Cervical cancer is one of the few cancers the world knows how to eliminate yet in Africa, it continues to claim the lives of thousands of women every year. The science is settled, the vaccines exist, and proven delivery models are already saving lives in parts of the continent. So why does the disease remain such a formidable public health threat?
In this exclusive interview, Health Business magazine Editor Samwel Doe Ouma speaks with Zwelethu Bashman, Managing Director, MSD South Africa and Sub-Saharan Africa, to unpack the real barriers holding Africa back from eliminating cervical cancer—and the opportunities within reach. From the role of higher-valency HPV vaccines and gender-neutral vaccination, to the urgent need to protect women living with HIV and other “missed cohorts,” Bashman outlines why a girls-only, school-based approach is no longer enough and what a truly holistic elimination strategy must look like.
At a moment when political commitment is rising and momentum is building across the continent, this conversation makes one thing clear: eliminating cervical cancer in Africa is no longer a question of possibility, but of leadership, partnership, and speed.
Q1: Cervical cancer is often described as preventable. Why does it remain such a major killer of women in Africa?
A:Cervical cancer continues to be a major cause of death because many women are diagnosed too late. Late-stage diagnoses are common throughout the region, which leads to poor survival rates. In several countries, cervical cancer screening coverage is still as low as 10%, well below the WHO target of 70%. This lack of screening contributes to delays in diagnosis.
Additionally, many women were never vaccinated because numerous girls and adult women did not receive protection against cervical cancer with the HPV vaccine, particularly before national HPV vaccination programmes started. Rwanda was the first country to implement a national HPV vaccination programme in 2011, and Ghana successfully launched its own programme in 2025. All of this is occurring on our continent, which bears the highest burden of cervical cancer globally.
Nineteen of the top twenty countries with the highest incidence of cervical cancer are located in sub-Saharan Africa. Furthermore, given the region’s disproportionate HIV prevalence, sub-Saharan Africa accounts for 65% of all people living with HIV globally, and women in the region who are living with HIV are six times more likely to develop cervical cancer.
Q2: What role does HPV play in cervical cancer, and how effective are vaccines?
A:HPV is the core driver of this disease. In fact, HPV is responsible for more than 95% of cervical cancer cases.
The good news is that vaccines are extremely effective and safe. HPV vaccines can prevent almost 90% of cervical cancer, especially when provided before exposure. HPV vaccines are type-specific and the presently available HPV vaccines target 2,4 and 9 different HPV types. The number of HPV types within a vaccine formulation is is referred to as ‘valency’.
Q3: What role do higher-valency HPV vaccines play in elimination efforts?
A: Higher-valency HPV vaccines like the 9-valent HPV vaccine offer broader protection by targeting more HPV types linked to cervical and other cancers, including those affecting men. In summary – they broaden protection for girls and women, boys and men. More than 70 countries globally have transitioned to higher-valency vaccines to accelerate the elimination of cervical cancer. In Africa, countries transitioning to higher-valency HPV vaccines, like Mauritius, are strengthening their programme resilience and aligning with global elimination pathways. 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.
Q4: Why has Africa focused primarily on vaccinating adolescent girls?
A: The girls-first strategy comes directly from the WHO Cervical Cancer Elimination roadmap. Countries are working to ensure that 90% of girls are fully vaccinated by age 15, because adolescence is when the vaccine is most effective, cost efficient, and easiest to deliver through schools. Many countries have followed Rwanda’s model, where school-based delivery and strong political commitment consistently achieve high adolescent coverage. This adolescent-first approach is a necessary foundation, but not the full solution.
Q5: Why is vaccinating adolescent girls alone not enough to eliminate cervical cancer?
A:Countries started programs to vaccinate girls at different times between 2011 and present day. The reality is that many girls and adult women did not receive protection against cervical cancer through an HPV vaccine, and these unvaccinated women are the ones driving the burden in the next decade. Girls-only strategies also don’t interrupt community transmission enough. That’s why elimination requires reaching older adolescents, adult women, and boys.
Q6: Why is HPV vaccination for boys and men important?
A: HPV stands for Human Papilloma Virus. It’s a human virus, HPV isn’t only a “women’s virus.” Men are carriers of HPV, and vaccinating them strengthens programme resilience. Gender-neutral vaccination is a proven strategy that strengthens programme resilience and expands herd protection. It also prevents HPV-related cancers in men, like penile and anal cancers, which are rising globally. In short: protecting boys protects everyone.
