Status Report:

Cervical Cancer Elimination

in the APEC Region

Measuring Progress Towards the APEC

Roadmap to Promote Sustainable Economic
Advancement for Women Through Cervical
Cancer Prevention and Control 2021-2025
 2

Introduction and Table of Contents

Cervical cancer is the fourth most common cancer
among women worldwide, with an estimated 600,000 Introduction
new cervical cancer cases and more than 340,000 Introduction to the Dashboard 2
estimated deaths in 2020 alone. However, cervical
cancer presents an opportunity for prevention, Methodology 3
screening, early detection, and treatment. By Regional Progress Towards the APEC Roadmap
implementing interventions across the prevention and
Meeting WHO Targets for Cervical Cancer Elimination as a Public 4
control continuum, APEC economies can reduce the Health Problem
disease burden and enable women to lead healthy and
productive lives. Nevertheless, despite the compelling The Status of Cervical Cancer Elimination Planning in APEC 5
case for investing in strategies for cervical cancer Programming and Funding Across the Cervical Cancer Prevention 6
prevention and control, there remains insufficient and Care Continuum
investment, particularly in preventive measures. Introducing and Expanding HPV Vaccination 7

In 2016, the APEC Health Working Group (HWG) and Advancing Cervical Cancer Screening 8
Life Sciences Innovation Forum (LSIF) introduced a
Progressing from Diagnosis to Monitoring and Treatment 9
multi-year roadmap to scale efforts to build technical
capacity and support policies that improve primary and Tracking Uptake of the Prevention and Care Continuum 10
secondary prevention, treatment, and palliative care,
with the ultimate goal of cervical cancer elimination. In Introducing Communications Strategies to Reduce Disease Burden 11
August 2021, APEC member economies endorsed an
updated APEC Roadmap to Promote Sustainable Conclusion
Economic Advancement for Women through Key Findings 12
Cervical Cancer Prevention and Control
(‘Roadmap’) through 2025. The updated roadmap Summary and Limitations 13
aligns with the WHO’s Global Strategy to Accelerate Appendix 14
the Elimination of Cervical Cancer as a Public Health
Sources 24
Problem, which launched in November 2020 with
targets set for 2030.
 3

Methodology
Status Report Overview Methodology

The Status Report on Cervical Cancer Elimination in the APEC Region is The report was created using a mixed methodology to understand
an initiative to understand current status of the goals included within the current status of the Action Plan’s key indicators in the APEC
the APEC Roadmap, including implementation of comprehensive HPV region. The primary data source was a survey disseminated to all 21
vaccination, cervical screening, treatment, and elimination programs APEC member economies via email. 17 economies responded (81%)
within APEC economies. (“Reporting Economies”) between September 2022 and February
2023. The survey was then supplemented through a review of
The report aims to measure the progress of programs across the existing literature and data repositories, including WHO cervical
prevention and control continuum throughout the region. The report cancer [economy] profiles and WHO/UNICEF Immunization
presents data on a regional basis, although economy-specific Dashboard. Supplemental data was used both for reporting
information has been collected and can be used to develop specific economies and non-reporting economies.
capacity-building activities.
Survey results were collected from the following APEC member
The report is organized by different HPV and cervical cancer economies: Australia; Brunei Darussalam; Canada; Hong Kong, China;
interventions, policies, and health system enablers. Each measure in Indonesia; Japan; Republic of Korea; Malaysia; Mexico; Peru; the
the report is based on the goals and outputs/outcomes of the Philippines; the Russian Federation; Singapore; Chinese Taipei;
Roadmap. Spotlights from APEC economies share existing practices Thailand; the United States of America; Viet Nam.
that can inform implementation and expansion of interventions and
programs, and support progress towards meeting the Roadmap goals Supplemental research was exclusively used for the following
more broadly. economies: Chile; People's Republic of China; New Zealand; Papua
New Guinea.
This project supports HWG 05 2022S, Promoting Sustainable Economic
Advancement for Women by Addressing Policy Barriers to Prevention, Unless indicated, all measures are calculated using 21 as the
Control, and Elimination of HPV and Cervical Cancer. denominator, counting missing data as ‘no data.’ Additional
methodology can be found in footnotes and the Appendix.

Acknowledgements
This report was prepared by the project overseers’ partners. Principal authors include Ms. Alexa Trost and Ms. Anne Blatchford of C&M International.
Special thanks to the project overseers, Dr. Suleeporn Sangrajrang of the Thailand National Cancer Institute and Dr. Edward Trimble of the United States
National Cancer Institute, as well as to the APEC Secretariat for their support. The views expressed in this paper are those of the authors and do not
necessarily represent those of APEC Member Economies.
 4

Meeting WHO Targets for Cervical Cancer Elimination

In August 2020, the WHO adopted the Global Strategy for cervical cancer elimination by 2030, which is centered around three pillars
and their corresponding targets. Achieving the WHO 90-70-90 targets by 2030 is estimated to avert more than 74 million new cases of
cervical cancer and over 62 million deaths by 2120:

70% of women screened with

90% of women identified with
90% of girls fully vaccinated a high-performance test by 35
years of age and again by 45 cervical disease receive
with HPV vaccine by age 15
years of age treatment

Progress towards meeting 2030 targets1

by % of APEC economies

% of complete dose HPV vaccine coverage, % of women screened for cervical % of women identified with cervical cancer
domestically eligible population or females2 cancer, by age3 who received treatment4
2021 or earlier years 2021 or earlier years
5% 10%
38% 14%
43% 29%

19% 52% 24% 5% Under 35 Under 45 20-49 57% 10% 33%

52% 52% 57%

Last 5 Years, Last 5 Years, 2019
or earlier or earlier

No Data <70% 70%-90% >90% No Data <70% >70% No Data 70%-90% >90%

1. Percentages are calculated using 21 as the denominator, counting missing economies as ‘no data.’
2. Survey responses on vaccination of domestically eligible populations are supplemented by WHO data on vaccination of females.
3. Survey responses on screening (using any screening method) are supplemented by WHO data. Data for the ‘Under 35’ and ‘Under 45’ categories exclusively reflect survey responses. Data for the
’20-49’ category reflect WHO data, in addition to two survey responses.
4. Survey data has not been supplemented.
View data and limitations by economy on page 16.
 5

