Preventable but Persistent: The Fight to Eliminate Cervical Cancer in East Africa
In East Africa, a silent killer continues to claim the lives of thousands of women every year. Cervical cancer accounts for 40% of all cancer diagnoses in women in the region. In Kenya, cervical cancer is the most common cancer death among women. Cervical cancer is largely preventable. Around 95% of cervical cancers are caused by the persistent untreated infection with the human papillomavirus (HPV), a sexually transmitted infection. Prevention of HPV infection and the subsequent onset of cervical cancer can be achieved through initiatives such as vaccination, screening, and early detection; however, in East Africa, this continues to be suboptimal.
The scale of this challenge remains significant. In Uganda 13.1 million women above the age of 15 are at risk for developing cervical cancer. In Kenya this number stands at 16.8 million women, in Tanzania it is 18.8 million, and Ethiopia has the largest number of women at risk, at 36.9 million women 15 years and older.
Although highly effective tools and initiatives for prevention exist, and have been implemented in some regions, East Africa continues to have the highest rates of cervical cancer in the world, over three times higher than what is seen in Europe or North America. Ineffective screening programs, vaccine hesitancy, and access to healthcare services drive this disparity. Without urgent action to improve access to vaccination, screening and treatment, preventable cervical cancer deaths will continue to rise, placing an increased burden on health and healthcare systems, while exacerbating existing health inequities and gender disparities. However, sustained political will, equitable resource allocation and community engagement, has the potential to transform cervical cancer outcomes and secure a healthier future for women in East Africa.
Vaccine Uptake
High-risk HPV type 16 and 18 are the most common causes of cervical cancer; however, there are 6 existing vaccines that prevent against these forms of HPV. The World Health Organisation (WHO), recommends that the HPV vaccine should be prioritised for girls between the ages of 9 and 14, before they are sexually active. This vaccine is administered in 1-2 doses; however, for individuals with compromised immune systems, 2-3 doses are recommended. In some regions of the world, boys are also vaccinated to help further reduce the burden of HPV. The vaccine has proven to be safe and highly effective in preventing HPV infection and the development cervical cancer.
As HPV vaccination is crucial for cervical cancer prevention, it is important to understand the barriers and facilitators to its uptake. Although the HPV vaccine was introduced into routine immunisation programs in Kenya in 2019, in 2020, just 33% of eligible adolescent girls in Kenya had received their first dose of the vaccine, and only 16% of eligible girls had received a full dose. Barriers to HPV vaccine uptake in Kenya include widespread misinformation and misconceptions about the safety of the vaccine, distance to healthcare facilities, associated costs, and socio-cultural beliefs. Conversely, community engagement, public education and school-based campaigns have been identified as facilitators to vaccine uptake in the country. It is worth noting, that despite school-based vaccine campaigns promoting the uptake of the HPV vaccine, such initiatives often exclude the most vulnerable individuals. Girls that are out of school, or living in rural and informal settlements miss out on this crucial vaccination. Without targeted interventions, these groups will continue to face low vaccination rates, further exacerbating the disparities with cervical cancer.
Even with the low rates of HPV vaccine uptake in some East African countries, there are also countries that have made substantial progress with their vaccination programs. Rwanda was the first country in Africa to issue a nationwide HPV vaccine program in 2011. This initiative targeted girls below the age of 15 and aided in over 1 million girls receiving their first dose of the HPV vaccine between 2011 and 2018. This number represented 98% of all girls eligible to receive the vaccine. As a result, Rwanda is now recognised as having one of the highest rates of HPV vaccination in the world. Similarly, in Ethiopia, a four-day nationwide vaccine campaign in March 2024 was able to administer the vaccine to 1.5 million 14-year-old girls. Despite global HPV vaccine shortages, Ethiopia has still made great progress, with over 6.3 million girls having received one dose of the vaccine to date.
The political commitment to accessible and equitable vaccination in Rwanda and Ethiopia underscores how strong governance and strategic planning can overcome barriers to uptake. This highlights the critical role of leadership and governance in minimising disparities in vaccine access, and offers important lessons for neighbouring countries to scale up their HPV vaccination efforts to reduce preventable health inequities.
