Learning from Rwanda

GENEVA – How is it that Rwanda, among the world’s poorest countries – and still recovering from a brutal civil war – is able to protect its teenage girls against cancer more effectively than the G-8 countries? After just one year, Rwanda reported vaccinating more than 93% of its adolescent girls against the human papillomavirus (HPV) – by far the largest cause of cervical cancer. Vaccine coverage in the world’s richest countries varies, but in some places it is less than 30%.

In fact, poor coverage in the world’s richest countries should come as no great surprise, especially when one considers the demographics of those missing out. Where available, evidence suggests that they are mainly girls at the lower end of the socioeconomic spectrum – often members of ethnic minorities with no health-care coverage. This implies that those who are at greatest risk are not being protected.

It is a familiar story, one that is consistent with the global pattern of this terrible disease, which claims a life every two minutes: those most in need of protection have the least access to it. Of the 275,000 women and girls who die of cervical cancer every year, 88% live in developing countries, where mortality rates can be more than 20 times higher than in France, Italy, and the United States. That is not just because vaccines are not readily available; it is also because women in these countries have limited access to screening and treatment. Without prevention, they have no options if they get sick.

Alarmingly, in some of the wealthy countries, where both screening and treatment should be readily available, vaccine coverage now appears to be declining, raising a real danger that socioeconomically disadvantaged girls there will face a similar fate. If it turns out that girls at risk of not receiving all three doses of the HPV vaccine are also those with an elevated risk of being infected and missing cervical screenings as adults, they may be slipping through not one but two nets.