Q7: Which populations are most vulnerable to cervical cancer in Africa?
A: As mentioned before, the highest-risk group is women living with HIV (WLHIV), who are six times more likely to develop cervical cancer. They experience faster progression, higher recurrence, and poorer outcomes. More broadly, any woman who missed adolescent vaccination is at increased risk, especially in African countries where late-stage diagnosis is widespread and screening coverage remains as low as 10% as I mentioned earlier
Q8: What evidence supports vaccinating adult women who are already sexually active?
A:There is strong evidence that adult women still benefit. Studies show they may not have been exposed to all high-risk HPV types, and catchup vaccination can substantially reduce future cancer incidence, especially when combined with screening.Furthermore, the WHO recommends the vaccination of adult women in line with the global scientific evidence. This is particularly important for WLHIV, where modelling shows targeted vaccination could significantly reduce cases.
Q9: Who are the “forgotten cohorts” in current HPV prevention strategies?
A:Primarily: Women who ‘aged-out’ before HPV programmes were introduced, Adult women who missed vaccination due to COVID 19 disruptions, Women living with HIV, and Out of school girls not reached by classroom based delivery. These are the women most at risk today.
Q10: How could HPV vaccination be expanded beyond schools?
A: There are many practical options. Countries can integrate HPV vaccination into HIV programmes, reproductive health services, university clinics, and community-based approaches similar to Cameroon’s model. Collaboration is key, particularly with the private sector where workplace programmes for families could be particularly effective. Eswatini has shown it’s possible to reach older adolescent girls and WLHIV through expanded platforms.
Q11: What is the economic case for expanding HPV vaccination?
A:The economics are compelling. Women contribute significantly to Africa’s GDP, and cervical cancer hits women in their most productive years. Prevention avoids treatment costs, protects families, and keeps women in the workforce. Cervical cancer is almost entirely preventable, yet Africa still bears 21% of all cervical cancer deaths worldwide, a burden that is entirely avoidable with investment.
Q12: How are African governments responding so far?
A:There is strong, growing momentum. Over 30 sub-Saharan African countries have introduced HPV vaccination into their national immunization programmes, though 12 countries have yet to introduce HPV vaccines at all.Furthermore, progress is accelerating: Botswana integrated higher-valency HPV vaccines into HIV care, Eswatini expanded HPV vaccination in 2024, and Rwanda achieves consistently high coverage above 90% through sustained political will.
Q13: How important are partnerships in achieving cervical cancer elimination?
A:Cervical cancer will not be eliminated by isolated efforts. The countries making the fastest progress are those embracing integrated, multisector collaboration. Partnerships are essential. The path to elimination demands collective strength, partnerships across governments, private sector, civil society, and international organisations play a critical role in driving earlier diagnosis, building referral systems, strengthening vaccination acceptance, and ensuring timely treatment.Collaboration is the backbone of achieving the WHO 90-70-90 targets for the elimination of cervical cancer.
Q14: What is the biggest barrier to eliminating cervical cancer in Africa today?
A: The biggest barrier is a combination of vaccine hesitancy, misinformation, and low HPV screening rates.These challenges deepen inequity and slow down progress even where vaccines and tools exist.
Q15: What is the central message for policymakers?
Elimination is fully achievable but only through a holistic pathway. Policymakers must connect the full continuum: HPV vaccination, screening, and timely treatment, while ensuring no one is left behind, especially missed cohorts which include older adolescents, women, boys and men. Women living with HIV, in particular, must be fully supported across the entire continuum of care. Countries progressing fastest are those treating prevention, screening, and treatment as one connected pathway.
Q16: Any other thing that you may want Health Business to know?
Yes the tools already exist, the evidence is overwhelming, and the region has strong success stories to build on. MSD is playing its part by ensuring supply continuity of HPV vaccines, investing US$2 billion in manufacturing, providing over 150 million HPV vaccine doses globally, and ensuring more than 50% of our supply goes to LMICs.But the real acceleration will come from African leadership, regional collaboration, and a willingness to expand protection to adult women, WLHIV, boys and men, and all who were previously missed. Africa can eliminate this disease, the question now is not feasibility, but ambition and speed.
