunately, only one-third of girls aged 13 to 17 have been fully vaccinated," said Tom Frieden, director of the U.S. Centers for Disease Control and Prevention following the release of a study last year. "Countries such as Rwanda have vaccinated more than 80 percent of their teen girls.”
One reason is that curious American trait, prudishness. Virtually all cervical cancers are caused by one of two of the many types of the human papillomavirus, which is transmitted sexually. Many Christian groups oppose vaccinating teenage girls and younger against an STD.
“Conservatives worry that giving our daughters the vaccine undermines abstinence teaching,” wrote Lindsay O’Connor in the magazine Today’s Christian Woman. “They feel it could encourage promiscuity by disinhibiting them from having sex.”
Another factor is that doctors are just failing to suggest the prophylactic.
Each year, 275,000 women worldwide die of cervical cancer, the majority of them in low- and middle-income countries (or low-income communities in affluent countries). More than half a million women get cervical cancer annually.
In these communities, new preventive care strategies and the attention and expertise of global health coalitions offer a source of hope.
Silvana Luciani, a regional adviser for cancer prevention and control at the World Health Organization, agreed with Goltz about the HPV success story over the last decade. The commitment to overcoming political and technical barriers has “increased exponentially” in that time, she wrote in an email. Meanwhile, she said, there have been significant “scientific advances in better understanding the barriers and solutions for cervical cancer” where resources are slim and access to health care is spotty.
In such places, where cancer treatment via oncology or radiology is inaccessible at best and almost nonexistent at worst, this kind of preventive care for women is essential. Procuring and distributing the vaccine is therefore a vital piece of the larger prevention strategy that’s key to keeping health care costs down (which also hasn’t been embraced by the U.S. system, in which nearly $2 billion a year is spent treating cervical cancer).
That’s why pilot programs targeting girls in low- to middle-income countries are so promising. In Argentina, for example, the HPV vaccine is given to all 11-year-old girls, regardless of socioeconomic status, through WHO's program. Since being introduced in 2011, the first of three of the vaccine doses has reached 80 percent of girls in the target group, which medical experts say is a step toward being spared from cervical cancer as adults.
Peru, Uganda, Vietnam, and India are among the countries where an international nonprofit called PATH is implementing more pilot programs in hopes of collecting data that will make the HPV vaccine a public health priority. In Peru, PATH ensures that a high percentage of girls get the vaccine and the necessary followup shots by administering it through schools rather than relying on their families making repeated visits to a doctor.
“Unlike in a lot of other cancers and a lot of other things we work on in global health, we actually know what we need to do and have resource-appropriate strategies that are affordable,” said Goltz. “There’s really nothing stopping this work [from] getting done, but it needs to be a priority for the countries, the international organizations that work with those countries, and the global health community as a whole.”
That includes the United States. About 79 million Americans already have HPV, and about 14 million new cases occur each year, according to the CDC.
“Our low vaccination rates represent 50,000 preventable tragedies—50,000 girls alive today will develop cervical cancer over their lifetime that would have been prevented," said director Frieden.