The Human papillomavirus (HPV35), globally associated with only 2% of invasive cervical cancers (ICC), has a disproportionately higher prevalence in sub‐Saharan Africa, reaching rates of 22-30% in some countries among women with ICC lesions, according to a new study. Recently, a high-level panel called for redoubled efforts in HPV vaccination, screening and treatment to meet the WHO Global Strategy targets for 2030 – and eliminate cervical cancer by 2050 worldwide. 

Midway along the route toward the WHO 2030 targets for cervical cancer elimination, some 340,000 women a year, mostly in low-income countries, are still dying from cervical cancer – due to the dearth of simple solutions like screening, treatment off pre-cancerous cells, and low HPV vaccination coverage for adolescent girls.

Meanwhile, HPV 35—a genotype of the HPV virus that is steadily spreading throughout Africa—is not targeted by existing vaccine formulations. This highlights the urgent need to speed up research and development to create an updated vaccine.

At the same time, success stories from a handful of developing countries such as Rwanda demonstrate that the 2030 targets for 90% HPV vaccine coverage, 70% screening and 90% treatment can be attained – when political will exists. Meeting those targets would put countries on track to meeting the global elimination goal of less than 4 cervical cancer cases annually per 100 000 women as early as 2050.

Those were key messages emerging from a recent high-level seminar on a Cervical Cancer-Free Future, convened by the Center for Global Health Development and Inclusion (CeHDI) together with the UN in Geneva  ambassadors of Barbados, Germany, Guyana and Malawi.

“Although cervical cancer is both preventable and curable when detected early, it remains the fourth most common cancer and cause of cancer death among women worldwide,” said Guyana’s ambassador, Leslie Ramsammy. “In Guyana, for example, it is the number two cause of cancer deaths among women. For some countries, it’s the number one cause of cancer death among women each year.”

About 600,000 women annually are diagnosed with cervical cancer, representing 6.5% of new cancer cases and 7.7% of cancer deaths. And 94% of cervical cancer deaths occur in developing countries. As such, “cervical cancer has become a mirror of global health inequity,” he added.

The goal: global elimination of cervical cancer by 2050 

Most developed countries are on a trajectory to meet the WHO 2030 goals and moving on from there, to eliminate cervical cancer as a public health risk by 2050.

However, developing countries are on a much longer trajectory. And at current rates of progress, most will only reach elimination in 2120, said Ramsammy.

“Today’s High-Level dialog is a call to change the trajectory for elimination from 2120 to earlier… closer to 2050 when many European countries and North America would have achieved elimination.”

Said Ramsammy, “The question is no longer whether cervical cancer can be eliminated, but when and whether the world will mobilize the political will and resources needed to ensure that no woman dies from a preventable disease. Just as international collaboration led to the eradication of smallpox, the global community can work together to end cervical cancer.”

Incidence rates in African countries 10–20 times higher than 2030 goal

Most developed countries already have a cervical cancer incidence of between 10-4 cases annually per 100 000 women – with 4/100 000 being the elimination threshold.

But many countries in Africa have cervical cancer incidence of 60-70 or even eighty cases annually per 100 000 women, said Nathalie Broutet, of the University of Sydney, Australia, citing Malawi and Eswatini as examples. As a former WHO staff member, Broutet helped draft the WHO cervical cancer elimination strategy, which was approved by the World Health Assembly in 2020.

To get on course for elimination “we need to reach the 2030 targets, which are 90% HPV vaccination coverage; 70% of women screened with a high performance, twice in a lifetime; and 90% of women detected with a cervical disease treated,” she said.

In terms of vaccination, for instance, apart from the region of the Americas, which has almost reached 80% coverage, all other WHO regions remain far behind the 90% goal for 2030. “So, the work that we have to do to reach 90% is enormous,” said Broutet.

Better adapted vaccines – the missing HPV 35 genotype 

However, along with more uptake of HPV vaccination, HPV vaccines need to be better adapted to the needs of girls and women in low- and middle–income populations. And recent research undertaken by CeHDI together with the International Agency for Research on Cancer (IARC) is pointing to a big gap in Africa.

That is the lack of vaccine coverage for the HPV 35 genotype, which now a common subtype of the virus in Africa, in comparison to the rest of the world.

