Why UNICEF’s new Cervical Cancer Toolkit matters for women’s health
Women in lower-income countries likely to benefit most as UNICEF offers a complete supply solution for cervical cancer programmes.
Far too frequently, women’s reproductive health issues go undiagnosed and untreated. Cervical cancer accounts for one in four cancers among women, killing over 340,000 people each year. Often referred to as a silent killer, cervical cancer may take years to develop. However, once symptoms are present, it is often too late to treat.
Prevention, screening and early treatment are vital to save lives. In January 2023, UNICEF launched the Cervical Cancer Toolkit, a comprehensive tool for combating the disease. Tatsiana Ptashnik, in UNICEF Supply Division’s Health Technology Centre, explains this significant development.
There is no silver bullet when it comes to tackling cervical cancer. We need all the tools at our disposal to fight this disease across the continuum of care – prevention, diagnosis and treatment. This toolkit enables us to go to health leaders, governments, donors and policy makers and say “We have everything we need to eliminate cervical cancer as a public health problem.” This toolkit contains the novel HPV vaccines, high-performing diagnostic tests for HPV, and portable devices for pre-cervical cancer treatment which are very well-suited for low-resource settings. These tools can help countries make enormous strides in tackling cervical cancer and save many lives each year.
Women’s health is a very important area for UNICEF and our global health partners. Over 340,000 women are killed by this disease each year, with 500,000 reported cases. This is likely to be an underestimate as some countries lack the capacity to test for this cancer, some are cautious to unfold bigger screening programmes, facing an ethical dilemma: should you test for a disease if you cannot offer treatment? Now, we can offer affordable supply solutions to countries. If we pool the demand, we hope to drive down prices even further as we push the market to make these supplies even more affordable.
This toolkit enables UNICEF and allies to advocate loudly and clearly to governments and donors that we have the tools available to prevent, diagnose and treat but we need more investment. There is no time to waste. Cervical cancer if undetected or detected late, robs women of their lives and robs children of their mothers and their childhood.
Yes, many of the components of the toolkit were recently developed or approved. Let’s take a look at the individual components:
HPV DNA-based diagnostic tests
Following prequalification by the World Health Organization (WHO) between 2017 and 2019, UNICEF added a number of HPV DNA molecular tests to our Supply Catalogue, offering them to governments and partners around the world. In July 2021, WHO recommended DNA-based HPV testing as the preferred screening method for cervical cancer, which gave a new impulse to countries’ efforts and boosted demand for HPV diagnostics.
The first three HPV vaccines which protect against cervical cancer were prequalified by WHO in 2009. UNICEF began supplying HPV vaccines in 2013 but demand through UNICEF was initially ad-hoc and limited. However, global demand surged as interest in preventing cervical cancer through HPV vaccination increased. This resulted in global supply constraints from 2017 onwards and limited UNICEF’s ability to meet increased demand from low- and middle-income countries. In 2018 and 2021, two more HPV vaccines were prequalified by WHO. The supply situation for HPV vaccine is now improving with increased production capacity from existing manufacturers and new vaccines entering the market.
UNICEF started delivering affordable, fit-for-purpose portable thermal ablation devices for cervical pre-cancer in 2022. The use of thermal ablation to destroy pre-cancerous cells in the cervix was pioneered in Germany in the 1960’s. However, the technology did not gain widespread popularity at the time. The evidence base has since expanded and the technology came into the global spotlight in 2019, when WHO introduced the guidelines for the use of thermal ablation for cervical pre-cancer lesions. The guidelines aim to address the issue of delayed or even a lack of treatment following a positive screening test, which undermines prevention through a screen-and-treat approach.
This treatment tool is very well-suited for low-resource settings. The device can be used not only by doctors but also by trained medical professionals. Almost 90 percent of deaths from cervical cancer occur in low- and middle-income countries. Therefore, increasing affordable and effective treatment solutions can drastically reduce deaths if cancer is detected early.
There are few situations where we have the full range of tools available to diagnose, prevent and treat a major killer disease. COVID-19 became one of the rare exceptions, where extraordinary investment coupled with global prioritization led to the rapid development of diagnostics, vaccines and treatments. Now, we have this powerful combination with the cervical cancer toolkit. We have everything we need – to diagnose, vaccinate and treat. That’s where we want to be in public health for each and every disease. We have proven cost-effective strategies and tools to make tremendous gains against this killer disease that affects women and girls.
One of the biggest challenges is the recognition of cervical cancer as a pressing public health priority. If a disease is not killing people on the spot, it can be overlooked, and response may be delayed. We need to break this narrative. We should not be delaying. We need to mobilize resources and scale up our supply solutions and programmatic support. No one can do this alone, and UNICEF has been working together with strong, committed partners: Gavi, Unitaid, WHO, UNFPA, CHAI (Clinton Health Access Initiative), Expertise France and many others. We need to build and nurture these alliances and partnerships to eliminate cervical cancer and bring about systemic shifts to prioritize women’s reproductive health globally.
UNICEF has decades of experience and deep expertise working on the procurement, supply and logistics of health products. We collaborate closely with governments and partners in 190 countries to strengthen health systems and better serve the needs of women and children.
As one of the largest public buyers in the world, we have the power to influence markets. We use this weight to secure access, equity and sustainability for many essential health supplies including vaccines, diagnostics, medical devices and treatments.
UNICEF advocates to drive interest and expansion of health programmes and mobilizes vital resources. We offer comprehensive programmatic and supply support to governments and partners working towards elimination of cervical cancer. With this new toolkit, UNICEF can rapidly scale up to provide cervical cancer tools that meet the required demand. This will benefit health programmes and lead to better health outcomes, enhancing the lives of women, mothers and children, particularly in lower resource settings.