The Status of Cervical Cancer Elimination Planning in APEC

A comprehensive cervical cancer elimination strategy requires multi-year commitments to the cervical cancer prevention and control
continuum. Strategic planning for cervical cancer elimination should include considerations for health system capacity and
infrastructure, including comprehensive information systems.
# of APEC economies with current or outdated/undated multi-year plans that include cervical cancer elimination1

All include HPV

2 include HPV
vaccination,
vaccination, 3 include
screening, and
screening
3 treatment

4
Cervical Cancer Elimination Plan
4
~67% of APEC economies have in
place a current multi-year plan Pan-Cancer Plan that includes Cervical Cancer
that includes cervical cancer
countermeasures: vaccination,
screening, and/or treatment. NCD or Broader Health Plan that includes Cervical
~24% have an outdated, undated, Cancer
or in-progress plan.
Plan in-progress or not available

10
8 include HPV
vaccination, all
include screening

1. View all plans on page 15.

 6

Programming and Funding Across the Cervical Cancer Prevention and Care Continuum
Several economies do not report public funding for all cervical cancer interventions, even those reported to be included in domestic
elimination programs. Additionally, in the absence of a funded domestic cervical cancer elimination program, some economies
report funding via domestic budgets or universal health coverage.

Approximate % of APEC economies which report funding

for cervical cancer interventions in domestic elimination % of APEC economies that report:
programs, budgets, or universal health coverage:1
of APEC economies report cervical cancer elimination
Cervical Cancer ~67% 1 programs, which introduce and/or provide funding for
19% 33% 48%
Elimination cervical cancer interventions to varying degrees.

of APEC economies report including HPV vaccines in

HPV Vaccination2 19% 10% 71% 86% schedules or programs;3 of these economies, only 7 report
funding for the entire domestically eligible population.4

of APEC economies report programs or capabilities for

HPV/cervical cancer screening,4 however, access to public
Screening 19% 10% 71% 95% funding may be dependent on factors such as diagnostic
outcome and income level.

of APEC economies report including treatment in domestic

cervical cancer elimination programs; ~76% provide public
Treatment 19% 5% 76% ~67%
funding, indicating that some economies provide treatment
funding outside of elimination programs. 4
No Data No public funding Public funding available

1. Survey data on public funding has not been supplemented. Percentages are calculated using 21 as the denominator, counting missing economies as ‘no data.’
2. Economies measured as having public funding available for HPV vaccination include those which only provide public funding for some populations included in domestic immunization programs.
3. Inclusion of HPV vaccines in domestic programs could include cervical cancer elimination programs, vaccine-specific programs, or partial programs that only cover certain jurisdictions or
populations.
4. Data on inclusion of vaccination and screening in cervical cancer elimination programs are supplemented by WHO data. Survey data on treatment has not been supplemented. Percentages are
calculated using 21 as the denominator, counting missing economies as ‘no data.’
View data and limitations by economy on pages 17 and 18.
 7

Introducing and Expanding HPV Vaccination

Since the approval of the first commercial HPV vaccine in 2006, 71% of economies report including HPV vaccines in economy-wide
immunization schedules or programs; in an additional 14% of economies, HPV vaccines are reported to be available in certain
jurisdictions and/or only for private purchase. Vaccine-eligible populations vary across economies and include girls, boys, and adults,
with the primary target cohort typically being young adolescent girls, aged 9-14.

As of 2021, only one APEC economy reached

Approximate % of APEC economies which report including HPV vaccination for certain
the WHO target of 90% 2-dose vaccination
populations in economy-wide immunization schedules or programs, 2021-2023:1
coverage:

Girls 14% 14% 71%

Meeting WHO 2030 Vaccination Targets:
Progress as of 2021
Boys 76% 24% 10% of APEC economies reached
>90% first dose coverage for
domestically eligible cohorts or girls
Catch-up (15+)2 5% 57% 38% in 2021. 33% achieved rates
between 70% and 90%.3

2
Adults (18+) 5% 71% 5% 19%
5% of APEC economies reached >90%
complete dose coverage for
domestically eligible cohorts or girls.
No Data
Not Included
24% have achieved rates above 70%,
but below the 90% WHO target.3
Available in Certain Jurisdictions or with Private Funds
Included Economy-wide

1. Survey data has been supplemented with data from WHO for all populations. Data are only considered complete for inclusion of girls and boys. Percentages for all populations are calculated
using 21 as the denominator, counting missing economies as ‘no data.’
2. Some economies have removed catch-up or adult programs due to successful adolescent vaccination.
3. Survey data has been supplemented with data collected by WHO on immunization coverage. Data are missing for both first dose coverage and complete dose coverage. Percentages are
calculated using 21 as the denominator, counting missing economies as ‘no data.’
View data and limitations by economy on pages 16 and 19.
 8

Advancing Cervical Cancer Screening

If chronic HPV infection cannot be prevented and pre-cancerous lesions 95% of APEC economies report domestic
develop and are not diagnosed and treated in time, they have the potential capabilities to conduct screening and diagnostic
to become an invasive cancer, decreasing the likelihood of survival if not testing, however, only 24% report screening
recognized in early stages. Several types of screening are currently available >70% of at least one measured population:
in APEC economies, most commonly cervical cytology (also known as PAP Under 35, Under 45, and/or Ages 20-49.2
tests) (~86%), followed by HPV DNA testing (~52%), and visual inspection
with acetic acid (~19%). As economies begin shifting screening programs to
include HPV DNA testing – the WHO preferred method as of 2021 – at least % of Economies reporting different types
19% have introduced collection through self-sampling, which is increasingly of screening available, 2021-2023:3
viewed as a promising intervention due to its simplicity of delivery and the
potential to reduce stigma.1
~86% Cervical Cytology
(PAP Test)