“This is a genotype which is very common in African countries, which is responsible for around even more than 4% of cervical cancer cases in Africa,” said Broutet. “Yet this genotype is not included in the current HPV vaccine.”

One brand-new study points to an even higher incidence, said Haileyesus Getahun, CEO of CeHDI, citing a new review of the “Burden of HPV 35 in African Cervical Pathologies” in the journal Medical Virology.

That peer-reviewed study published this month, cites HPV35 prevalence of 19-30% in Mozambique, 22-26% in Kenya, 17% in South Africa and 11% in Zimbabwe and Tanzania among women with ICC lesions. In women with pre-cancerous lesions, rates of 20-26% were found in Botswana and Tanzania.

In sharp contrast, studies from China, Canada, Sweden and Europe pointed to a prevalence of less than 1%. Globally, the prevalence among women with ICC lesions was only 2%.

“Specifically, HPV35 has been more frequently associated with precancerous cervical lesions and accounts for a significant proportion of ICC [invasive cervical carcinoma] (4%–10%) in these populations, with a higher fraction than that observed in other regions,” concludes the authors from the University of Cape Town, South Africa; as well as medical research faculties in Tanzania, Botswana and Zimbabwe.

Overcoming the key problems in service delivery 

There are cited three key problems in service delivery, vaccination gaps, lack of access to low-cost HPV testing and related laboratory services; and lack of access to cancer treatments, such as radiation therapy, which are out of reach in most rural clinics and in the public health systems of many urban centres.

To overcome the challenges, global experts recommend the following:

School-based vaccination – This is the first time a vaccine must be delivered to an adolescent population, leading to challenges with both disinformation as well as the need to put new systems in place.

“We know in countries that use school- based delivery has been quite a success,” said Broutet. “Gender-neutral vaccination can improve the coverage and lift barriers that we see regarding the HPV vaccination of girls-only; and strong community engagement – communication needs to be in place.

Shift from Pap smears to HPV testing  – In high income countries with high rates of cervical cancer screening, the most used test remains the Pap smear – a cytology-based test. In low income countries BIA or bioimpedance screening, which uses electrical signals to detect abnormal cells, has been widely used as well due to its low–cost and rapid results.

But WHO as well as many national health systems are now recommending a shift to HPV testing, widely regarded as more accurate and ultimately more cost-efficient. That involves  testing specifically for the human papillomavirus genotypes that are the most common cause of cancer.

“Even in countries that we think reach 70% coverage, there is a lot of work to be done to switch out the existing technology, which is basically cytology, and in low-income countries, BIA. Instead, all countries need to switch toward HPV testing,” says Broutet. “And we need also to ensure that innovation is available, and one of them is self-sampling, so self-collection and also urine samples. We need to ensure that all countries have access to this technology.”

Self-screening and community-based treatment  – Treatment immediately following screening is the third basic tool needed to reach elimination targets. Such treatment can remove pre-cancerous cells before they develop further.

“Mobile screening clinics can be an option to increase coverage, task shifting to community health workers,” said Broutet. “This expands coverage. And finally, digital registry [of screening results]. We need to follow up and track women who have been screened to ensure those with a positive test have been treated.”

Improving vaccine composition   

Improving vaccine composition is also a critical mission, said Getahun. Together with IARC, CeHDI is supporting an even more thorough African and global review of the evidence on the HPV 35 genotype and its burden.

“Our collaboration with IARC will help generate the evidence needed to inform the development of next-generation HPV vaccines that better reflect regional disease patterns, including the burden of HPV 35 in sub-Saharan Africa,” he observed.

“Going forward we hope this will stimulate dialogue with the manufacturers, countries, WHO and global procurement partners such as Gavi and Unitaid to ensure that this genotype is included in the next generation of vaccines, particularly those deployed in Africa.”

Currently, none of the main HPV vaccine manufacturers, which include the UK- and USA-based GSK and MSD(Merck), as well as the Serum Institute of India and two Chinese firms include HPV 35 in their vaccine formulations.

However, a 14-valent vaccine by another leading Chinese pharma innovator, Sinocelltech, has a 14-valent vaccine SCT1000 in Phase 3 trials with some 18,000 women, which includes the HPV 35 genotype.

“Especially in regions with high HIV prevalence, such as sub-Saharan Africa, the application of polyvalent HPV vaccines (including HPV 35) is essential, as people living with HIV are more prone to multiple HPV infections requiring broader protection,” state an October 2025 review by Chiara Paternostro and Elmar Joura, of the Medical University of Vienna.

