In 2020, the WHO announced its goal of eliminating cervical cancer by 2030. Its ‘90-70-90’ target was to ensure that 90% of girls would be fully vaccinated against HPV by 15 years old; 70% of women would be screened with a high-performance test by age 35 and again by 45; and 90% of women identified with cervical disease would receive treatment.

Over the past three years, the 21 member economies of the Asia-Pacific Economic Cooperation (APEC), an inter-governmental forum that promotes free trade through the Asia-Pacific region, have achieved varying levels of success in meeting the 90-70-90 target. Many have faced some barriers to the implementation of their vaccination, screening and treatment programmes.

To track efforts and measure the progress of this goal, the APEC Health Working Group recently released its KPI Report on Cervical Cancer Elimination in the APEC Region. Here are some key takeaways.

Greater emphasis is needed on preventative measures

With more than 90% of women identified with cervical disease receiving treatment in roughly a third of all APEC member economies, some places are doing well in meeting the targets for treatment. This is unsurprising, as treatment is the traditional approach to disease management for cervical cancer.

For preventative measures, however, only 24% of APEC member economies are meeting the screening targets and only 5% are meeting vaccination targets. Since proper prevention strategies can halt the progression of HPV infection to cervical cancer, it is essential to accelerate efforts to meet these targets. The KPI report highlights the urgent need for APEC member economies to increase investment and adoption of preventative measures, over the current reactive approach via treatment strategies.

Solid plans, but funding limits implementation

Despite progress in each pillar of the 90-70-90 target, no APEC member economy has achieved all 3 targets. On the plus side, 67% have implemented a multi-year plan that includes vaccination, screening and/or treatment, but the degree of funding varies greatly across different age ranges, socio-economic brackets and genders.

While 86% of APEC member economies report that they include HPV vaccination in cervical cancer elimination programmes, only 7 of those are fully funded for eligible populations. Screening programmes seem to fare better, with 95% reporting that cervical cancer screening programmes are available. However, while 71% of these programmes have public funding available, access to these funds is often dependent on various prerequisites, including the outcome of a disease diagnosis and socioeconomic status.

The gap between a plan and implementation still exists for many economies and needs to be addressed to ensure an equitable spread of resources for all who need it. In addition to accelerating efforts towards achieving targets for vaccination and screening, it is also important for economies to establish and/or integrate digital data systems and registries to enable improved tracking of their elimination programmes in order to monitor changes in disease burden and facilitate well-informed decision making both at the clinical and policy level.

Steps in the right direction

Despite the remaining gaps and barriers to implementation, we nonetheless see many steps in the right direction across all three pillars of the 90-70-90 targets, as well as in broader efforts to improve awareness and education around cervical cancer elimination.

Vaccination – 71% of APEC member economies have adopted vaccination programmes for the primary prevention of cervical cancer. However, efforts are still needed as only 5% have achieved >90% first-dose coverage for domestically eligible cohorts or girls, with 24% having achieved rates between 70% and 90%.

Screening – 95% of APEC member economies have domestic screening programmes or capabilities to conduct screening and diagnostic testing. Of the different testing methods, only 57% report including HPV DNA testing, which is considered the gold standard and recommended by the WHO. To overcome barriers to improving screening rates, at least 19% of member economies have programmes that use self-sampling as a collection method (for more, please click here).

Treatment – 62% of APEC member economies have clinical guidelines for individuals who have been diagnosed with, or are at risk of, HPV. 76% have definitive strategies for referrals to secondary and tertiary care, including referral systems.

Awareness and Education – 71% of APEC member economies have vaccine confidence or communications programs that are targeted towards adolescents and/or their parents. Dispelling misinformation and establishing effective communication strategies about HPV and cervical cancer to multiple stakeholders is important as it allows public trust and participation of eligible cohorts in these programmes.

It is encouraging that many APEC member economies have incorporated strategies for the elimination of cervical cancer within their respective healthcare systems. Now, it is crucial that acceleration happens to meet the goals set out by the WHO and to make cervical cancer elimination a reality.