By Zwelethu Bashman
Cervical cancer remains one of the leading causes of cancer-related deaths among women globally, despite being almost entirely preventable. In Africa, it continues to claim lives not because science has failed, but because policy ambition has fallen short. Over 200 strains of human papillomavirus (HPV) exist, with 12 high-risk types responsible for most HPV-related cancers.
Although HPV vaccines can prevent almost 90percent of cervical cancer, most women remain unvaccinated, leaving cervical cancer among the top killers of women worldwide, with more than 94percent of deaths occurring in low- and middle-income countries. At current rates of vaccination and coverage, hundreds of thousands of African women will die from a cancer that could have been prevented with vaccines already available.
Cervical cancer hits the hardest where vulnerability is greatest. The World Health Organization (WHO) identifies sub-Saharan Africa as the region with the highest prevalence of cervical HPV, affecting nearly one in four women. Women living with HIV face an even steeper risk, as weakened immune systems make them more susceptible to persistent HPV infection and four to five times more likely to develop invasive cervical cancer.
Without urgent action, these inequities will continue to drive preventable deaths across the continent. Recently, Gavi’s inclusion of higher-valency HPV vaccines is an important development in the global HPV prevention landscape and a relevant consideration for countries across sub-Saharan Africa as they continue to strengthen cervical cancer prevention efforts.
Vaccinating Girls First: Africa’s Critical Foundation
In 2018, the WHO launched a global call to eliminate cervical cancer as a public health threat, built on three pillars: vaccination, screening, and timely treatment. Central to this strategy is fully vaccinating 90percent of girls by age 15. This focus on adolescent girls is a critical foundation, and African countries have made meaningful progress in recent years.
Rwanda offers a powerful example. In 2011, it became the first African country to introduce a national HPV vaccination program targeting adolescent girls through a robust school-based platform. Today, Rwanda has achieved over 90 percent coverage among eligible girls, one of the highest rates globally. This success reflects strong political leadership, community trust, and effective delivery systems.
But even Rwanda’s success highlights a fundamental limitation. High coverage among adolescent girls alone does not protect older women, boys, or men, nor does it fully interrupt HPV transmission within the broader population. A girls-only strategy, while necessary, is insufficient for elimination.
HPV Is Not a Women-Only Virus
HPV continues to be framed primarily as a women’s health issue because of its link to cervical cancer. This framing is both incomplete and counterproductive. Men are not only carriers of HPV, they are also affected by HPV-related disease. Globally, one in three men is infected with at least one HPV strain, often after age 15. In sub-Saharan Africa, HPV prevalence among men remains high, sustaining community-level transmission.
HPV also causes anal, penile, and oropharyngeal cancers, conditions that disproportionately affect men and are increasing globally. Excluding boys and men from vaccination strategies perpetuates transmission to women and leaves men unprotected from largely preventable cancers.
Why Gender-Neutral Vaccination Matters for Elimination
If Africa is serious about elimination, vaccination strategies must reflect how HPV actually spreads. Expanding vaccination to boys and men is not only a matter of equity, it is an epidemiological necessity. Gender-neutral vaccination accelerates herd immunity, reduces circulation of high-risk HPV types, and offers critical protection for high-risk populations, including people living with HIV.
Yet progress remains uneven. Only 29 of 54 African countries have implemented national HPV vaccination programs, and nearly all focus exclusively on girls aged 9 to 14.This is an important starting point, but it will not break the cycle of transmission. Elimination demands moving beyond a single cohort and a single gender.
The Forgotten Cohort: Women Who Aged Out
While adolescent girls remain the priority, millions of women across Africa missed HPV vaccination entirely. Many aged out before programs were introduced, while others were missed due to COVID 19 disruptions. These women, now in their 20s and 30s, represent the largest group at near term risk and will drive cervical cancer incidence over the next decade if left unprotected.
In addition, women living with HIV (WLHIV) require tailored protection. Sub-Saharan Africa carries the world’s highest prevalence of HIV among women. WLHIV experience higher rates of persistent HPV infection, faster quicker disease progression, increased recurrence, and poorer outcomes. Modelling shows that vaccinating WLHIV aged 10–45 could reduce new cervical cancer cases by 4.7percent overall and by 10 percent among WLHIV.
The evidence is clear. Sexually active women over 15 still benefit from HPV vaccination, as they may not have been exposed to all high-risk HPV types. Catch-up vaccination, particularly when combined with screening, can substantially reduce future cancer incidence. Integrating HPV vaccination into HIV care, university health services, and workplace health programs offers practical, scalable pathways to reach this cohort.
The socioeconomic case is clear. Women contribute an estimated 35–45 percent of GDP across the region. Preventing cervical cancer protects households, sustains productivity, and reduces catastrophic health expenditure. Yet across the continent, adult women remain largely invisible in HPV prevention policies. This gap is not scientific. It is political.
Leadership, Systems, and Smarter Policy Choices
African governments are central to closing the HPV protection gap. While the number of countries delivering HPV vaccines has tripled since 2019 and coverage has doubled, the regional average remains just 52percent, far below the 90percent target. Sustainable progress requires integrating HPV vaccines into routine immunization schedules, securing predictable domestic financing, and strengthening supply chains.
Kenya’s recent decision to introduce a single-dose HPV vaccine for girls shows how policy can adapt to improve efficiency and access. However, simplification alone will not address missed cohorts or limited population-level protection. Other countries in the region are also adapting policy to expand reach, with Botswana integrating higher-valency HPV vaccines within national prevention planning aligned with HIV care, and Eswatini expanding HPV vaccination in 2024 to include adolescent girls and young women living with HIV.
Adult vaccination pathways should be integrated into reproductive health services, alongside catch-up vaccination for older adolescents and women. Efforts should target cohorts missed by school-based programmes, including out-of-school girls and WLHIV – using multi-channel delivery platforms such as clinics, HIV programmes, mobile outreach, and innovative community-based models.
As science evolves, policy must keep pace. Transitioning to nonavalent vaccines offers broader protection against high-risk HPV types and greater long-term impact in high-burden settings. Procurement decisions should be driven by epidemiology, cost-effectiveness, and sustainability, not short-term constraints.
The Role of Partnerships and Innovation
Industry, alongside governments and civil society, has a role to play in supporting national cervical cancer elimination goals.
Between 2021 and 2025, MSD supplied over 115 million HPV vaccine doses to low- and middle income countries, supported by a US$2 billion investment in manufacturing capacity. MSD has also reaffirmed its commitment to Gavi, the Vaccine Alliance, to support sustainable HPV vaccine supply and equitable access across Sub-Saharan Africa.
These efforts support broader vaccination strategies, including protection of older cohorts and women living with HIV, and enable country transitions to higher-valency HPV vaccines – an important step toward averting millions of future cancer cases and deaths.
The Choice Africa Must Make
Africa cannot eliminate cervical cancer and all other HPV-related diseases by protecting adolescent girls alone. HPV does not respect age, gender, or delivery platforms, and elimination requires population-level protection. This means vaccinating girls, protecting boys, catching up women who were left behind, and building resilient systems that sustain coverage over time.
The tools exist. The evidence is overwhelming. What remains is the choice. If governments and partners act decisively now by expanding HPV vaccination beyond adolescent girls and investing in durable prevention systems, cervical cancer can become a disease of the past. Elimination is not a question of feasibility. It is a question of ambition, and the time to choose is now.
Bashman is Managing Director, MSD South Africa and Sub-Saharan Africa, Marloes Kibacha, Managing Director, Africa Health Business, Cheyenne Braganza, Senior Project Associate, Africa Health Business
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