HPV in Low Income Countries - An Important Cause Area for EA

Why HPV needs more attention

HPV (Human Papillomavirus) is a commonly sexually transmitted virus, and long-term infection of certain strains is responsible for nearly all cases of cervical cancer. Cervical cancer – which is the fourth most common cancer in women globally – causes over 300,000 deaths per year (Ewongwo et al., 2024). Despite being large in scale (and therefore an important cause), as well as easily tractable through proven interventions, I believe that HPV and the cervical cancer it causes remains a somewhat neglected cause area. In this post I make the case for increased attention and funding to eradicate the burden of HPV in low and middle income countries.

The Scale of the Problem – Why is it Important?

Cervical cancer caused 350,000 deaths in 2022 with 95% of these cases being attributable to HPV (WHO, 2025). The number of deaths alone is convincing evidence that the prevention of HPV and subsequent screening and treatment for cervical cancers should undoubtedly be receiving public attention and funding.  

Cervical cancer is the leading cause of cancer death in 37 countries, but this distributed unequally with a disproportionate burden in low and middle income countries (Bray et al., 2024), in 2022, 94% of deaths from cervical cancer occurred in low and middle income countries (WHO, 2025).

If the WHO global elimination strategy aiming to eradicate HPV in all countries by 2100 by scaling up HPV vaccinations as well as increasing cervical screening, then more than 74 million cases would be averted (Brisson et al., 2020). This cause area clearly has a very large scope as well as an obviously unequally distributed burden and therefore should be viewed as a priority for governments and global health experts.  

A Neglected Cause

Despite this evidently significant scale, HPV and cervical cancer prevention and treatment has received comparatively little attention in recent years. After great successes in HPV reductions in high income countries, there has been a plateau in attention and funding of HPV prevention such as the vaccine to ensure eradication globally. Reducing HPV infections and thus cases of cervical cancer is a very significant cause area as even though most high income countries have reduced rates of HPV significantly, there still remains 12.4 deaths from cervical cancer per 100,000 in low income countries compared to 4.8 for high income countries (Bray et al., 2024). Furthermore, there is evidence to suggest that the incidence of cervical cancer may have even been increasing over the last 10-25 years in Eastern and Southern regions of Africa in countries such as Malawi and Kenya (Jedy-Agba et al., 2020).

The remaining burden of HPV and cervical cancer in lower income countries even after marked progress towards eradication in higher income countries suggests that this cause area needs additional funding and research into how best to implement measures to ensure full eradication in remaining high-prevalence regions such as sub-Saharan Africa. Furthermore, the vast majority of those still affected by HPV and cervical cancer are women in lower income countries – populations who often have limited political and financial power, and therefore it is key that the international community sees HPV and cervical cancer as a priority.

Effective Interventions

HPV and cervical cancer should be considered an important cause area for EA as there are extremely tractable solutions. Cervical cancer is highly preventable through HPV vaccinations and early detection through routine screening, and incidence and mortality have been significantly reduced in many countries – proving that successful intervention is certainly possible.

•      1. HPV vaccination

HPV vaccinations are an extremely effective form of prevention for HPV and thus cervical cancer. A 2021 study showed that the HPV vaccine administered to girls aged 12 to 13 has reduced cervical cancer rates by almost 90% in later life (Falcaro et al., 2021). The successful rollout of the HPV vaccination through national schemes such as in the UK proves the potential for tractable prevention of HPV on scale, if sufficient infrastructure and funding is in place.

Not only is the HPV vaccine successful at preventing HPV and therefore cervical cancer cases, but it is also cost effective – yet another reason why HPV and cervical cancer protection should warrant increased attention from the EA community. In a study calculating incremental cost effectiveness ratios (ICERs) for the HPV vaccination in different countries found that the vaccine could be delivered in the highest burden countries (such as those in sub-Saharan Africa) for only around US$800 per DALY averted (Rosettie et al., 2021). This suggests that implementation and expansion of the vaccine on a large scale is likely a cost-effective measure to prevent HPV and avert DALYs – especially in countries that are eligible for subsidized vaccines (such as from Gavi-the Vaccine Alliance) (Rosettie et al., 2021).

Furthermore, there is increasing evidence pointing to the effectiveness of a one dose regimen of the HPV vaccine which would reduce costs associated with vaccine procurement and administration, making it an even more tractable solution (Hamid et al., 2025)

•  2. Screening for Cervical Cancer

Alongside vaccination rollout, routine screening should be implemented to identify pre-existing cases in their early stages. Cervical HPV testing is 90% sensitive for detecting precancers (Perkins, 2023) and routine screening has been shown to greatly increase the odds of successfully treating cancers and precancers. Early detection through screening can be done using self-sampling kits – which should be scaled up as they help to remove stigma barriers of accessing the health services (Hamid et al., 2025). Screening can also be carried out through visual inspection with acetic acid (VIA) which is a cost-effective method with minimal resource requirements.

With the integration of rapid testing into local clinics, it is possible to quickly refer those who test positive for cervical cancer or precancers for treatment such as chemotherapy and radiation therapy (Hamid et al., 2025).

Countries with the highest cervical cancer incidences of >25 cases per 100,000 women (90% of which are in sub-Saharan Africa) are unlikely to reach an elimination of HPV by 2100 using vaccines alone. A combined approach of scaling up the rollout of the HPV vaccine as well as implementing robust, routine screening services has the potential to avert 22 million DALYs over the next 10 years (Ewongwo et al., 2024)

Conclusion

Given the large scale of people affected by HPV and cervical cancer and its apparent neglectedness relative to its burden, I suggest that its prevention should become a more focused cause area with effective altruism. There exist clearly tractable solutions – in the vaccine and screening programmes – which have proven to be successful through implementation in man high income countries. I believe it is certainly possible to apply these same interventions to the remaining high burden countries in order to eliminate HPV in a cost effective intervention for this important cause area.

This post was published after 5 weeks of the Intro EA Readings, as part of of the Effective Altruism Cambridge Project-Based Fellowship. Learn more here: https://www.eacambridge.org/ and reach out to [email protected] if you'd like to learn more about the fellowship.