Screening
Cervical cancer screening is recommended for all women, regardless of HPV vaccination status. This should begin by the age of 30 and must be conducted every 5-10 years. As women living with HIV are more susceptible to HPV infections, this screening should occur every 3 years starting at the age of 25. This kind of routine testing is of particular importance, as precancers rarely produce symptoms, making early detection essential for effective and timely treatment. The WHO has a goal of eliminating cervical cancer, to achieve this, they aim for 70% of eligible women to be screened by 2030; however, even with these efforts cervical cancer screening remains limited in East Africa.
There are three main methods for cervical cancer screening. These include HPV testing, the primary method for screening, Visual Inspection with Acetic Acid (VIA), which is used when HPV testing is unavailable, and a Pap smear, which is primarily used for women under the age of 30. Kenya has implemented a strategic plan to promote cervical cancer screening; however, there are still 9 cervical cancer deaths every day. In 2014 only 19.4% of eligible women were screened and this number was even lower in 2022 at 16.8%. In Rwanda, as the vaccination program only targeted girls in grade six, many women were too old to receive the vaccine. This placed them at a higher risk for developing cervical cancer. In many regions in East Africa, distance to health facilities, knowledge of cervical cancer screenings, level of education, long wait times at health facilities, and low quality of care were all identified as barriers to screening.
Mobilisation and Momentum
Across East Africa there are several interventions underway, to expand HPV vaccination, strengthen screening services, and raise public awareness. In Kenya, the Ministry of Health, along with multilateral originations such as WHO, Gavi and UNICEF as well as local stakeholders continue to work in collaboration to deliver school-based HPV vaccination programmes. Additionally, in Kenya the Beyond Zero initiative has deployed at least one mobile clinic in all the 47 counties. These mobile clinics intend to serve hard-to-reach communities, offering free services and health education. The Beyond Zero initiative has partnered with counties such as Embu and Kilifi, to screen, treat, and raise awareness on cervical cancer.
In Uganda, there has been successful national strategies aimed at improving the uptake of cervical cancer screening for women living with HIV. Following the campaigns initiation, over 280,000 screening visits were recorded. In 2020 the Ugandan Ministry of Health planned to scale-up these screening services, with the support of the Global Fund, PEPFAR and the Clinton Health Access. This resulted in 141,257 women being screened every 6 months. Rwanda continues to be a notable example of sustained success. Its nationally coordinated, school-based vaccination strategy has achieved coverage rates exceeding 90%. This demonstrates the value of political commitment, robust community mobilisation, and integration into existing health systems necessary for HPV and cervical cancer management. Meanwhile, Tanzania exemplifies innovation through a layered approach. The HPV Plus, Gavi-funded initiative in Zanzibar packaged HPV vaccination with reproductive health education, nutrition checks, and vision screening. This reached 20,000 adolescent girls in just four days, boosting vaccination from 14% to 85%.
Despite the notable success of these initiatives, many of them remain pilot-based or reliant on external funding, limiting scalability and sustainability. Greater domestic investment, integration into broader reproductive health programmes, and regional knowledge-sharing will be essential to translate promising interventions into equitable, long-term impact.
Conclusion
Cervical cancer in East Africa is not an inevitable tragedy but a reflection of preventable inequities. HPV vaccination, timely, and effective screening, and health education are crucial to the elimination of cervical cancer, yet these initiatives still seem to fall short, with inconsistencies and inequitable implementation. The region has successful, and diverse experiences, ranging from Rwanda’s nationwide coverage to grassroot initiatives in Tanzania and Kenya. These campaigns demonstrate how political commitment, community engagement and adequate resource distribution have the potential to yield real progress. Eliminating cervical cancer will require comprehensive, multisectoral strategies that will promote capacity building, community mobilisation, and effective integration of prevention campaigns. Cervical cancer in the region may serve as a marker of the existing systemic inequities, but more importantly it is serves as marker of opportunities for transformative progress.
