The humid Majuro air hung heavy as Dr. Neier Kabua scrolled through the latest social media updates about the upcoming vaccination campaign for cervical cancer. In her office, she is discussing the messaging for the campaign with her fellow doctor— images of awareness, infographics about human papillomavirus (HPV), and vaccination – a digital lifeline in the fight against a silent killer.

The Republic of Marshall Islands (RMI) in the north Pacific is grappling with one of the highest cervical cancer incidence rates in the world, at 70 cases per 100,000 women in 2020, five times higher than the global average.

In this small island country of approximately 40,000 people where the sense of community is strong, and family ties run deep, health conversations can sometimes be shrouded in cultural sensitivity. However, information concerning the growing number of women becoming sick with cervical cancer is becoming louder.

“Our numbers are alarming; five times higher than the global average,” said Dr Neier, the Director of Cancer Programme at the Leroij Atama Zedkeia Memorial Hospital.  “But our challenge is more than just medical. It is cultural. In a society where privacy is paramount, discussing intimate health issues like cervical cancer is often taboo, which makes early screening a challenge," she admitted.

Prevention and early screening are key to addressing this preventable but killer disease. The vaccination campaign targeting 2,000 girls between the ages of 9-14 focuses on prevention of the disease, and is aiming to protect them from its devastating impact.

“During the COVID-19 pandemic, the HPV vaccination campaigns had stalled, leaving a gap. This campaign will address that gap and cover the girls that were missed during the pandemic.”

Though vaccination is in place, vaccine hesitancy remains a significant issue. Therefore, secondary prevention through screening is essential, particularly for women of reproductive age who may be unvaccinated, and at an increased risk of developing the disease.

Consequently, in its fight against cervical cancer, last year, RMI government launched a National Cervical Cancer Elimination Policy and Strategy (2024-2030), developed in partnership with UNFPA Pacific. The national policy and strategy outlines a comprehensive approach to combating the disease, including the introduction of the HPV DNA testing as a ‘gold standard’ screening method. To support the implementation of the strategy, UNFPA with the  funding support of the Chugai Pharmaceuticals (Japan) and regional partners is commencing the “Test and Treat Project” with an aim to screen approximately 8,000 women and girls for HPV, covering the majority of the target women in the Marshall Islands.  

“We’re also prioritizing self-testing for sample collection in our screening efforts, especially for women in the outer islands," Dr. Kabua explained. "Often, the only health workers available are men, and that can make women uncomfortable. Self-testing gives them control."

In collaboration with local partners, the project is also carrying out an extensive public awareness campaign to sensitize communities about cervical cancer prevention and the importance of early detection.