Countries across the Middle East and North Africa (MENA) region are facing a set of unique challenges, including the growing burden of Non-Communicable Diseases (NCDs), compounded by disparities in access to affordable and equitable health services (Middle East and North Africa Health Strategy 2013–2018). NCDs and injuries account for more than 75% of total disability-adjusted life years (DALYs).
Cervical cancer is one such NCD and is a top driver of death and disability across the MENA region. Between 2012 and 2018, the number of deaths every year due to cervical cancer doubled in most countries in the MENA region, as defined by UNAIDS. Today, cervical cancer causes at least 7,601 deaths annually in the region (Cancer today 2019). If decisive steps are not taken at the national and regional levels, annual deaths due to this preventable disease will double again by 2040, reaching 15,728 deaths per year across the MENA region (Cancer tomorrow 2019).
Nearly all cases of cervical cancer are caused by Human papillomavirus (HPV), the most common viral infection of the reproductive tract. In particular, HPV types 16 and 18 cause approximately 70% of invasive cervical cancers (Cancer today 2019). HPV also causes infections and cancers in other areas. Across countries in the MENA region, HPV prevalence rates vary. Some studies show that more than 21.1% of women in the general population of some MENA region countries have HPV type 16 or 18 at a given time (Cancer today 2019; Bruni et al. 2018).
HPV infection can be prevented by widespread uptake of the HPV vaccine and progression to cervical cancer can be averted with regular HPV and cervical cancer screenings. Countries must implement a comprehensive approach to these deadly diseases, incorporating preventive measures, as well as community education and awareness efforts, early and high-quality treatment for cervical abnormalities, cervical cancer and other cancers related to HPV infection, and palliative care. Sadly, these effective interventions are not in broad use on a national and regional level in the MENA region.
Annually, at least 11,202 women in the MENA region are newly diagnosed with cervical cancer (Cancer today 2019). Across countries in the MENA region, incidence and mortality rates vary [Fig. 23.1]. Somalia and Morocco have some of the highest incidence and mortality rates, with 24.0 and 17.2 women per 100,000 being newly diagnosed with cervical cancer annually and at least 21.9 and 12.6 women per 100,000 dying due to cervical cancer per year, respectively. Whereas Iran, Iraq and Yemen have the lowest (around 2 per 100,000 women are diagnosed per year and about 1 per 100,000 die because of cervical cancer annually) (Cancer today 2019).
Cervical cancer incidence and mortality rates are, on average, lower in the MENA region compared to the rest of the globe. Therefore, scaling up the right preventive and care interventions at the national and regional levels could potentially steer the region toward HPV and cervical cancer elimination. But without early and effective action against HPV and cervical cancer, these rates could increase quickly and elimination may become much more difficult.
Despite this disease burden and the current opportunity for elimination, only two countries in the MENA region have integrated the HPV vaccine into their national vaccination programs—the United Arab Emirates (UAE) and Libya. Other countries, including Morocco, have announced their plans to roll out the vaccine in the near future (Internet 2019). Discussions around HPV and cervical cancer prevention in the region have been ongoing, with a number of countries raising the importance of these preventable diseases on their national health agendas and carrying out local and national cervical cancer screening campaigns. However, the lack of leadership and clear action from the majority of countries in the region risks future increases in annual deaths and new cases of cervical cancer across the MENA region.
While the MENA region as a whole is experiencing HPV and cervical cancer epidemic, a one-size-fits-all solution would be inappropriate, considering distinct political, economic and social contexts across the region. In terms of health spending, MENA region countries spend on average 5.3% of their Gross Domestic Product (GDP) on healthcare, an abysmally low figure in comparison with the global rate of 8.6% of total expenditure on health as a share of gross domestic product. Moreover, the region is characterized by a high share of out-of-pocket expenditure for health services which represented 35% of the entire healthcare spending in 2013 [13–76%], when the average in OECD countries is 13%. Therefore, with these constraints in health financing and the catastrophic burden of diseases, countries in the MENA region require a tailored approach to improving healthcare policy decision-making and the redesign of healthcare services (Asbu et al. 2017).
To ensure public health interventions to stem the tide of HPV and cervical cancer are successful in the region, policies must evolve alongside rigorous monitoring of effectiveness, accessibility and applicability. Any effort to scale up training for health workers, implement new practice in managing preventive service delivery, or launch community-based interventions must be informed by data and evidence from the affected communities. In this regard, it is important for policymakers and researchers to have easy access to key data points from health, demographic and epidemiological surveillance systems (Lang 2011). This data-driven approach offers a “data-first” feedback mechanism that can transition the current public health systems in the MENA region toward evidence-based practice and policy design. In addition, integrating these data sources with spatial analysis offers a revolutionary way to explore public and global health data. Indeed, Geographic Information Systems (GIS) and related information and mapping technologies are considered by a recent WHO report as “the forefront of cutting edge tools that are being used to build reliable public health information and surveillance systems” (Organization WH 2006).
While data sources on a wide range of public health issues, including HPV and cervical cancer, are available online, accessing and combining these data sources is not straightforward. Most data sources use different data structures, terminologies and semantics. Combining these data points is time-consuming and technically challenging (Butler 2006). Moreover, considering the opportunities for data sharing and integration of GIS technology in the region, and low and middle-income countries in general, the lack of development in the field of data science represents a large impediment in the MENA region (Lang 2011).