Summary
For the first time, the World Health Organization (WHO) has set an ambitious goal to eliminate a cancer as a public health problem. Aotearoa New Zealand (NZ) committed to this goal in 2020. Four years on, NZ has made some great strides but is still far from meeting the 2030 targets required to put us on the path to elimination.
Elimination is possible because almost all cases of cervical cancer are caused by the human papillomavirus (HPV). We have the tools now to prevent cervical cancer through HPV vaccination, HPV primary screening and treatment of abnormal cervical cell changes. If all women and people with a cervix can access these three things, cervical cancer will be eliminated in NZ within the lifetime of today’s children.
NGOs, researchers and the public are calling on the Government to take action now to set us on the path to eliminate cervical cancer and help create a future where almost no one in NZ dies from this now preventable cancer.
Eliminating cervical cancer is within reach. We can create a future where almost no one in NZ dies from this now preventable cancer. This Briefing describes current progress towards this goal and what steps the Government needs to urgently take to get us there.
WHO’s Cervical Cancer Elimination Goal
The World Health Organization (WHO) set an ambitious goal to eliminate cervical cancer as a public health problem. Aotearoa New Zealand has committed to this goal, which will save lives. Every year approximately 175 people in NZ are diagnosed with cervical cancer and 55 people die from it.1 Almost all cases of cervical cancer are caused by the human papillomavirus (HPV).2 Recent research showed health system costs for colposcopy and colposcopy directed treatments were $49 million during 2019-2022.3
Elimination of cervical cancer as a public health problem is defined by WHO as fewer than four cases per 100 000 women-years.4 To get there, the WHO set three targets that countries must meet by 2030 to be on the path to eliminate cervical cancer.
The WHO targets are:
- 90% of girls fully HPV vaccinated by age 15 years
- 70% of women are screened by 35 years of age and again by 45 years of age
- 90% of women identified with cervical disease receive treatment (90% of women with precancer treated, and 90% of women with invasive cancer managed).
Cervical screening in NZ
In September 2023, NZ switched to HPV primary screening and introduced the option to self-test. This policy was a game-changer and is already having an impact.5
The HPV primary test is a better, more sensitive test than the smear test.6 Research shows people prefer the HPV self-test because it is easier and faster, and that they would recommend it to others.7
Since the switch, 80.7% of people chose to self-test and 18.9% of tests were individuals who were previously unscreened/underscreened.8
There have been some recent promising gains for Māori and Pacific peoples.8 But more progress is needed to make sure all groups achieve equitable coverage as both these groups remain below 70% coverage (Figure 1).
Figure 1: Cervical screening coverage, by ethnicity
Source: Te Whatu Ora Shiny App, Graph by Flourish
The Minister of Health recently confirmed that free cervical screening will continue for “women with higher risk of cervical cancer”. However, the funding model is still a key barrier to achieving elimination.
Cervical screening is the only cancer screening programme that is not fully funded in NZ. The current funding is not guaranteed, is inadequate, and creates confusion among service providers, so many people miss out. Previous Parliamentary Review Committee reports have raised this barrier and called for a fully funded programme so that all eligible people receive free cervical screening.9
HPV vaccination in NZ
The HPV vaccine is safe and effective at protecting against HPV infection that causes almost all cases of cervical cancer (and five other cancer types).10
NZ has offered HPV vaccination since 2008. In 2017, it became free for everyone aged 9 to 26. It is offered through most schools in Years 7 or 8, when it is most effective.
But NZ’s HPV vaccine coverage rates are woefully low, and nowhere near the WHO 90% target (Figure 2).
Figure 2: Current HPV vaccination coverage (% final dose), by ethnicity
Source: Te Whatu Ora, Chart by Flourish
Reasons for this low coverage vary but include a marked drop in access during Covid-19 lockdowns. There are calls to urgently address this gap by improving access in schools and pharmacies, increased health promotion efforts and a national awareness campaign.
