Good afternoon Your Majesty Gyalyum and dignitaries, and my sincere gratitude for inviting me to deliver this keynote address.
Your commitment to eliminate cervical cancer as a public health problem is truly inspiring, not just because of the lives it will save, or the suffering it will avert, but because of what it represents:
First, the conviction that every woman and girl, everywhere must have equitable access to high-quality, essential, comprehensive and person-centred health services;
And second, the belief that with targeted focus, every country – whatever its size, income or development status – can apply cost-effective and available technologies and tools to tackle existing health threats, and dramatically improve health and well-being, especially for groups at risk of or who are already being left behind.
Let Bhutan’s example be an example not just for the South-East Asia Region, but for the world.
And let us recall: It was Bhutan who brought this agenda to the WHO Executive Board in 2019, resulting in a new Global Strategy for cervical cancer elimination, launched in 2020, along with an annual Global Day of Action.
You have my highest commendations.
Today, cervical cancer is the fourth most common cancer among women globally, with an estimated 604 000 new cases and 342 000 deaths in 2020.
Of these, the Region accounted for 32% and 34%, respectively, despite comprising just over a quarter of the world’s population.
Globally, almost 90% of all cervical cancer deaths occur in low- and middle-income countries, which is a tragedy that we must not and do not accept.
This is why for almost a decade, the WHO South-East Asia Region has intensified action across three strategic pillars:
First, prevention through HPV vaccination of all adolescent girls before 15 years of age;
Second, detection through routine screening, in particular HPV DNA testing;
And third, prompt treatment of pre-cancerous lesions and invasive cancers, including through surgery, radiotherapy and chemotherapy.
Today, six Member States – Bhutan, Indonesia, Maldives, Myanmar, Sri Lanka and Thailand – have introduced nation-wide HPV vaccination, which Bangladesh, India and Timor-Leste will soon also introduce.
Almost all countries of the Region carry out population-based cervical cancer screening, and several have also included cervical cancer screening in essential service or universal health coverage packages.
In 2017, the Region became the first WHO region to publish a training package for health workers on cervical cancer screening and management of cervical pre-cancers, and amid the COVID-19 response, continued to carry out Regional health worker trainings in colposcopy and cervical cancer prevention.
Ten of the Region’s 11 Member States provide tertiary care services for cancer diagnosis and treatment – including surgical and chemotherapy services – and nine also offer radiotherapy services.
However, gaps and challenges persist, which if unaddressed, will prevent the Region from achieving the global 90-70-90 targets:
That is, by 2030, ensuring that 90% of girls are fully vaccinated with HPV vaccine; that 70% of women are screened using a high-performance test by 35 years of age, and again by 45 years of age; that 90% of women identified with cervical disease or precancer are treated; and that 90% of women with invasive cancer are effectively managed.
For this, WHO is calling for action in four strategic areas.
First, mobilizing the highest level of political commitment to eliminate cervical cancer as a public health problem, recognizing that with today’s tools, attaining this outcome is not just feasible but cost effective.
Based on workforce participation alone, for every one US$ invested an estimated US$ 3.20 will be returned, which rises to US$ 26 when the benefits of improved women’s health on families, communities and societies are considered.
On this, I extend my utmost gratitude to Bhutan for its tremendous leadership, reflected at this high-level event, which has obtained the highest levels of support, from the Queen Mother herself.
Second, introducing and/or expanding HPV vaccination coverage to at least 90%, which as you know, Bhutan achieved almost a decade ago, in 2014.
Importantly, new evidence shows that a single dose of HPV vaccine delivers protection comparable to the 2-dose schedule, which alongside additional cost reductions, must be taken full advantage of.
Third, promoting a rapid and comprehensive shift to HPV DNA testing, a first-choice method for cervical cancer screening that is cost-efficient, and suitable for all settings, areas and countries – as Bhutan itself has shown.
This must be accompanied by timely access to management of pre-cancerous lesions as well as to quality, appropriate and timely diagnosis and multidisciplinary care for invasive and advanced cancers, including palliative care.
And fourth, integrating efforts to eliminate cervical cancer with other key services and programmes, such as for HIV/AIDS, sexual and reproductive health, family planning and cancer control, especially at the primary health care level.
On this, Bhutan is well advanced, and I wish it all success in expanding its Service with Care and Compassion Initiative, an award-winning adaptation of the WHO PEN-HEARTS package.
Across these and other priorities, WHO will continue to provide Member States – including Bhutan – its utmost support, while promoting partner engagement that avoids duplication and fragmentation, and which mobilizes adequate, predictable and sustainable resources.
I urge all participants to make the most of this meeting – to learn and to share, to strategize and to plan, and to strengthen the power of your collective voice.
Because on this critical issue, Bhutan’s success will be the world’s success – an example of how every country can protect, promote and support the health and well-being of every woman and girl, everywhere.
I wish you productive deliberations and look forward to our onward journey, together.
Thank you.