A global blueprint for
cervical cancer elimination:
learnings from Sweden

Supported byA global blueprint for cervical cancer elimination: learnings from Sweden

2About this report
A global blueprint for cervical cancer
elimination: learnings from Sweden is an
Economist Impact report, supported by MSD.
It examines the extent to which countries aremeeting, and in some instances exceeding, theWorld Health Organization’s (WHO) 90-70-90
goals for cervical cancer elimination within thiscentury. The report describes the exemplary
performance of Sweden, which could comeclose to eliminating cervical cancer before
2030. It also looks at other select countries,
across a range of income levels, population
health needs and budget constraints, thathave prioritised cervical cancer as a key healthpriority and are now reaping the benefits of
their commitment. The report is based ondesk research, an in-depth literature review,
and insightful interviews with a range ofglobal and national-level experts in the field,
including those involved in both upstream
and downstream levels of policy, strategy andimplementation. Through the synthesis of thesesuccess stories, it concludes with a 10-point
plan as a baseline of recommendations forother countries to consider in their pursuit ofeliminating cervical cancer.
We could not have developed this report
without the critical input and support of thefollowing experts (in alphabetical order):Dr Nino Berdzuli, Director of the Division ofCountry Health Programmes, WHO, Regional
Office for Europe, Switzerland
Professor Joakim Dillner, Head of Unit at
the Karolinska University Hospital, Center for

Cervical Cancer Elimination and Director of
Research & Development (FoU-chef) at theMedical Diagnostics Karolinska, Sweden
Dr Marc Hagenimana, Ag. Director of Cancer
Diseases Unit, Rwanda Biomedical Centre,
Ministry of Health, Rwanda
Ulrika Årehed Kågström, Secretary General,
Cancerfonden (Swedish Cancer Society), Sweden
Professor Daniel Kelly OBE, Co-Chair,
European Cancer Organisation HPV Action
Network, UK
Professor Rui Medeiros, Professor of Virology
and Molecular Oncology, Head of MolecularOncology and Viral Pathology GRP; IPO Porto
Board Director of NRN-LPCC-Portuguese
League Against Cancer President of Associationof European Cancer Leagues; Co-Chair of theEuropean Cancer Organisation HPV Action
Network, Portugal
Barbro Sjölander, Chair, Network Against
Gynaecological Cancer, Sweden
Dr Karin Sundström, Principal Researcher andepidemiologist, Karolinska Institute and theKarolinska University Hospital, Sweden
Economist Impact bears sole responsibility forthe content of this report. The findings andviews expressed do not necessarily reflect theviews of the sponsor.
The research was led by Emily Tiemann. The
report was authored by Ingrid Torjesen andedited by Shaileen Atwal. Rob Cook oversaw theresearch programme.

©Economist Impact 2023

A global blueprint for cervical cancer elimination: learnings from Sweden

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Executive summary

Cervical cancer is a significant global healthchallenge, affecting over 604,127 womenand leading to 342,000 preventable deaths
worldwide.1 In Europe alone, there were30,447 new cases and 13,437 deaths as aresult of cervical cancer.2 Unless contained,

and eventually eliminated, the impact of
cervical cancer has the potential to destabilise
economies and societies, particularly those oflow- and middle-income countries (LMICs),
where inadequate resourcing remains a key
public health challenge that leads to a steadyrise in the number of new cases and deaths
from cervical cancer.3 Without swift andsubstantive action, the global cost of cervicalcancer is expected to increase to US$682bn
between 2020 and 2050; therefore, thecondition does not simply present a publichealth problem but a sizeable economic one.4
As a result of the remarkable advancements inscience and technology, the goal of eliminating
cervical cancer is now more viable than ever.
This optimistic sentiment has been propagatedand amplified through the concerted messaging
efforts of multiple stakeholders, including
policymakers, patients and patient advocates,
bio-pharmaceutical organisations, researchers,
and healthcare professionals. However, concreteplans to achieve this ambitious goal are still
nascent. Building on from the World HealthOrganization’s (WHO) global strategy forcervical cancer elimination, adopted by theWorld Health Assembly in August 2020,5 many
countries have begun developing national andregional strategies in pursuit of this lofty goal. For
instance, Europe’s Beating Cancer Plan (EBCP),launched by the European Commission in 2021,
includes, among its many goals, the eliminationof cervical cancer, as well as other cancers causedby human papillomaviruses (HPV).6©Economist Impact 2023