In Malaysia, HPV DNA testing, commenced in phases by the MOH in 2019 using a
‘screen-triage-treat’ approach, is offered to women aged 30 to 65 years in primary
care facilities in 13/15 states. Women who are HPV positive undergo cytology triage
at primary care facilities prior to further intervention. The MOH is the primary
provider for cervical cancer screening using cytology and HPV DNA tests; the MOH
~57% HPV DNA Testing
provides ~65% of screening coverage while the remaining 35% is afforded by other
agencies, private practitioners, and NGOs,* with whom the MOH collaborates to
monitor cervical cancer screening data. This is vital as Malaysia is committed towards
achieving the targets for cervical cancer elimination.

Additionally, the ROSE Foundation - a collaboration between University of Malaya

~19% Visual Inspection with
and the Australian Centre for the Prevention of Cervical Cancer - offers HPV self-
sampling to women in several primary care settings.
Acetic Acid (VIA)

*e.g., National Population and Family Development Board, National Cancer Society of Malaysia, Ministry of Higher Education Hospitals
1. Survey data has not been supplemented. Percentages are calculated using 21 as the denominator, counting missing economies or data as ‘no data.’
2. Data on screening capabilities are supplemented with data from WHO and calculated using 21 as the denominator. Data are available for all economies. For screening coverage, measured
populations include ‘Under 35,’ ‘Under 45,’ and ’20-49.’ Survey responses on screening coverage (using any screening method) are supplemented by WHO data.
3. Data on availability of screening interventions are supplemented with data from WHO; supplemental data only measures primary screening tests and may not be fully representative of the full
range of interventions available in each economy. Percentages are calculated using 21 as the denominator, counting potentially missing data (e.g., availability of screening methods other than
the primary method) as ‘no data.’
View data and limitations by economy on pages 16 and 20.
 9

Progressing from Diagnosis to Monitoring and Treatment

Clearly defined clinical guidelines and referral systems from secondary to tertiary care following diagnosis of HPV or cervical disease
underpin effective interventions across the continuum.1

Multi-sector partnerships can provide economies with additional

~62% report clinical guidelines for individuals who have resources, capacity, and expertise to introduce tailored programs
been diagnosed with, or are at risk of, HPV and improve access to services. The Philippines Department of
Health, for example, is collaborating with Jhpiego to find
innovative improvements for the detection and prevention of
Cervical Cancer through capacity building activities such as the
~76% report definitive strategies for referrals to introduction of innovative technologies, and creation of a
secondary and tertiary care, including referral woman-centered and more holistic approach to integrated
systems services within the primary health care framework.

~33% report established programs linking individuals who have been diagnosed with, or are at risk of, HPV
or cervical disease with prevention, treatment, and care resources

~67% report standardized procedures for treatment follow-up

~62% report domestic cervical cancer treatment facilities

1. With the exception of strategies for referral systems using WHO data, survey data has not been supplemented. Percentages are calculated using 21 as the denominator,
counting missing economies as ‘no data.’
View data and limitations by economy on page 21.
 10

Tracking Uptake of the Prevention and Care Continuum

The APEC Roadmap calls for economies to build and/or integrate accessible and digital
data systems and registries for vaccination, screening, cancer/treatment, and deaths in Australia is working to link domestic health
registries through the National Cancer
order to better track program impact and monitor changes in disease burden.
Screening Register (NCSR) to ensure a more
Establishing and maintaining proficient and comprehensive information systems can comprehensive representation of the
support development of evidence-based policies and programs guided by the most population within their health data system.
recent surveillance data, research, and other evidence. Establishing and linking registries This ensures that underreported groups -
can support clinical and policy decision-making by providing a comprehensive overview such as Indigenous communities – are
of access to cervical cancer interventions at the individual and population level. accounted for.

% of APEC economies reporting registries to track vaccination, screening, cancer/treatment, and deaths:

Comprehensive, interoperable vaccination Cancer registries can facilitate the systematic

registries that enable providers to report collection of data on cancer incidence, diagnosis,
~62% administration and access all immunization 86% and treatment, in order to ensure patients
records can support economies in accurately receive appropriate and timely care. Data is also
capturing and encouraging HPV vaccination. used by policymakers to make informed decisions
Vaccination1 Cancer2 on funding and program implementation.

Screening registries and health data systems Establishing death registries to collect mortality
should be able to fully capture screening rates data can be used to improve quality and safety of
~62% and support program implementation – however, ~71% care, but data in registries is often incomplete or
only ~38% of economies have health data inaccessible to general practitioners.
systems to track individuals through the health
Screening1 system after an abnormal screening test, and Death1
evaluate quality and timeliness of the screening
program.3

1. Data for vaccination, screening, death, and digital health data systems was limited to survey results. Percentages are calculated using 21 as the denominator, counting missing economies as ‘no
data.’
2. Survey data on existence of cancer registries are supplemented by WHO data, and is available for all 21 APEC economies.
3. Data on existence of health data systems were not supplemented and are missing from 4 economies. Percentages are calculated using 21 as the denominator, counting missing economies as
‘no data.’
View data and limitations by economy on page 22.
 11

Introducing Communication and Delivery Strategies to Reduce Disease Burden

Effective communications strategies and delivery systems should be evidence-based and targeted to eligible populations in order to
bolster awareness and uptake of vaccines, screening, and treatment, as well as improve health equity. Educational programs are most
effective when they target all stakeholders involved in prevention and care – including adolescents, parents, adults, and providers.

