Creating Connections for HPV Prevention and Cervical Cancer Elimination in Africa

Dr. Matshidiso Moeti, from Botswana, is the first woman to be elected as WHO Regional Director for Africa. She spoke with Sabin’s President of Global Immunization Anuradha Gupta in advance of the 74th Session of the World Health Organization Regional Committee in Africa about a side event at the meeting co-hosted by the Global HPV Consortium, Gavi, the Gates Foundation, UNITAID and the World Bank’s Global Financing Facility focused on building engagement in the region for eliminating cervical cancer.

What keeps you awake at night about the situation with cervical cancer in Africa?

I think what keeps me awake is that the burden, the huge burden of cervical cancer in Africa, is worse than any other part of the world.  Out of the 20 countries with the highest burden of cervical cancer, 18 are in Africa, mostly sub-Saharan Africa. And it’s the number one cancer killer of African women.

On the other hand, there is such a huge opportunity to do something about it. The story of cervical cancer can be so different from other cancers, because there is a way to prevent, detect, and effectively treat it in early stages.

In a way, that’s what spurs me to be very determined to do something about it and also excites me about the opportunity. Progress in the region to leverage those opportunities is moving slowly. It needs to speed up. That’s what I would like to take the opportunity to do in my position and with access to decision-makers in the countries and partners.

What struck you about the approach to building momentum taken by the Global HPV Consortium?

It’s not starting from scratch with a new program in the traditional vertical way of working. Instead, the Consortium is bringing together the people and groups in communities who are already sensitized and hopefully mobilized. The approach uses existing teams and highlights the cervical cancer issue, incorporating it into what’s already going on and what’s needed.

And very importantly our region bears the heaviest burden of cervical cancer and also the heaviest burden of HIV. We’ve had HIV programs in place in most of the countries for decades. People living with HIV have high risk of developing cervical cancer and that connection should be utilized to advance cervical cancer awareness and prevention.

The opportunity to combine access to services for screening and for early detection using, hopefully, the more effective tests that are available and then incorporating cervical cancer interventions into existing HIV services is simply too huge to let go. That’s what I find most exciting. That’s what makes me feel encouraged – that it’s doable and that it is people interested in working together, who understand the imperative to leverage opportunities, to take advantage of them, to make the impact that’s so needed for women.

What are you hoping to achieve by bringing everyone together?

What encourages me a lot is this brings new opportunities to the effort to eliminate cervical cancer. The first opportunity is just as a reminder. Sometimes in Africa there are so many competing health problems that areas where there is an opportunity to actually do something transformative might be overlooked. I think it’s our responsibility to provide that reminder and have a conversation that may be challenging, but that’s also positive because there is huge opportunity in terms of what’s happening. Together, it’s possible to utilize the tools that are available and implement some of the programmatic, service delivery, and access opportunities that already exist.

In terms of eliminating cervical cancer, what gives you the most hope?

First of all, there’s a vaccine that’s proven very effective at prevention. Secondly, there is new advice from the regional technical advisory group on immunization that actually we can vaccinate girls once and that will offer lifelong protection. We have also made quite a lot of progress in discussions in the region about prioritizing more primary health care, which would include an integrated approach with screening and early detection.

I also think young people in Africa can be such a powerful force. They are so into technology, they’re so connected, being in touch and in communication constantly, especially when compared to 10 or 20 years ago when I started working with the HIV program at national and regional level. This is potential for finding young influencers and youth leaders who mobilize others to get informed, and who can be encouraged to vaccinate and encourage others as well.

What do you think are some of the potential barriers to cervical cancer elimination that will arise going forward?

First and foremost, the culture of working in certain vertical ways linked to funding – where funding comes from a particular source, and we often end up recreating programs in our own health system right down to the village level – is still very strongly in place. We are discussing it in Africa and I’m expecting that we will need to have more discussions.

Because very often what is driving verticality is the way programs are supported and funded. So, talking with health ministers and partners will be very important to prioritize integration.

If you could do just that one thing to eliminate cervical cancer in Africa, what would that be?

That’s such a tough question to answer! I think I would focus on the promise of the vaccine and getting that out to girls at an age when it is most effective. It’s a very sensitive issue in some of our societies, and it needs a lot of discussion. Convincing individuals as well as communities that this is needed and important, and that no one is trying to exploit these young girls. I think that is why we see that vaccination coverage in the region still has a long way to go. We need to do all that we can with the education systems, with the adolescent health systems, with the partners that are concerned so people understand the importance. And then, of course, access to the supplies of vaccine that are needed. It’s very difficult to choose one thing!

What are some next steps in the effort to eliminate cervical cancer?

Creating connections makes this such a hopeful endeavor in my view. It’s so encouraging to know that if we do this and bring more awareness, it will accelerate the result that we want, and it will be a lasting result. That is what inspires me to be part of it. There may not be a global fund created for this but working together across boundaries is a principle that works not only for cervical cancer and HIV, but for many health interventions. This could be a model and an example and an inspiration for having the courage to make these connections across funding models, agencies, departments, teams, and countries.