By Jennie Aylward, Consultant at Pink Ribbon Red Ribbon . . .
Celina Schocken, CEO of Pink Ribbon Red Ribbon, submitted testimony on April 3 to the U.S. House of Representatives’ Appropriations Subcommittee on State and Foreign Operations. Celina’s testimony requested the subcommittee’s support for development and humanitarian programs that assist people in low-resource settings around the world, as well as statutory language in the appropriations bill that focuses the U.S. Government’s attention on cervical cancer.
The full text of the testimony is below.
Written Testimony by Celina Schocken
Chief Executive Officer
Pink Ribbon Red Ribbon
House Appropriations Subcommittee on State, Foreign Operations, and Related Programs
April 3, 2017
I thank the Subcommittee on State, Foreign Operations, and Related Programs for this opportunity to testify on appropriations under your jurisdiction for FY 2018. My testimony addresses development and humanitarian programs under Title III (Bilateral Economic Assistance) and Title V (Multilateral Assistance), as well as statutory language in Title VII (General Provisions), Section 7058 (Global Health Activities).
On behalf of Pink Ribbon Red Ribbon, a multilateral partnership that addresses breast and cervical cancers in low- and middle-income countries, I would like to request first that you preserve robust funding in FY 2018 for development and humanitarian programs that assist people in low-resource settings around the world. These programs reflect the U.S. value of providing assistance to those living in poverty overseas, helping them improve their lives and grow their economies. These programs also address the root causes of poverty that undermine political stability in low- and middle-income countries.
Secondly, I request statutory language in the appropriations bill that focuses the U.S. government’s attention on cervical cancer, a neglected health issue facing women in low- and middle-income countries. Our requested statutory language is as follows:
“Within 180 days of enactment of this Act, the Secretary of State shall submit to the Committees on Appropriations a report on the impact of cervical cancer in priority high-prevalence, lower-income countries, together with a plan to scale up cervical cancer vaccination for girls and screening and treatment services for women in those countries.”
Cervical cancer is the most common cancer in women in 38 low- and middle-income countries, killing 266,000 every year[i] – roughly as many as die from all causes of pregnancy-related deaths.[ii] Yet cervical cancer deaths are largely preventable with simple, proven, cost-effective tools that we already have on hand.
One of those tools is vaccination against human papillomavirus (HPV), which causes most cases of cervical cancer. Vaccination can be provided for an estimated cost per girl of $14.13 (cost of vaccine plus delivery).[iii]
A second tool is screening for and treatment of precancerous lesions and invasive cervical cancer. As little as $25 can provide a woman with life-saving screening for and treatment of cervical lesions,[iv] which can easily be integrated into existing interventions in HIV and AIDS, reproductive health, family planning and maternal health.
By scaling up these tools, within a generation cervical cancer could become the first cancer in the world from which virtually no one dies – an astounding prospect.
Furthermore, an investment in cervical cancer programs protects existing U.S. government investments in global health – especially U.S. programs to fight HIV and AIDS. Women living with HIV are especially vulnerable to cervical cancer. It makes no sense to save a woman from AIDS, complications of childbirth, waterborne illnesses, tuberculosis, or any of the other health challenges addressed by U.S. global health programs, only to let that women die from cervical cancer.
Recognizing the value of addressing cervical cancer globally, the U.S. government, via the President’s Emergency Program for AIDS Relief (PEPFAR) and the National Cancer Institute, is doing great work in this area. PEPFAR, in fact, is a founding partner of Pink Ribbon Red Ribbon, and much of Pink Ribbon Red Ribbon’s cervical cancer screening and treatment builds on PEPFAR’s successful efforts to address HIV and AIDS in Botswana, Tanzania, Ethiopia, Namibia and Zambia.
There is considerable demand for scaling up cervical cancer prevention and treatment programs from Ministries of Health around the world. I can offer a few examples from countries where Pink Ribbon Red Ribbon works. Dr. Patty Garcia, Peru’s Minister of Health, made cervical cancer control a priority in the beginning of her term, and one of her first acts as Minister was to draft national guidelines for the management and control of cervical cancer. The Government of Botswana, through the Ministry of Health, committed in 2013 to a long-term plan to provide screening and treatment sites in all health districts, and incorporated HPV vaccination into the country’s Expanded Program on Immunization. In Tanzania, Pink Ribbon Red Ribbon partners have supported the Government’s development of national quality-improvement guidelines for cervical cancer screening, and the development of harmonized national treatment protocols for invasive female cancers.
The leaders in these and other countries recognize the value of cervical cancer programs for women, whose stories are often moving and inspiring. In the words of one beneficiary: ““My name is Lydia Mwelwa and I live in Zambia. I heard about the cervical cancer screening activity through an announcement in my village. I really was not interested in undergoing screening but I was encouraged when a group of ladies came to my home and told me they were part of the team that had come to do cervical cancer screenings. They started teaching me and my neighbors about the importance of undergoing cervical screening and some of the signs and symptoms that I should look out for. I then realized that I had one of the signs because I had been experiencing prolonged menstrual bleeding for a long time now. So I decided to come through for screening.”
In closing, I recognize the enormous challenges you face in deciding what to prioritize with limited fiscal resources. I appreciate your efforts each year to ensure that the United States funds high-quality programs with demonstrable results both to the people served in other countries, and to the American taxpayers. I thank you for your consideration of statutory language that will ensure attention to proven cervical cancer interventions that generate considerable impact for dollars spent – saving lives, supporting communities, and compounding the value of our investments in other global health programs.
[i] GLOBOCAN data from 2012
[ii] Global Burden of Disease data from 2015
[iii] Comprehensive Global Cervical Cancer Prevention: Costs and Benefits of Scaling up within a Decade. Harvard School of Public Health and the American Cancer Society, 2016. https://www.cancer.org/content/dam/cancer-org/cancer-control/en/reports/the-cost-of-cervical-cancer-prevention.pdf
[iv] Campos N, et al. When and How Often to Screen for Cervical Cancer in Three Low- and Middle-Income Countries: A Cost-Effectiveness Analysis. Papillomavirus Research. 2015;1:38-58. Available from: