Advancing towards cervical cancer elimination targets in 76 LMICs: updated analysis to support a new cervical cancer elimination planning tool
RIVAS ROMERO D. 1, SIMMS K. 1, CARUANA M. 1, ERVIK M. 2, KEANE A. 3, HUI H. 1, HALL M. 1, TORODE J. 4, WRIGHT A. 5, VARNEY-HOPKINS N. 5, COLLEE I. 5, SOERJOMATARAM I. 2, CANFELL K. 1
1 Cancer Elimination Collaboration, Sydney School of Public Health, University of Sydney, Sydney, Australia; 2 International Agency for Research on Cancer, World Health Organization, Lyons, France; 3 The Alan Turing Institute, London, United Kingdom; 4 Institute of Cancer Policy, King’s College London, London, United Kingdom; 5 Cancer Research UK, London, United Kingdom
Background
The WHO strategy for cervical cancer elimination recommends that countries achieve 90-70-90 targets for HPV vaccination, cervical screening, and cancer treatment by 2030. Previous modelling indicated that scaling-up these services from 2020 and meeting the 2030 targets in 78 low-income and lower-middle-income countries (LMICs) would avert 62.6 million deaths over a century. However, many countries have faced challenges in scaling-up services, and updated estimates are needed.
Objectives
To quantify the health and economic impacts of delayed implementation of the WHO 90-70-90 strategy across LMICs, and to evaluate mitigation approaches (e.g. catch-up vaccination/screening and accelerated scale-up) that could offset losses due to delays, providing country-level evidence for planning via the EPT dashboard.
Methods
Using the well-established Policy1-Cervix platform, we evaluated multiple scale-up scenarios starting between 2020 and 2025, including different levels of service coverage, vaccination-only strategies, both-sex vaccination, and mitigation approaches such as accelerated scale-up to reach the 90-70-90 targets by 2030, and catch-up vaccination and/or screening for missed cohorts.
Results
Our analysis indicates that each year of delayed implementation beyond 2020 results in approximately 400,000 fewer deaths averted by 2120, relative to the original elimination strategy. Consequently, delaying scale-up of the 90-70-90 strategy from 2020 to 2025, with targets reached by 2035, results in 2.0 million fewer deaths averted by 2120 compared with the original elimination strategy starting in 2020. Relative to this 5-year delay scenario (base case), various mitigation approaches could partially offset these losses. Offering vaccination catch-up to missed cohorts could avert an additional 700,000 deaths by 2120, increasing to 1.3 million if vaccination catch-up is extended to age 25. Providing screening catch-up to missed cohorts, combined with accelerated screening scale-up to reach the 70% target by 2030, would avert an additional 600,000 deaths. Accelerating both screening and treatment to reach the 90-70-90 targets by 2030 would avert 500,000 additional deaths, increasing to 1.5 million when combined with both vaccination and screening catch-up for missed cohorts.
Alternative scale-up scenarios showed that a 50-50-50 strategy implemented in 2025 would avert 8.2 million fewer deaths by 2120 compared with a 90-70-90 strategy starting the same year. Vaccination-only strategies at 90% and 50% coverage implemented in 2025 would result in 17.1 million and 31.1 million fewer deaths averted, respectively.
Implementing a 90-70-90 strategy in the near future with targets reached by 2035, requires USD 5.68 billion over 10 years, yielding a return of USD 23.2 per dollar invested over 30 years and USD 70.1 over 50 years. Mitigation strategies involving catch-up and accelerated scale-up increase resource needs and budget but maintain similar returns, while extending vaccination to older cohorts or including boys substantially increased costs and reduced returns. Lower-coverage strategies reduced budget but achieved smaller health gains, resulting in lower short-term returns but higher long-term returns.
Conclusion
Timely implementation of the full 90-70-90 strategy remains critical, while targeted mitigation approaches can reduce the impact of delays. These results also provide countries and policymakers valuable evidence to make informed decisions and optimize resource use for planning cervical cancer elimination strategies.