Girls will receive their first jab in the fifth grade and their second jab a year later, both during School Student Immunization Month (BIAS), which usually falls in August and November.

The HPV vaccination program builds on nationwide pilots in successive years from 2016 to 2022, starting with Jakarta in 2016 followed by Yogyakarta (2017), Surabaya (2018), Manado in North Sulawesi and Makassar in South Sulawesi (2019), and then Karanganyar and Sukoharjo in Central Java (2020), Kediri and Lamongan in East Java (2021) and finally in Bali, East Java and Central Java (2022).

Health Minister Budi Gunadi Sadikin said on May 24 that the government hoped to reduce cervical cancer incidences and deaths through the program. The primary group targeted in the vaccination program was adolescent girls aged 11-12, because the HPV vaccine is more effective when given at younger ages.

According to 2021 data from online database the Global Cancer Observatory (Globocan), 36,633 Indonesian women developed the disease, with 21,003 dying from it.

Vaccination is part of the government’s two-pronged strategy to beat cervical cancer. No less crucial is regular screening, which includes Pap smears and visual inspection with acetic acid (VIA) tests.

Budi said the Health Ministry was preparing a program to demonstrate DNA-based testing for HPV to detect patients with precancerous lesions. The tests, now on trial in Jakarta, were deemed more effective in detecting and preventing cervical cancer.

The big leap in the government’s endeavor to prevent, control and eliminate cervical cancer deserves plaudits. But given the disease’s stubbornly high incidence rate, achieving the 2030 target is an uphill challenge.

From 2019 to 2020, Indonesia ranked first in incidence rate and second in mortality rate for cervical cancer in Southeast Asia, according to data from the Indonesian Society of Gynecologic Oncology (INASGO). To eliminate the disease by 2030, the incidence rate must be reduced to less than four new cases per 100,000 women per year, from 23.4 cases per 100,000 women at present.

“It’s very ironic because actually, cervical cancer is preventable and treatable, as long as we can detect and diagnose it as early as possible,” said Tofan Widya Utami, an obstetrician and gynecologist from the University of Indonesia medical school.

The high incidence and mortality rates could be attributed to low screening participation, she added.

Screening is important because Indonesia has 102.5 million women aged 15 years and above, the demographic group that research has found is at risk of developing cervical cancer.

As of December last year, screening for cervical cancer was just 9.35 percent.

Tofan suggested there was no other choice but to expand coverage of HPV vaccination and cervical cancer screening to eradicate the disease.

Screening remains a barrier to the efforts to eliminate cervical cancer in not only Indonesia, but also the Asia-Pacific region.

A recent survey by Roche Diagnostics revealed that only 11 out of 20 respondents, or 55 percent, had easy access to cervical cancer screening. Worse, only around 22 percent of respondents felt they were very knowledgeable about cervical cancer.

These findings are alarming, as more than 58 percent of cervical cancer cases in the world occur in Asia.

Meanwhile, the COVID-19 pandemic has widened the gap in accessing health care, including cervical cancer screening.

Allison Rossiter, managing director of Roche Diagnostics Australia, said check-ups and screenings had been de-prioritized during COVID-19 because the global health system was under extreme pressure to fight the pandemic. As a consequence, catastrophic illnesses such as cancer were now becoming more severe than when screening was available.

Rohit Sahgal, founder of The Voices Project Asia, deemed that the biggest challenge to stimulating change in Asian societies, particularly in women’s health, was the norms, beliefs and preconceptions on what health issues were considered medical problems and what were the acceptable ways to treat these problems.

“[The challenge] is impactful to sexual and reproductive health care and rights for women,” he said.

It’s safe to say that Indonesia has taken key steps toward eliminating cervical cancer by boosting nationwide coverage of HPV vaccination, screening tests and treatment.

Financing, a key component in the fight against cervical cancer, should be a nonissue. The national healthcare agency, BPJS Kesehatan, covers the costs of two cervical cancer screenings: Rp 25,000 (1.67 US cents) per woman for VIA tests and Rp 125,000 for Pap smears. BPJS Kesehatan also covers co-testing, which combines the Pap and HPV tests.

Meanwhile, it is hoped that 70 percent of cervical cancer cases in Indonesia can be detected through DNA-based testing by 2030. Around 8,000 out of 15,000 HPV DNA test kits have been distributed for trialing in Jakarta.

To better detect cervical cancer, INASGO and the Indonesian Society of Obstetrics and Gynecology (POGI) are proposing that the age limit for screening be raised to 25-65 from currently 30-50 under Health Ministry Regulation No. 34/2015.

This recommendation makes sense, because one in nine Indonesian women marry before they are 18, while 45 percent of cervical cancer cases are found in women over 50, according to data from Cipto Mangunkusumo hospital.

As 2030 is only seven years away, the fight against cervical cancer cannot take a “business as usual” approach. Screening needs to top the priorities again, like it did before the pandemic. The gap in knowledge of cervical cancer should also be eliminated, because this disease is preventable.

Screening awareness is all about education, since we know that 90 percent of cervical cancer deaths occur in low- and middle-income countries. With a bigger focus on education for cervical cancer, we can make a difference and save thousands of lives.

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The author is a staff writer at The Jakarta Post.