of APEC economies report clinical HPV and

In Hong Kong, China, there is ongoing publicity by the government to raise public
cervical cancer educational programs awareness and empower women in cervical cancer prevention and screening, including
~57% targeted towards providers, which can dissemination of messages to correct common misconceptions which may keep some
support providers to optimize patient women from regular cervical screening - such as having no family history of cervical
care.1 cancer, no symptoms, and having been vaccinated against HPV. Messages are
disseminated via multiple channels, including social media and other traditional means,
such as TV and radio, websites, printed materials, published articles, media interviews,
of economies report vaccine confidence or and telephone education hotlines. Relevant resources can be accessed at the thematic
~71% communications programs, either targeted website of Cervical Screening Programme. Individual counselling is provided for women
towards adolescents/their parents.1 attending Maternal and Child Health Centers and DOH Women Health Centers.

of economies report screening The Public Health Agency of Canada (PHAC) Immunization Partnership Fund (IPF) funds
~62% communications programs that are over 100 diverse community-based initiatives to encourage vaccine confidence and
targeted towards eligible adults.1 uptake. An example of a project specific to HPV vaccine, in Quebec, Canada developed
and evaluated parent-focused strategies, such as motivational interviewing, education,
of economies report requiring decision-making tools, and consent form reminders to increase HPV vaccination
comprehensive sexual health educations in coverage rates in select elementary schools.
~62% schools to provide adolescents with the
knowledge and tools they need to
promote their own health.1 In 2012, Brunei Darussalam introduced a domestic school-based HPV vaccination
program offering free or subsidized HPV vaccines to all female students ages 10-17
of economies report school-based years old in both government and private schools. Parental or guardian consent is
~71% vaccination programs.2 obtained in writing before the HPV vaccine is provided. In 2021, 94.4% of the eligible
Bruneian students was fully vaccinated.

1. Survey data has not been supplemented. Percentages are calculated using 21 as the denominator, counting missing economies or data as ‘no data.’
2. Survey data has been supplemented with data collected by WHO on school-based vaccination. Percentages are calculated using 21 as the denominator, counting missing economies as ‘no
data.’
View data and limitations by economy on page 23.
 12

Key Findings
The results of Status Report: Cervical Cancer Elimination in the APEC
Region indicate that while most economies have implemented some Of the WHO pillars, economies appear to be most
strategies for cervical cancer elimination, whether through a successful in reaching targets for cervical cancer
comprehensive cervical elimination program, ongoing development of treatment. This reflects a traditional focus of health
a plan, or intervention strategies included in a broader cancer plan, systems, but in order to reduce the disease incidence,
there remain gaps in implementation. increasing investment and uptake of vaccination and
screening is an urgent imperative to prevent cervical
Of the 44 measures included in this report, reporting economies (n=17) cancer from occurring.
met an average of 26 measures.1

Although APEC economies have made progress towards the WHO 90-70-90 targets, none have reached all 3 targets for
vaccination, screening, and treatment. 2
48%2 of APEC economies meet one or more of the WHO 90-70-90 targets:
5%2 of APEC economies administered 2 doses of HPV vaccine to 90% of girls, although 71% have introduced HPV vaccines into
their economy-wide schedules. To bolster vaccination rates, economies can develop targeted disease awareness strategies,
introduce and increase routine vaccination of eligible populations, and build comprehensive vaccination registries to track
progress.

24%2 of APEC economies screened 70% of one or more age groups included in this analysis,3 despite 95% of economies measured as
having domestic screening programs or capabilities to conduct screening and diagnostic testing. Introducing high-performance
tests, providing public coverage for services, establishing referral strategies, and ensuring linkages to prevention, treatment,
and care resources can support economies in preventing progression to cervical cancer by detecting abnormalities early.

~33%2 of APEC economies treated 90% of women identified with cervical cancer. Ensuring access to a global standard of care for
treatment, symptom management, and palliative care can provide the best overall outcome for patients. Adopting preventive
interventions can make treatment less intensive and costly.

1. This calculation is based on economies for whom a definitive ‘Yes’ was measured in responses to the survey and/or external research. Economies measured as ‘ND’ may have additional
measures in place that are not captured in this report.
2. Survey responses on vaccination of domestically eligible populations are supplemented by WHO data on vaccination of females. Survey responses on screening (using any screening method)
are supplemented by WHO data. Survey data for treatment has not been supplemented, and is based on survey data indicating that 7 reporting economies have treated 90% of women
identified with cervical cancer. Percentages for all measures are calculated using 21 as the denominator, counting missing economies as ‘no data.’
3. Data for the ‘Under 35’ and ‘Under 45’ categories exclusively reflect survey responses. Data for the ’20-49’ category reflect WHO data, in addition to two survey responses.
 13

Summary
In order to achieve the goals of the APEC Roadmap to Promote Mission
Sustainable Economic Advancement for Women through
Cervical Cancer Prevention by 2025, as well as to support the To foster exchange of best practices, build technical capacity, and
support policy decision-making to address barriers to primary and
vision and mission (right), economies should plan to invest in secondary prevention of cervical cancer and invasive cervical cancer
holistic strategies across the prevention and care continuum. treatment and palliative care.
Continuing to strengthen data systems, introduce
countermeasures, and develop communication and delivery
strategies will support the health and well-being of women Vision 2025
during the years of peak productivity and contribution to Women and girls in APEC member economies live healthy and
society, as well as the years in which many women attain productive lives, with a substantially reduced burden of HPV-related
leadership positions and raise families. cervical cancer morbidity and mortality.

