World Cancer Leaders’ Summit 2015
Vaccination as preventative treatment for cervical cancer
Dr Ophira Ginsburg - World Health Organization Genève, Canton de Genève, Switzerland
The main issues facing women everywhere regarding cancer are primarily breast and cervical cancer for which hundreds of thousands of women die needlessly and suffer needlessly each year. In the case of cervical cancer the inequity is really stark – eight in ten women who develop cervical cancer and nine in ten women who die of it live in low and middle income countries. This is really a preventable tragedy because we have vaccination, we’ve had demonstration projects that show how effective and very cost effective vaccination of girls can be, we could avert 600,000 deaths, within one generation we could get this disease under control with a combination of vaccination and effective screening and treatment of pre-cancerous lesions. But we’re not doing it, so why is that?
The way I see it is primarily an issue of gender inequity and lack of women’s empowerment. If we can help improve the status of women in countries, including my own country of Canada, we can make a better impact on cancer control and also non-communicable disease management which hits women particularly hard in the prime of life. In the case of breast cancer this is a cancer which historically was not a huge risk in many countries and is becoming rapidly the number one cancer in women almost everywhere. In only 38 countries cervical cancer is more common than breast cancer.
There is an issue of education too because how are you going to get advocacy up to scratch and get opinion leaders speaking out and so on if they don’t know what the issues are and they don’t know how to get the team behind them? Because that’s what they need, they need to build teams from the ground up; it’s not going to happen in most countries from the top down because at the top there aren’t many women either. So how will you go about building those teams, I think you call it capacity building in the WHO?
This is a very interesting issue about how to build capacity for women’s rights, women’s health and women’s cancers in particular. Grass roots movements, women advocates, particularly women who survive cancer, can be tremendously effective in mobilising interest, mobilising resources and bringing attention so that ministries and, in some cases, heads of state and other sectors at the district level and all the way up to national governments can really be effectively engaged. This has happened in some small ways, I’ve seen personally in countries like Bangladesh and Vietnam. In the case of Vietnam there has been partnership with a women’s cancer advocate from the US, Carolyn Taylor, she has an NGO called Global Focus on Cancer and it’s the doctors in Vietnam who actually took an interest and helped bring together the first breast cancer and other cancer support groups for women and also for men and children. This is now getting the attention of the governments and right now in central Vietnam there’s a big meeting going on with hundreds and hundreds of patient advocates, doctors and government officials taking part.
I’ve seen the same with WECAN, the Women’s Empowerment Cancer Advocacy Network, out of the Fred Hutchinson Cancer Center in Seattle, which every other year they’re either in Eastern Europe or the former Soviet republics or in East Africa and they bring together, they really are mobilising, networks of women’s cancer advocates, the ministries are in the room, the other NGOs who are doing tremendous work in breast and cervical cancer programmes, particularly cervical cancer. So PATH and Jhpiego and all of the other players are together in one room interacting, hearing the women’s stories and then developing programmes and mobilising resources because the profile is so greatly increased by these initiatives.
I’m hopeful actually seeing these programmes in action but there’s a lot more we can do. And it is from the ground up, at the same time we need to work with governments to show them what can be done and in my role at the World Health Organisation we hope to be able to do that using a cost effectiveness analysis such as from the disease control priorities which is being launched this week at the AORTIC event in Marrakesh to show what an essential package of cancer care and how much it would cost per capita in different resource settings. So in the lowest income settings they have a higher percentage of their GDP that needs to go towards cancer so they can’t do it completely from domestic financing but we can show what’s possible and help target the resources where it’s needed most. A lot of this is about breast and cervical cancer control.