Vaccinating girls, abandoning women: the financing asymmetry between HPV immunization and the cervical cancer treatment cascade in low- and middle-income countries

Cervical cancer is the first cancer for which the World Health Organization has adopted a global elimination strategy with explicit incidence and coverage targets, and that strategy rests on three pillars: vaccinate 90% of girls, screen 70% of women, and treat 90% of those found to have disease. Only the first is backed by a global pooled-procurement and co-financing mechanism. Screening, triage, treatment of precancer, and the management of invasive disease are financed nationally where they are financed at all, through general budgets, benefit packages, and time-limited donor projects, and where those fall short, they are paid for at the point of use. This Perspective argues that this gap is structural rather than incidental and that it produces a particular kind of unfairness. Vaccination protects a cohort that will not meet the disease for decades. The women dying of cervical cancer now were born too early to be vaccinated, and every remaining step of care carries a price. Recent changes moving vaccine financing into national budgets sharpen this problem rather than resolving it. Four remedies are proposed, each concerning what governments agree to buy and how they pay for it rather than how much external money arrives.