This status report aims to support economies in their domestic Goals

and collective efforts to introduce comprehensive cervical The Roadmap aims to support efforts by APEC member economies to
cancer elimination plans, implement the APEC Cervical Cancer eliminate cervical cancer as a public health problem and to:
Roadmap, and collaborate to enhance elimination programs by 1. Accelerate and scale primary prevention of cervical cancer through HPV
sharing best practices. vaccination of eligible populations*
2. Accelerate and scale secondary prevention of cervical cancer through
effective screening and treatment of precancerous lesions
APEC economies can also support progress towards cervical 3. Expand the application of health-systems tools, including communications
cancer elimination through use of other APEC resources, such as technologies and electronic health records management systems, to
improve the quality of treatment and palliative care for people with HPV
the APEC Healthcare Financing Roadmap and the Health and cervical cancer
Working Group’s Best Practices and Recommendations for APEC 4. Improve infrastructure to support acceleration and scaling of primary
Collaboration on Cancer Control. prevention, secondary prevention, treatment, and palliative care
*Vaccine-eligible populations may include girls, boys, and adults at-risk for HPV infection
Limitations

The research conducted in this study has some limitations. The primary limitation was receiving responses to the survey from only 17 of 21 APEC economies;
given limited aggregated external data options for many measures and economies, results do not reflect the full status of the measured cervical cancer
elimination strategies within the APEC region and individual economies. Data caveats have been added throughout the report to indicate where supplemental
data is unavailable. Second, the report measured the extent to which measures have been introduced. Within each measure, the authors expect differences in
scope (e.g., eligible populations, funding levels, jurisdictional vs. economy-wide) and status of implementation (e.g., pilot projects vs. ongoing legislation, newly
introduced measures vs. comprehensive long-term programs) across APEC economies.
 14

APPENDIX | Acronyms

APEC: Asia-Pacific Economic Cooperation

DIP: Domestic Immunization Program
DNA: Deoxyribonucleic acid
HPV: Human papillomavirus
HWG: Health Working Group
IPF: Immunization Partnership Fund
Jhpiego: Johns Hopkins Program for International Education in Gynecology and Obstetrics
KPI: Key performance indicator
LSIF: Life Sciences Innovation Forum
MOH: Ministry of Health
NCSR: National Cancer Screening Registry
PHAC: The Public Health Agency of Canada
ROSE: Removing Obstacles to Cervical Screening
UNICEF: United Nations Children’s Fund
VIA: Visual inspection with acetic acid
WHO: World Health Organization
 15

APPENDIX | Data by APEC Economy

Multi-year plans that include references to HPV and/or cervical cancer

Cervical Cancer Elimination Plans or Regulations Non-Communicable Disease (NCD) or Broader Health Plans that
include Cervical Cancer
Canada: Action Plan 2020-2030
Brunei Darussalam: NCD Action Plan 2021-2025
Indonesia: Regulations 2015, amended 2017 (NCD/Health
Strategic Actions) People's Republic of Health Initiative 2019-2030
China:
Malaysia: Action Plan 2021-2030 (Pan-Cancer Plan 2021-
2025) The United States: Health Plan 2020-2030; 64 plans from states,
jurisdictions, tribes/tribal organizations, and
Peru: Plan 2017-2021 (Pan-Cancer Plan 2020-2024) the Cancer Council of the Pacific Islands
Viet Nam NCD Strategy
Pan-Cancer Plans that include Cervical Cancer

Plan in-progress or not available

Chile: Plan 2018-2028
Australia: Cervical Cancer Strategy development in
Hong Kong, China: Strategy 2019-2025
progress; expected April 2023 (Draft; Draft
Japan: Plan Appendices); 10-year pan-cancer plan
development in progress, expected April 2023
Republic of Korea: Plan 2016-2020
The Philippines: Cancer Control plan in drafting process
Mexico: Program (2016)
Singapore: N/A
New Zealand: Action Plan 2019-2029

Papua New Guinea: Action Priorities 2017-2021

Russian Federation: Plan 2019-2024

Chinese Taipei: Plan

Thailand: Program
 16

APPENDIX | Data by APEC Economy

Meeting WHO Targets for Cervical Cancer Elimination

People's Republic

United States of
Chinese Taipei*
New Zealand
Darussalam*

Philippines*

Federation*
Hong Kong,

Papua New
Republic of

Singapore*
Indonesia*

Viet Nam*
Malaysia*
Australia*

Thailand*
Measure

America*
Canada*

Mexico*
of China

Russian
Korea*

Guinea
Japan*
China*
Brunei

Peru*

Total
Chile
Coverage rates reported
for 2021 or earlier years

% first dose HPV vaccination

87% 98% ND ND 88%3 80% 3.3% 88% 16%6 10% ND ~4%7 ND >90%9 85% 0% 77% ND
(domestic cohort)1 2
HPV Vaccination program
87% 67% ND 68% ND ND
coverage, first dose, females2
% complete dose HPV
vaccination (domestic 81% 95% ND ND 86%3 61% 1.9% 66% 14%6 10% ND <1%7 ND 88%9 76% 0% 62% ND
cohort)1 1
HPV Vaccination program
87% 57% ND 58% ND 53% ND
coverage, last dose, females2
15%-
% of women <35 62% 25% ND 29%3 49%5 44% 42-48% 30% 20% ND 31%9 64% 70% ND 15% 1
screened in last five
15%-
years, or earlier1 <45 67% 28% ND 38%3 56%5 52% 29-30% 50% 30% <1%7 ND 43%9 84% 70% ND 30% 2

