The Cost of Elimination

Last week I wrote about “The Halo Effect,” the profound financial, cultural and societal contributions and impact each woman makes, underscoring why her loss to a preventable Cervical Cancer diagnosis is so devastating.

Now, let’s talk about the economic case and cost for Elimination.

Cervical Cancer Elimination requires funding for education and access to healthcare resources across three critical touch points on the care continuum:

• Vaccination in childhood against HPV, the virus that causes cervical cancer
• Screening for HPV infections and Cervical pre-cancers
• Treatment for Cervical Cancer diagnoses

So, how much funding is required? For each country and globally? In my work and research, I haven’t yet come across this number and it’s a critical missing piece to this equation.?

Here’s why: World Health Organization estimates that for every $1 invested in Cervical Cancer Elimination, an additional $3.20 is directly returned to the economy due to each woman’s workforce contributions; when accounting for her multifaceted Halo Effect that ROI jumps to a whopping $26.

The gains for each woman, family and society are clear.?

So, let’s compute the cost by country and globally required to fund Elimination. And then, let's take that case to the leaders and decision-makers who can make it happen.

The Background

In 2018, WHO Director General Dr. Tedros Adhanom Ghebreyesus “announced a global call for action to eliminate cervical cancer, underscoring renewed political will to make elimination a reality and calling for all stakeholders to unite behind this common goal. In August 2020 the World Health Assembly adopted the Global Strategy for cervical cancer elimination.”?

To do so, WHO established an action plan and framework outlining what’s known as the 90/70/90 Targets -- care coverage goals at each care continuum stage. Achieving these coverage rates for vaccination, screening and treatment will set the country on track to eliminate Cervical Cancer by 2030.

The Context:?

• Despite Elimination tools -- vaccines, screening & treatment -- being available for a number of years, many countries, particularly LMICs, don’t have established Cervical Cancer vaccination, screening and treatment programs because of costs, prioritization & access challenges
• It’s not enough to fund one pillar and not all; for example, funding a national screening program without funding for treatment when disease is inevitably discovered is unacceptable
• Recent tailwinds will reduce Elimination costs and can accelerate support for efforts, for example, the number of HPV vaccine manufacturers has doubled and children can now receive a single vaccine dose for life-long protection compared to the originally indicated 3-dose series

What the US can learn from abroad:

In many respects, Elimination cost challenges in the US mirror the global picture. Despite the US being a wealthy country with coverage across the care continuum, screenings have been on the decline for years, advanced diagnoses are on the rise again and inequity exists in access to treatment.?

A concerted Elimination effort in the US will require a back-to-basics approach where a baseline measurement of each state’s care coverage across vaccination, screening and treatment can be established.

From there, we can calculate the amount of incremental funding, human resources and healthcare tools required for all eligible women and families to access care.

What I’m curious to see the data on:

• US national & state-level coverage and costs data for current Cervical Cancer vaccination, screening and treatment

Key questions to ask:

• How much have other global public health eradication efforts cost? E.g. Polio eradication
• How was the funding secured and the resources deployed?
• How was investment impact tracked and measured?
• What is the financial downside and economic loss of not funding Elimination efforts?

On a personal note …

In my time at Google and YouTube, we studied the elements of effective storytelling that moved people to take action. The most successful messages told a powerful human impact story, with the data to back up the message.?

When I moved into healthcare, I experienced the same phenomenon: in our early Brachytherapy innovation efforts, we originally led with numbers showing the lift to lives saved and families intact. We received feedback that the problem was clear and the story was compelling, but how much would it cost and how much money could be made? I quickly learned to tell the human impact story backed up with a business plan.?

The same will be true for making the economic case for every country to fund Elimination efforts -- each country needs to have a clear price tag for the investment required so they can understand the dollar-for-dollar gains their society and economy will reap by protecting their most valuable asset: healthy women and families.

Source: World Health Organization