A global blueprint for cervical cancer elimination: learnings from Sweden

4WHO’s 90-70-90 targets to achieving cervical cancer elimination:

90%

70%

90%

of girls fully vaccinatedwith HPV-vaccination by
15 years of ageof women are screened using
a high-performance test by 35
years of age and again by 45
years of ageof women identified withcervical disease receive
treatment

EBCP targets for cervical cancer elimination:

90%

90%

90%

of the European Union’s (EU) target
population of girls fully vaccinated withHPV-vaccination and the vaccination ofboys significantly increased by 2030of the EU target population
offered cervical cancer
screening by 2025

of eligible patients have access toComprehensive Cancer Centresfor treatment by 2030

The WHO estimates that investing ininterventions to meet the 90-70-90 targets
would add $28 billion to the world’s economy
and avert 300 000 cervical cancer deaths before
2030, over 14 million by 2070, and over 62
million by 2120.8 Progress towards achieving theWHO’s 90-70-90 targets is highly variable both
between and within countries. Several countries– particularly (but not exclusively) high-income
countries (HICs) – are close to meeting, or evensurpassing, the targets by 2030. Such countries
include Sweden, Australia, Portugal and Rwanda,
the last being the exception in the list as theonly low-income country. These countries have
many lessons to offer the rest of the world,
particularly Sweden, which is an exemplar ofsuccess, as demonstrated by its developmentof world-renowned registries, organised healthprogrammes, evidence-based decision-making,strategies to improve vaccination coverage forboth males and females, increasing screening
coverage, and most importantly, throughhigh-levels of political commitment within thecountry. As a result of these organised efforts,
Sweden is likely to be the first country toeliminate cervical cancer by 2030.
Based on the insights of experts interviewed,
published evidence and learning from countries
leading the way towards cervical cancer
elimination, Economist Impact recommends a10-point plan as a baseline for policymakers toconsider when developing national strategies
aimed at eliminating cervical cancer.

©Economist Impact 2023

A global blueprint for cervical cancer elimination: learnings from Sweden

5The 10-point plan for
cervical cancer elimination
Point 1
Build political commitment and momentum

Point 2
Ensure multi-stakeholder collaboration

Point 3
Prioritise HPV within national cancer policies and vaccination schedules

Point 4Generate data through the development of robust registries

Point 5
Include screening and vaccination under universal health coverage

Point 6
Understand the target population and design the roll-out of organised andaccessible immunisation programmes

Point 7
Ensure equitable vaccination and screening access to the entire population

Point 8Address the barriers of vaccination hesitancy and misinformation

Point 9Ensure equitable access to high-quality treatment and optimal care pathways

Point 10
Learn lessons from the Covid-19 pandemic to build system resilience andscale screening and vaccination coverage

Positively, many countries have madesignificant gains in their efforts to eliminate
cervical cancer, with Sweden set to be the first
country to achieve this before 2030, followedby Australia by 2035. But all countries studied
in this report have demonstrated that politicalcommitment is the essential foundation forachieving this ambitious goal. This politicalcommitment is often built on evidence-based
decision making, which requires actors fromthe health and science community to takeaccountability for the generation of data tounderstand and communicate the true needsof their unique populations. The 10-point planforms the baseline of actions each country
should consider when developing national
strategies and implementing measures aimed
at the elimination of cervical cancer. The
recommendations in this baseline plan will not
only alleviate fiscal pressures, but also ensurethat women are protected from this highlypreventable cancer.

©Economist Impact 2023

A global blueprint for cervical cancer elimination: learnings from Sweden

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While every effort has been taken to verify the accuracy of thisinformation, Economist Impact cannot accept any responsibility
or liability for reliance by any person on this report or any of theinformation, opinions or conclusions set out in this report.
The findings and views expressed in the report do not necessarilyreflect the views of the sponsor.

©Economist Impact 2023