By Dr Poonam Khetrapal Singh, WHO Regional Director for South-East Asia
As of 2020, the SEA Region accounted for a substantial portion of the global cervical cancer burden, with 200,000 new cases (32% of the global burden) and 100,000 deaths (34% of global fatalities), according to Global Cancer Observatory 2020. The global strategy for elimination was launched by the World Health Organization (WHO) in November 2020. Since the launch of the global strategy, Member States have demonstrated commendable political will, exemplified by the formulation and launch of elimination strategies at national level. The Interim targets within the three key pillars of the strategy are promising, viz: 1. HPV Vaccination Coverage: 90% of girls have been fully vaccinated with the HPV vaccine by age 15.
2. Screening: 70% of women have undergone high-performance testing by age 35, with a repeat screening by age 45.
3. Access to Treatment: 90% of women with precancerous conditions receive timely treatment, and 90% of women diagnosed with invasive cancer are effectively managed. Member States have made remarkable progress in preventing, screening, and managing cervical cancer. Under the Flagship Priority of "Prevention and control of noncommunicable diseases through multisectoral policies and plans, with a focus on best buys," cervical cancer prevention is one of the 'best buys.'
Over the past three years, the South-East Asia Region has achieved several milestones in the elimination roadmap, marked by the development and implementation of strategic frameworks as • Regional Implementation Framework: A comprehensive plan for cervical cancer elimination as a public health problem covering the period 2021-2030.
• Regional Vaccine Action Plan: Encompassing the years 2022–2030.
• NCD Implementation Roadmap: Covering the period 2022-2030.
• Regional Strategic Framework: Accelerating universal access to sexual and reproductive health for 2020–2024.
The SEA Region is among the pioneers in creating an implementation framework aligned with the global strategy for eliminating cervical cancer. As of today, six Member States of the Region have introduced the HPV vaccine nationwide (Bhutan, Indonesia, Maldives, Myanmar, Sri Lanka and Thailand), two Member States (India in Sikkim State and Bangladesh in Dhaka Division) have introduced it at sub-national level, two have planned introduction of the vaccine in 2023-24 (Nepal and Timor-Leste) while one (India) has plans to increase the scope of HPV vaccination by expanding its use to additional states. The coverage of HPV vaccination among the target girls in Bhutan has been high since 2017. Some of the other countries in the Region that faced challenges of HPV vaccine rollout during the COVID-19 pandemic are organizing catch-up vaccinations. Further, the WHO recommendation on one-dose schedule of HPV vaccination as an alternative to the two-dose schedule has been adopted by some Member States in the region. On screening, ten out of 11 Member States reported national population-based screening programs, with nine providing early detection services at the primary health care level. Progress has been made in adopting HPV DNA screening, with Bhutan and Thailand leading in its utilization. However, achieving the 70% target by 2030 requires sustained efforts. However, a positive development is that screening has been included in essential service packages or UHC packages in several Member States. Several Member States have established centers for managing cervical precancerous lesions, including colposcopy and thermal ablation methods. WHO support has played a pivotal role in capacity building and establishing treatment facilities. In 2022-23, WHO supported Timor-Leste in setting up the first-ever facility for treating precancerous lesions (Colposcopy and Thermal ablation) in the national hospital and expanding to three more colposcopy centers with thermal ablations. Bhutan and Myanmar were also supported in the expansion of these facilities. Ten Member States in the region have tertiary-level cancer care. Pathology services for cancer diagnosis, chemotherapy and cancer surgeries are also available in ten countries. Nine countries have services for radiation therapy. With the aim of accelerating the scaling up of treatment services for invasive cancers, SEARO has established the South-East Asia Cancer Grid (SEACanGrid), which facilitates leveraging the strengths of one institution in building capacity of another across countries. Primary health care and community-based palliative care is expanding in the region, with exemplary initiatives in Bhutan, India and Sri Lanka. Population-based cancer registries are operational and being strengthened in eight Member States. Ensuring all women have access to affordable and effective cervical cancer prevention and management services remains a priority. While ten out of 11 Member States report having pathology services for cancer diagnosis, cancer treatment facilities at tertiary levels, including surgical, chemotherapy, and radiotherapy services, are not universally accessible, especially among socioeconomically disadvantaged groups. To address this, a robust health system through Universal Health Coverage is imperative, ensuring services are available without causing catastrophic expenditure to beneficiaries. Despite setbacks caused by the COVID-19 pandemic, efforts to resume and strengthen HPV vaccination and cervical cancer screening programs are underway. It is crucial to emphasize that cervical cancer is a preventable and curable disease if detected early and treated adequately. The commitment and support of Member States extended during the Regional Committee meetings of WHO-SEARO to the global cervical cancer elimination initiative is unwavering, as demonstrated by dedicated discussions and agenda items during Regional Committee meetings held in 2019 and 2022. Let us continue our collaborative efforts, navigate challenges, and propel the region towards the shared goal of eliminating cervical cancer. | 