Gavi board: approved inclusion of improved vaccines once available 

Asked by Health Policy Watch about the need and potential to update existing vaccines to include the HPV 35 genotype, Gavi, the Vaccine Alliance, said its board had in 2025 approved the inclusion of improved vaccines covering more virus genotypes in its portfolio as soon as they become available:

“Current HPV vaccines are designed to protect against the large majority (70%) of cervical cancers. The importance of this evolving research is that we now have a better understanding of the disease burden of HPV-35 in countries across Africa, which Gavi supports – as well as how that burden is expected to increase over time as other types decrease due to improved vaccine coverage,” a Gavi spokesperson said.

“While there are currently no licensed vaccines that provide protection against HPV‑35, the Gavi Board in December 2025 approved, based on WHO and SAGE guidance, an expansion of Gavi’s portfolio so that higher-valent vaccines can be made available to countries as and when they come available. We encourage our manufacturing partners to work with us in helping bring this about.”

WHO pointed to a recent systematic review by WHO/IARC  (Wei et al. 2024) confirming that  HPV35  is part of  the remaining known 10 HPV causal genotypes, it causes only about 5% of cases worldwide, “but with some notable regional variations, including a higher proportion (~4%) for HPV 35 in Africa than in other regions.”

“Currently, HPV35 is not among the types covered in the two existing, licensed (highest valency)  HPV9 vaccines that contain the same  7 oncogenic types (16,18, 31, 33, 45, 52, and 58),” a spokesperson said. “We are aware additional work is being done on HPV35 that may provide more information on this strain and its contribution to cervical cancer burden– in particular, in the African region. In future that may inform vaccine developers in their choice for additional HPV type to be included in ‘even higher valency’.”

Rwanda: on track to beat 2050 global elimination target    

But vaccination is not in itself an answer. It must be part of a multi-pronged approach.

“Over the next 50 years, scaling up screening and treatment could avert up to 14.6 million deaths, three times more than vaccination alone,” noted Cabo Verde’s UN Ambassador in Geneva Clara Delgado and a member of the Unitaid Executive Board.

Since 2019, Unitaid has introduced HPV testing, self-sampling methods and portable thermal ablation treatment devices (for removal of precancerous lesions) across approximately 50  low- and middle income countries, driving down costs significantly.”

Bulk procurement has reduced HPV test prices by 40% and the costs of thermal ablation by 45% “making these lifesaving tools affordable where they are needed most.”

But just as important are country models that work, she stressed, citing Rwanda, South Africa, Malawi and the Philippines as “champion” examples.

“For example, in Rwanda with Unitaid’s partnership since 2019, a national screen and treat program now operates in over half of the country. Women in rural communities are being reached through HPV self-collection kits, a simple, dignified approach that brings services closer to home, breaking barriers of distance, stigma and cost.

As a result of the partnership, Rwanda is on track to beat the 2030 elimination targets by three years, “proving that elimination is not just possible, but achievable.”

Repeating the success of smallpox eradication  

“Just as international collaboration led to the eradication of smallpox, the global community can work together to end cervical cancer by 2050,” said Ramsammy, “Today we have an opportunity to elevate cervical cancer elimination on the multilateral agenda as a matter of equity, gender justice and the right to health.”

Said Getahun, “At a time when global solidarity and multilateralism are under strain, health diplomacy is more important than ever in strengthening North–South and South–South cooperation and advancing the global effort to eliminate cervical cancer.”

Adds Broutet, “We have a generation to end cervical cancer, and we have the tools,” citing  national elimination targets; sustainable financing; regional cooperation to decrease the price of the tools and investing in treatment infrastructure as key political levers.

“The science exists, the roadmap exists, but the inequity persists. Political will determines the outcome.”

Most important is the need to address gender inequities.

“Each country of the world needs to understand, what are these drivers of inequity in their own country?” she said, citing the late WHO director Mahmoud Fathalla, who once said: “women are not dying because of diseases we cannot treat. They are dying because societies have yet to make the decision that their lives are worth saving.”

Image Credits: UNICEF, WHO , N. Broutet/WHO, ecancer.org, Murahwa et al, Reviews in Medical Virology, 33 March 2026, Broutet, Gavi, HPV World .