A previous PHCC Briefing11 outlined this issue, and called for the HPV vaccination schedule to shift to a single dose. Minister Shane Reti was asked a written parliamentary question about switching to a single dose in July 2024, and responded saying he has asked for advice about what would be required to make this change.
NZ trails behind Australia
NZ is lagging well behind Australia which is set to become the first country in the world to achieve elimination thanks to very high rates of HPV vaccination and cervical screening.12
In 2023, Australia launched a National Strategy for the Elimination of Cervical Cancer, with a commitment by the Government to fund $48.2 million to support its implementation.
NZ does not have a cervical cancer elimination strategy (or dedicated funding for this), and it is desperately needed to drive progress and catch up with the benchmark set by Australia.
But some experts have criticised Australia’s programme, and highlighted the gap between indigenous Australians and others.13
NZ needs a strategy that is grounded in equity and Te Tiriti to ensure that elimination is achieved equitably for everyone.
Public support for elimination
There is growing public support for Government action to eliminate cervical cancer. The Cancer Society, Hei Āhuru Mōwai, Royal Australian and New Zealand College of Obstetricians and Gynaecologists and Te Tātai Hauora o Hine (National Centre for Women’s Health Research Aotearoa) have jointly released an Open Letter to the Health Minister, and this week launched a new phase of the campaign inviting New Zealanders to ‘help write the book on defeating cervical cancer’ (See Appendix).
What this Briefing adds
- NZ has signed up to the WHO goal to eliminate cervical cancer as a public health problem, which requires achieving 3 key targets by 2030.
- HPV is responsible for almost all cases of cervical cancer. Cervical cancer can be prevented through HPV vaccination, cervical screening and treatment of abnormal cervical cell changes. If all women and people with a cervix can access these three things, cervical cancer will be eliminated within the lifetime of today’s children.
- The public, researchers and NGOs are calling on the Government to take action to eliminate cervical cancer in NZ at www.endcervicalcancer.org.nz
Implications for policy and practice
The Government must act now so NZ can meet the WHO 2030 targets for HPV vaccination, HPV cervical screening, and treatment to get us on track towards elimination. This action includes:
- A fully funded, equitable Aotearoa Cervical Cancer Elimination Strategy
- Extending free cervical screening to all who are eligible
- Urgently increasing access to HPV vaccination among school children to reach uptake of 90%
Authors details
Emma Shields NZRD, Evidence and Insights Lead, Cancer Society of New Zealand
Ellen Fisher, Cancer Care Policy Lead, Cancer Society of New Zealand
Hannah Booth, Director of Government Relations and Advocacy, Cancer Society of New Zealand
Dr Kate Gregory, Medical Director, Cancer Society of New Zealand
All authors are employed by the Cancer Society of New Zealand who are currently campaigning for the elimination of cervical cancer.
Appendix
This month as passionate campaigners across the globe step up to mark World Cervical Cancer Elimination Day of Action, the Cancer Society and its partners are launching a book, inviting everyday New Zealanders to join the story and help write the book on defeating cervical cancer.
The allegorical-like picture book The Book that Ended Cancer: A story that can only be made true by you, represents phase two of Cancer Society’s campaign in partnership with Hei Āhuru Mōwai: Māori Cancer Leadership Aotearoa, the Royal Australian and New Zealand College of Obstetricians and Gynaecologists and Te Tātai Hauora o Hine — National Centre for Women’s Health Research Aotearoa.
The campaign started with an open letter in August calling on Government action with three specific asks to: extend free cervical screening to all who are eligible; fully fund an equitable Cervical Cancer Elimination Strategy; and urgently increase access to the human papillomavirus (HPV) vaccination. To date this has been signed by 900-plus individuals and 22 organisations.
The names of those collected to date, plus the chorus of others collected through the new interactive site with the animated story over the coming weeks, will appear in the finished book that will be presented to the Government.
More can be found out at endcervicalcancer.org.nz.