Proportion of women 20-49

50-70 50-70 >70 ND 10-50 ND <104 10-50 10-50 10-50 ND >70 ND 10-50 ND 50-70 50-70 ND 50-70 >7010 10-50 3
report screening, 20191, 8
% of women with cervical
94% 100% ND 91%3 ND ND ND >90% ND ND 100% 76% 89.8%9 90% 95% ND ND 7
cancer treated1
*Submitted survey responses
1. Source: Survey of APEC Economies. All decimals have been rounded to the nearest whole number.
2. Source: WHO/UNICEF Joint Reporting Form on Immunization. Human Papillomavirus (HPV) vaccination coverage. All decimals have been rounded to the nearest whole number.
3. In Hong Kong, China, in school year 2020-2021 first dose HPV vaccination was measured in primary five female students and complete dose HPV vaccination was measured in primary six female
students. For screening, based on the Health Behaviour Survey 2018/19, a local survey covering the land-based non-institutional female population: 29.0% of women aged 25-34 and 37.5% of
women aged 25-44 were screened in 2018/19. For treatment, 91.4% of patients with cervical cancer had received surgery, radiotherapy or chemotherapy (or a combination).
4. According to the Indonesia survey response, 9.35% of woman aged 30-50 years old were screened in the last three years, 2020-2022
5. In Japan, according to the interview-based survey conducted every three years, the latest participation rates across 5-year age groups in 2019 are as follows: 15.1％ of 20－25 year-olds, 36.6％ of
25－30 year-olds, 49.4％ of 30－35 year-olds, 53.0％ of 35－40 year-olds, 56.1％ of 40－45 year-olds.
6. In Malaysia, there was no HPV vaccine supply in 2021 due to global shortages, hence the low coverage. The average HPV vaccination coverage before 2021 has been consistently more than 95%.
7. In the Philippines, out of 1,036,009 target population, 43,960 received the first dose of HPV vaccine in 2021. Out of 1,036,009 target population, 3,519 completed the HPV vaccine in 2021.
Currently Philippine data aggregates women screened for cervical cancer age 20 y/o and above. 2021-74,900 women screened out of 33,455,399 eligible population; 2020- 40, 420 women
screened out of 32,789,368 eligible population; 2019-224,620 women screened out of 31,508,155 eligible population
8. Source: WHO. Maternal, Newborn, Child and Adolescent Health and Ageing Data portal.
9. According to the Singapore survey response, >90% of the 15-year-old cohort had received 1 and 2 doses of HPV vaccine under the school-based vaccination programme in 2021; >87% of 15-year-
olds in the resident population, which is similar but not identical to the school-based programme, had received 2 doses. 30.5% of women aged 18-35 years and 42.7% of women aged 18-45 years
reported screening. The National Population Health Survey captures self-reported data for women screened at appropriate intervals for cervical cancer (last 5 years for HPV testing, and last 3 years
for pap smear). Treatment coverage reflects women who were diagnosed in 2020 and received treatment thereafter; data on treatment is limited to up to 6 months post-diagnosis.
10. According to the United States survey response, 80% of women between the ages of 21-65 years have been screened within the last 3 years.
 17

APPENDIX | Data by APEC Economy

Programming and Funding Across the Cervical Cancer Prevention and Care Continuum (1/2)

People's Republic

United States of
Chinese Taipei*
New Zealand
Darussalam*

Philippines*

Federation*
Hong Kong,

Papua New
Republic of

Singapore*
Indonesia*

Viet Nam*
Malaysia*
Australia*

Thailand*

America*

Total Yes
Canada*

Mexico*
of China

Russian
Korea*

Guinea
Japan*
China*
Brunei

Peru*
Chile
Measure

% of APEC economies with interventions available through cervical cancer elimination or intervention-specific programs

Domestic cervical cancer

Yes Yes Yes ND ND No Yes No Yes Yes Yes ND ND Yes Yes Yes Yes Yes Yes Yes No 14
elimination program1

HPV Vaccination1 Yes Yes Yes Yes3 Yes4 No Yes Yes Yes Yes Yes5 No Yes Yes Yes Yes No

18
HPV included in
vaccination programme Yes No Yes2a Yes No R2a, 6
or schedule2

Screening1 Yes Yes Yes Yes3 Yes No No Yes Yes Yes Yes Yes Yes Yes Yes Yes No
20
Screening programme
Yes Yes Yes2a Yes2a Yes No Yes2a
for cervical cancer exists2

Treatment1 Yes Yes Yes Yes3 Yes No No Yes Yes Yes Yes Yes Yes Yes Yes Yes No 14
*Submitted survey responses
R: Restricted to private purchase
1. Source: Survey of APEC Economies. Economies measured as ‘Yes’ assume HPV vaccines are available for girls, at minimum. More detailed data can be found in page 19.
2. Source: WHO/UNICEF data on Vaccination schedule for Human papilloma virus and WHO Cervical Cancer [Economy] Profiles were used for economies which did not submit survey
responses.
a. This data was also used for Japan, Republic of Korea, and Viet Nam, which, for example, may not report interventions in broader cervical cancer elimination programs as is
asked in the survey, but instead have standalone programs (e.g., screening programs or HPV in immunization programs) as is measured in the WHO Profiles.
3. Although there is no cervical cancer elimination program in Hong Kong - China, HPV vaccination, screening, and treatment are in place
4. In Indonesia, the introduction of HPV immunization has been carried out in stages: in 2021 20 districts had implemented HPV immunization, in 2022 132 districts had implemented
HPV immunization, and in 2023 HPV immunization will be expanded domestically.
5. According to WHO/UNICEF data on Vaccination schedule for Human papilloma virus in the Philippines, the HPV vaccine is administered to girls in certain regions.
6. In Viet Nam, the Ministry of Health has licensed the use of HPV vaccines for ages 9-26, but the vaccine is only available for private purchase at this time. Viet Nam plans to include HPV
vaccines in the Expanded Program on Immunization (EPI) by 2026.
 18

APPENDIX | Data by APEC Economy

Programming and Funding Across the Cervical Cancer Prevention and Care Continuum (2/2)

People's Republic

United States of
Chinese Taipei*
New Zealand
Darussalam*

Philippines*

Federation*
Hong Kong,

Papua New
Republic of

Singapore*
Indonesia*

Viet Nam*
Malaysia*
Australia*

Thailand*

America*

Total Yes
Canada*

Mexico*
of China

Russian
Korea*

Guinea
Japan*
China*
Brunei

Peru*
Chile
Measure

% of APEC economies with publicly funded coverage available through domestic cervical cancer elimination program, domestic budget, or universal health coverage, by
intervention1

Cervical cancer
Yes Yes Yes ND ND No Yes No No Yes No ND ND Yes No No Yes Yes Yes Yes No 10
elimination

