An Exercise in Economics: Cervical Cancer Prevention in the Developing World

| November 15, 2011 | 0 Comments

Due to a lack of basic screening, prevention and treatment methods, cervical cancer mortality rates in the developing world are astronomically greater than those in more developed nations. This trend highlights perhaps the most striking disparity in global health today. Figure courtesy of GLOBOCAN 2008.

Mortality from cervical cancer highlights the striking global disparities in access to healthcare.  The second most common cancer among women worldwide, cervical cancer causes 274,000 deaths each year with more than 80% of these deaths occurring in developing countries.[1] Lack of access to screening procedures (e.g. the Pap smear) delays diagnosis and accounts for the increased morbidity and mortality from this disease, which tends to strike down women in their prime.  In some resource-poor nations, cervical cancer deaths rob more years of life from women than any other cancer.

Recently, a safe and effective vaccine has been developed for the cancer-causing serotypes of the sexually transmitted human papilloma virus (HPV) – the cause of 70% of cervical cancer.  It has been heralded as the first vaccine to prevent cancer. However, its widespread introduction into the developing world is plagued by many factors, some familiar and some novel, but all detrimental for women with cervical cancer.

Economic resources in the developing world have not been adequately focused on the problem of cervical cancer.  The absence of widespread screening programs explains the more than eight-fold difference between the highest and lowest incidence rates of cervical cancer worldwide. Since screening, early diagnosis, and treatment technologies are beyond the reach of many developing countries, prevention is of the utmost importance. But a single course of HPV vaccine costs 300 USD, astronomical pricing compared to other vaccines, and virtually unaffordable for large-scale distribution.[2] In addition, many developing countries lack the infrastructure and trained staff to deliver the HPV vaccine, which is administered in three doses over the course of six months.

Governments must work together to pursue cheaper manufacturing technologies and local production options to bring the cost of the HPV vaccine within reach of economically fragile societies. For now, foreign aid will play a crucial role in subsidizing vaccine costs in the developing world.  GAVI, a global coalition of NGOs, the World Health Organization, the Bill and Melinda Gates Foundation, the vaccine industry, and public health institutions, provides crucial financial support to low-income countries, until more durable health solutions—i.e. lowering vaccine production costs—are in place.[1]

Another hurdle that needs to be addressed is the inherent suspicion in some cultures of vaccinations.  There are inveterate fears that immunizing young girls against HPV is somehow a form of sterilization. In addition, since HPV is spread through sexual contact, conservative elements in many societies, including our own, fear that immunizing against a sexually transmitted disease encourages promiscuity. Clearly, in addition to finding the resources to procure enough vaccine, education programs must be introduced.[3]

The significant disease burden in poor countries ultimately imperils their economic development. The technology exists to ease this burden but fiscal and political impediments abound. Cervical cancer, which cuts short the lives of hundreds of thousands of poor, young women each year is entirely preventable by vaccination. Other breakthroughs are on the horizon.  Recently, researchers at the University of Pennsylvania used modified killer T-cells to combat leukemia, an advancement that left the scientific community hopeful for a leukemia vaccine.[4]

As citizens of the global North, we must redouble our efforts to ensure that those in need in the global South have access to these breakthroughs and that the economic gap between the healthy and sick does not continue to widen.  As scientific advancements continue to be made, the global community needs to ensure that economics does not increase global health disparity.  Developing countries must also be allowed to reap the benefits from new drugs, treatments, and vaccines.


  1. Agosti, Jan M., and Sue J. Goldie. “Introducing HPV Vaccine in Developing Countries–Key Challenges and Issues.” New England Journal of Medicine (2007): 1915-928. 10 May 2007. Web. 6 Nov. 2011.
  2. Sankaranarayanan, R. “HPV Vaccination: the Promise and Problems.” Indian J Med Res 130 (2009): 322-26. Print.
  3. Tsu, Vivien D., and Carol E. Levin. “Making the Case for Cervical Cancer Prevention: What about Equity?” Reproductive Health Matters (2008): 104-12. Print.
  4. Penn Medicine News: Genetically Modified “Serial Killer” T Cells Obliterate Tumors in Patients with Chronic Lymphocytic Leukemia, Penn Researchers Report.” University of Pennsylvania Health System | Penn Medicine. 10 Aug. 2011. Web. 06 Nov. 2011. <>.

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