HPV vaccination for all

populations included in
Yes Yes ND ND ND No No Yes No Yes No ND ND Yes No No No No Yes Yes No 7
the domestic
immunization program

HPV vaccination for

some populations
Yes Yes Yes ND ND Yes Yes Yes Yes Yes Yes ND ND Yes Yes No Yes Yes Yes Yes No 15
included in the domestic
immunization program

Cervical cancer screening Yes Yes Yes ND ND Yes Yes Yes Yes Yes Yes ND ND Yes Yes Yes Yes Yes Yes Yes No 16

Treatment of invasive
Yes Yes Yes ND ND Yes Yes Yes No Yes Yes ND ND Yes Yes Yes Yes Yes Yes Yes Yes 16
cervical cancer

*Submitted survey responses

1. Data was limited to survey results. Percentages in the report are calculated using 21 as the denominator, counting missing economies or data as ‘no
data.’
 19

APPENDIX | Data by APEC Economy

Introducing and Expanding HPV Vaccination

People's Republic

United States of
Chinese Taipei*
New Zealand
Darussalam*

Philippines*

Federation*
Hong Kong,

Papua New
Republic of

Singapore*
Indonesia*

Viet Nam*
Malaysia*
Australia*

Thailand*

America*

Total Yes
Canada*

Mexico*
of China

Russian
Korea*

Guinea
Japan*
China*
Brunei

Peru*
Chile
Measure

Approximate % of APEC economies which include HPV vaccination for certain populations in immunization schedules or programs
Yes
Girls1 Yes Yes Yes3 Yes No Yes Yes4 Yes Yes Yes Yes Yes No Yes Yes5 No6 Yes7 Yes Yes Yes 18
(R)8
Boys2 Yes No Yes Yes No No No No No No No Yes No No No No No No No Yes No 5

Catch-up (15+)2 Yes Yes Yes ND No No No Yes No No No Yes No Yes No No Yes No Yes No No 8
Yes
Adults (18+)2 Yes No Yes ND No No No No No No No Yes No No No No Yes No No No 5
(R)8
*Submitted survey responses
R: Restricted to private purchase
1. Source: WHO Cervical Cancer [Economy] Profiles: WHO [Economy] Profiles were used to measure whether Domestic Immunization Programs (DIP) include HPV vaccines for
girls in Chile, China, New Zealand, and Papua New Guinea. This data measures if HPV is included in the DIP.
2. Source: WHO/UNICEF data on Vaccination Schedule for Human papilloma virus was used to measure whether DIPs include HPV for males in Chile, China, New Zealand, and
Papua New Guinea. The report was also used to measure inclusion of populations 15+ and 18+ in New Zealand.
3. In Canada, HPV vaccination is under the jurisdiction of Provincial and Territorial governments, so programs vary across regions. HPV vaccination programs in Canada include
all genders and all jurisdictions now have HPV immunization catch-up programs.
4. In Indonesia, HPV vaccines are administered to elementary school girls ages 11-12. The introduction of HPV immunization has been carried out in stages: in 2021 20 districts
had implemented HPV immunization, in 2022 132 districts had implemented HPV immunization, and in 2023 HPV immunization will be expanded domestically.
5. According to WHO/UNICEF data on Vaccination schedule for Human papilloma virus in the Philippines, the HPV vaccine is administered to girls in certain regions.
6. In the Russian Federation, HPV vaccines are not included in the immunization program, however, 17 regions conduct HPV vaccination of girls ages 12-14.
7. In Singapore, HPV vaccination is recommended for all females ages 9 to 26 years, under the National Childhood Immunisation Schedule (NCIS) and National Adult
Immunisation Schedule (NAIS).
8. In Viet Nam, the Ministry of Health has licensed the use of HPV vaccines for ages 9-26, but the vaccine is only available for private purchase at this time. Viet Nam plans to
include HPV vaccines in the Expanded Program on Immunization (EPI) by 2026.
 20

APPENDIX | Data by APEC Economy

Advancing Cervical Cancer Screening

People's Republic

United States of
Chinese Taipei*
New Zealand
Darussalam*

Philippines*

Federation*
Hong Kong,

Papua New
Republic of

Singapore*
Indonesia*

Viet Nam*
Malaysia*
Australia*

Thailand*

America*

Total Yes
Canada*

Mexico*
of China

Russian
Korea*

Guinea
Japan*
China*
Brunei

Peru*
Chile
Measure

Does your economy have:

Domestic capabilities to
conduct screening and Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes 20
diagnostic testing1

What type of screenings for cervical cancer are available in your economy?

HPV DNA test2 Yes No Yes Yes3 Yes No4 No No Yes Yes Yes No No Yes Yes Yes Yes Yes 12

Pap test2 No Yes Yes Yes Yes Yes No Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes 18

Visual Inspection with

No No No No Yes No No No No Yes Yes No No No No Yes 4
Acetic Acid (VIA) 2

Self-sampling2 Yes No No Yes No No No Yes No Yes No No No No No No 4

*Submitted survey responses
1. Source: WHO Cervical Cancer [Economy] Profiles were used to measure whether [domestic] screening programs exist in Chile, China, New Zealand, and Papua New Guinea.
2. WHO Cervical Cancer [Economy] Profiles were used to measure primary screening tests used in Chile, China, and New Zealand. The profiles do not measure all types of
screening available in these economies.
3. Source: HPV Information Center. Human Papillomavirus and Related Diseases Report, Chile
4. Indonesia has plans to conduct a pilot project to introduce HPV DNA testing in restricted populations.
 21

APPENDIX | Data by APEC Economy

Progressing from Diagnosis to Monitoring and Treatment

People's Republic

United States of
Chinese Taipei*
New Zealand
Darussalam*

Philippines*

Federation*
Hong Kong,

Papua New
Republic of

Singapore*
Indonesia*

Viet Nam*
Malaysia*
Australia*

Thailand*

America*

Total Yes
Canada*

Mexico*
of China

Russian
Korea*

Guinea
Japan*
China*
Brunei

Peru*
Chile
Measure

Clinical guidelines for

individuals who have
Yes No Yes ND ND Yes Yes No Yes Yes Yes ND ND No No Yes Yes Yes Yes Yes Yes 12
been diagnosed with, or
are at risk of, HPV

Definitive strategies for

referrals to secondary Yes Yes Yes Yes Yes Yes Yes No No Yes Yes Yes Yes No No Yes No Yes Yes Yes Yes 16
and tertiary care1

Established programs
linking individuals who
have been diagnosed
with, or are at risk of, Yes No Yes ND ND No Yes No No No No ND ND No Yes Yes No Yes No Yes No 6
HPV with prevention,
treatment, and care
resources

Standardized procedures
Yes Yes Yes ND ND Yes Yes No ND Yes Yes ND ND No Yes Yes Yes Yes Yes Yes Yes 13
for treatment follow-up

Domestic cervical cancer

Yes Yes Yes ND ND No Yes Yes ND Yes Yes ND ND No Yes Yes Yes Yes No Yes Yes 12
treatment facilities

*Submitted survey responses

1. Source: WHO Cervical Cancer [Economy] Profiles were used to measure whether clearly defined referral systems exist from primary care to secondary and tertiary care in
Chile, China, New Zealand, and Papua New Guinea. Although the profiles indicated that such systems exist in Japan, Republic of Korea, Peru, the Philippines, and Singapore,
survey responses were given preference.
 22

APPENDIX | Data by APEC Economy

Tracking Uptake of the Prevention and Control Continuum

People's Republic

United States of
Chinese Taipei*
New Zealand
Darussalam*

Philippines*

Federation*
Papua New
Hong Kong,

Republic of

Singapore*
Indonesia*

Viet Nam*
Malaysia*
Australia*

Thailand*

America*

Total Yes
of China
Canada*

Mexico*

Russian
Guinea
Korea*
Japan*
China*
Brunei

Peru*
Chile
Measure

Vaccination registries1 Yes Yes No ND ND No Yes Yes Yes Yes No ND ND Yes Yes Yes Yes Yes Yes No Yes 13

Screening registries1 Yes Yes Yes ND ND Yes Yes No No Yes Yes ND ND Yes Yes Yes Yes Yes Yes No No 13

Cancer registries2 Yes Yes Yes Yes Yes Yes Yes Yes No Yes No Yes No Yes Yes Yes Yes Yes Yes Yes Yes 18

Death registries1 Yes Yes Yes ND ND Yes No No Yes Yes Yes ND ND Yes Yes Yes Yes Yes Yes Yes Yes 15

Digital health data

Yes Yes Yes ND ND Yes Yes No Yes Yes No ND ND Yes No Yes Yes Yes Yes Yes No 13
systems

Health data systems to

track individual women
through health system
after abnormal screening Yes Yes No ND ND Yes No No No No No ND ND No No Yes Yes Yes Yes Yes No 8
tests and evaluate
quality and timeliness of
the screening program

Does your economy have:3

Screening registries to
identify women eligible Yes Yes No ND ND No Yes No Yes No No ND ND No Yes Yes Yes Yes Yes No No 8
for screening
Screening registries that
can track women’s Yes Yes No ND ND Yes Yes No Yes No No ND ND No No Yes Yes Yes Yes No No 8
history of screening
*Submitted survey responses
1. Data for vaccination, screening, death, and digital health data systems was limited to survey results. Percentages in the report are calculated using 21 as the denominator,
counting missing economies or data as ‘no data.’
2. Source: WHO Cervical Cancer [Economy] Profiles were used to measure whether population-based cancer registries exist in Chile, China, New Zealand, and Papua New Guinea.
3. This data was measured using the survey and is not explicitly included in the KPI report, but is included in the appendix for reference.
 23

APPENDIX | Data by APEC Economy

Introducing Communication and Delivery Strategies to Reduce Disease Burden

People's Republic

United States of
Chinese Taipei*
New Zealand
Darussalam*

Philippines*

Federation*
Hong Kong,

Papua New
Republic of

Singapore*
Indonesia*

Viet Nam*
Malaysia*
Australia*

Thailand*

America*

Total Yes
Canada*

Mexico*
of China

Russian
Korea*

Guinea
Japan*
China*
Brunei

Peru*
Chile
Measure

Clinical HPV and cervical

cancer educational
Yes No Yes ND ND Yes Yes No ND Yes No ND ND No Yes Yes Yes Yes Yes Yes Yes 12
programs targeted
towards providers1

Vaccine confidence
communications
programs targeted Yes Yes Yes ND ND Yes Yes Yes Yes Yes Yes ND ND No Yes Yes Yes Yes Yes Yes No 15
towards adolescents
and/or their parents1
Screening
communications
Yes No Yes ND ND Yes Yes No No Yes Yes ND ND No Yes Yes Yes Yes Yes Yes Yes 13
programs targeted
towards eligible adults1

Comprehensive sexual
health education Yes No Yes4 ND ND Yes Yes Yes ND Yes No ND ND Yes Yes ND Yes Yes Yes Yes2 Yes 13
required in schools1

School-based vaccination
programs, that include
HPV vaccination, for Yes Yes Yes Yes No Yes Yes No Yes Yes Yes Yes No Yes Yes No Yes Yes Yes No No 15
domestically eligible
populations 1,3
*Submitted survey responses
1. Source: Survey of APEC Economies
2. Only some jurisdictions require comprehensive sexual health education in the United States.
3. Survey responses were prioritized for most economies. WHO/UNICEF data on Routine Vaccines Delivered at School was used to measure whether HPV vaccines are administered in
schools in Chile, China, New Zealand, and Papua New Guinea. School-based programs were not defined in the survey and may include pilot programs and educational programs.
4. In Canada, most Provinces and Territories require sexual health education be included in elementary school curriculums, though ages at which topics are introduced vary amongst
jurisdictions.
 24

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